8. Foot and Ankle MCQs

A 55-year-old female presents with Coughlin and Shurnas Grade 2 hallux rigidus. Conservative management has failed, and a cheilectomy is planned. To prevent postoperative iatrogenic instability or dorsal subluxation of the proximal phalanx, resection of the dorsal first metatarsal head should not exceed what percentage?

When evaluating a patient for a suspected subtle Lisfranc injury, specific radiographic landmarks must be scrutinized. On a standard AP weight-bearing radiograph of a normal foot, which of the following alignments must be present?

A 45-year-old male with mild hallux rigidus presents with pain during the terminal stance phase of gait. He wishes to pursue non-operative management. Which of the following orthotic modifications is most appropriate?

A 35-year-old female presents with severe midfoot pain after a fall from a horse. Weight-bearing radiographs and a subsequent MRI reveal a purely ligamentous Lisfranc injury with 4 mm of diastasis between the medial cuneiform and the second metatarsal base, without any associated fractures. Which of the following is the most appropriate definitive management to minimize the risk of hardware failure and long-term reoperation?

A 58-year-old male runner complains of chronic, progressive right great toe pain. On examination, he has significant pain throughout the mid-range of first metatarsophalangeal (MTP) joint motion. Radiographs reveal severe joint space narrowing, subchondral sclerosis, and large dorsal and lateral osteophytes, consistent with Grade 3 hallux rigidus. He has failed shoe modifications and NSAIDs. What is the gold standard surgical treatment for this patient?

During open reduction of a midfoot fracture-dislocation, the surgeon must carefully identify and clear the interval housing the Lisfranc ligament to achieve an anatomic reduction. The primary stabilizing ligament of this complex originates and inserts on which of the following osseous structures?

A 45-year-old female undergoes a dorsal cheilectomy for Coughlin and Shurnas Grade 2 hallux rigidus. To relieve impingement and adequately increase first MTP joint dorsiflexion without causing joint instability, what is the maximum recommended percentage of the dorsal articular surface of the first metatarsal head that should be resected?

A 1-year-old male presents with severe fibular hemimelia (Achterman and Kalamchi Type II). Clinical and radiographic assessments project a leg-length discrepancy of 14 cm at skeletal maturity. The foot is rigidly fixed in extreme equinovalgus, possesses only two toes, and articulates via a ball-and-socket ankle joint. What is the most appropriate definitive management strategy for optimizing the child's long-term mobility?

A 24-year-old male football player sustains an axial loading injury to a plantarflexed foot. Non-weight-bearing radiographs demonstrate no obvious malalignment, but a distinct "fleck sign" is visualized between the medial cuneiform and the base of the second metatarsal. This radiographic finding specifically represents an avulsion of a structure from which of the following anatomic locations?

A 14-year-old male presents with a 6-month history of progressive right ankle pain, particularly with activity, and a rigid flatfoot deformity. He reports difficulty walking on uneven surfaces and occasional "giving way" sensations. Physical examination reveals limited subtalar motion and tenderness over the sinus tarsi. Radiographs show a "C-sign." Which of the following is the MOST likely diagnosis and its typical age of symptomatic presentation?

A 10-year-old patient is diagnosed with a tarsal coalition affecting the subtalar joint, leading to restricted hindfoot motion. Based on the normal biomechanics of the subtalar joint as depicted in the provided image and described in the case, which of the following statements accurately describes the coupled motion of the subtalar joint?

A 13-year-old female presents with chronic left hindfoot pain and a rigid flatfoot. Initial radiographs show an "anteater nose sign." To definitively characterize the coalition and plan for potential surgical intervention, which imaging modality is considered the gold standard, and what specific information does it provide that is crucial for surgical decision-making?

A 15-year-old male has a symptomatic talocalcaneal coalition that has failed 6 months of conservative management. Preoperative CT scans reveal a bony coalition involving 60% of the posterior facet of the subtalar joint, with early degenerative changes noted in the remaining posterior facet. Based on the provided table of indications and contraindications, what is the MOST appropriate surgical recommendation for this patient?

A 14-year-old patient undergoes a medial approach for a talocalcaneal coalition resection. After incising the flexor retinaculum, the surgeon identifies and retracts the posterior tibial tendon superiorly and the flexor digitorum longus tendon inferiorly. Which critical structure lies posterior and inferior to the FDL and must be meticulously protected throughout the case?

A 12-year-old patient undergoes a calcaneonavicular coalition resection via a lateral Ollier approach. Two weeks postoperatively, the patient complains of numbness and burning pain along the lateral aspect of the foot and ankle, extending to the little toe. Based on the provided table of complications, which nerve is MOST likely injured, and what is the primary preventative measure?

A 13-year-old patient is 2 weeks post-operative from a successful talocalcaneal coalition resection with fat graft interposition. The wound is healing well, and sutures have been removed. What is the MOST critical next step in the rehabilitation protocol to prevent recurrence and optimize long-term outcomes?

A 16-year-old patient, 18 months status post-talocalcaneal coalition resection, presents with persistent, debilitating hindfoot pain and progressive valgus deformity. A repeat CT scan shows an adequate initial resection but significant degenerative arthrosis of the posterior facet and early arthritic changes in the talonavicular joint. Non-operative measures have failed. What is the MOST appropriate salvage procedure for this patient?

A 14-year-old boy presents with a painful, rigid flatfoot and a history of recurrent ankle sprains. Subtalar motion is markedly limited. A continuous 'C' sign is observed on the lateral foot radiograph. Which of the following is the most accurate anatomical description of the most likely diagnosis?

A 9-year-old boy presents with frequent ankle sprains and a rigid, spastic flatfoot. A 45-degree internal oblique radiograph of the foot reveals an 'anteater nose' sign. If conservative management fails, what is the preferred surgical intervention to prevent recurrence after resection?

In an adolescent patient with a confirmed talocalcaneal coalition, which of the following is considered an absolute contraindication to isolated surgical resection of the coalition?