8. Foot and Ankle MCQs

A 45-year-old male presents with a painful, stiff great toe. Radiographs reveal a dorsal osteophyte on the first metatarsal head and mild joint space narrowing, but the plantar cartilage space is maintained. He has failed conservative management. Which of the following surgical interventions is MOST appropriate for this patient?

When performing a first metatarsophalangeal (MTP) joint arthrodesis for end-stage hallux rigidus, what is the optimal position for the fusion to ensure normal gait mechanics?

What characteristic physical examination finding is most commonly associated with symptomatic hallux rigidus?

A 55-year-old female with moderate hallux rigidus requests non-operative management. Which of the following orthotic modifications is MOST effective in alleviating her symptoms?

Which of the following factors is most strongly associated with an increased risk of nonunion following a first MTP joint arthrodesis?

A 35-year-old female with Grade 1 hallux rigidus is scheduled for a cheilectomy. To further improve her functional dorsiflexion and shoe wear tolerance, an adjunctive procedure is planned. Which of the following osteotomies is most appropriate?

A patient exhibits constant pain with ROM of the first MTP joint. Radiographs show significant dorsal osteophytes, subchondral sclerosis, and less than 50% joint space preservation. No loose bodies are visualized, and pain is absent in the midrange of motion. According to Coughlin and Shurnas, what is the grade of hallux rigidus?

A 55-year-old male runner complains of dorsal foot pain localized to the first metatarsophalangeal (MTP) joint. Radiographs show dorsal osteophytes and joint space narrowing. Examination demonstrates pain throughout the entire mid-range of MTP motion. Based on the Coughlin and Shurnas classification, what is the most appropriate surgical intervention?

A surgeon is planning a first MTP arthrodesis for a patient with end-stage hallux rigidus. To ensure optimal functional outcome and proper push-off during gait, in what position should the MTP joint be fused?

A 48-year-old female with moderate hallux rigidus is treated conservatively with a custom orthosis. Which orthotic modification is most effective for decreasing symptoms associated with this condition?

During a dorsal cheilectomy for hallux rigidus, a surgeon uses a standard dorsomedial approach to the first MTP joint. Which superficial nerve is at the greatest risk of iatrogenic injury during this exposure?

A 50-year-old female undergoes a cheilectomy for Coughlin and Shurnas Grade 2 hallux rigidus. To achieve adequate decompression and restore functional dorsiflexion, what percentage of the dorsal metatarsal head is typically resected?

A patient with hallux rigidus undergoes a first MTP arthrodesis. Six months postoperatively, the patient complains of pain at the plantar aspect of the interphalangeal (IP) joint of the great toe, particularly during the toe-off phase of gait. Radiographs show solid fusion of the MTP joint. What surgical technical error most likely caused this complication?

A 40-year-old physically active male presents with mild hallux rigidus (Coughlin Grade 1). He has preserved joint space but restricted functional dorsiflexion, causing pain when running. Conservative measures have failed. A Moberg procedure is planned. What does this specific procedure entail?

In evaluating a patient for hallux rigidus, what pathomechanical first-ray abnormality is most classically associated with the development of dorsal impingement and subsequent joint degeneration?

When staging a high-energy pilon fracture with a spanning external fixator, a transcalcaneal pin is often utilized. To minimize the risk of injury to the posterior tibial neurovascular bundle, how should this pin be inserted?

When performing an anterolateral approach to the distal tibia for a pilon fracture, which nervous structure crosses the surgical field and must be carefully identified and protected during the superficial dissection?

In a complex pilon fracture, the posterolateral approach is often utilized to fix the posterior malleolar fragment and the fibula. What is the correct intermuscular interval utilized for this approach?

During the posterolateral approach to the distal tibia for a posterior pilon fracture, the deep dissection is carried out through an internervous/intermuscular plane. Which two structures define this deep interval?

In managing an unstable rotational ankle fracture with a concomitant posterior malleolus fracture, what is the biomechanical rationale for fixing the posterior malleolus rather than placing trans-syndesmotic screws alone?