8. Foot and Ankle MCQs

A 65-year-old patient with end-stage ankle osteoarthritis is being evaluated for a total ankle arthroplasty (TAA). Which of the following findings is widely considered an absolute contraindication for this procedure?

A 52-year-old avid runner presents with severe dorsal forefoot pain. Examination shows a rigid 1st metatarsophalangeal (MTP) joint with less than 10 degrees of dorsiflexion. Radiographs reveal diffuse joint space narrowing, a flat metatarsal head, and large dorsal osteophytes (Coughlin and Shurnas Grade 3 Hallux Rigidus). Which surgical intervention provides the most reliable long-term pain relief and functional restoration?

A 45-year-old male presents with severe hindfoot pain and difficulty clearing his foot during swing phase, 2 years after non-operative treatment of a severely displaced, intra-articular calcaneus fracture. Radiographs show subtalar arthritis, severe loss of calcaneal height, and anterior talo-tibial impingement. What is the most appropriate surgical treatment?

A patient undergoes a standard triple arthrodesis for a severe rigid pes planovalgus deformity with generalized hindfoot osteoarthritis. Postoperatively, the patient develops a symptomatic non-union. Which joint involved in a triple arthrodesis has the highest reported rate of non-union?

A 55-year-old female requires isolated fusion of the talonavicular joint due to advanced osteoarthritis. If this joint is successfully fused, what percentage of native subtalar joint motion will approximately remain?

A 45-year-old manual laborer requires an ankle arthrodesis for post-traumatic end-stage osteoarthritis. To optimize gait kinematics and minimize adjacent segment stress, what is the most widely accepted optimal position for the fused ankle?

A 62-year-old patient with end-stage ankle arthritis is being evaluated for a total ankle arthroplasty (TAA). Which of the following conditions is considered an absolute contraindication for a standard primary TAA?

A 58-year-old female presents with severe pain and stiffness in her first toe. Radiographs reveal advanced joint space narrowing, large dorsal and lateral osteophytes, and subchondral cysts. Clinical examination shows pain throughout the mid-arc of motion. What is the gold standard surgical treatment for this patient?

When performing a triple arthrodesis for a severe rigid flatfoot deformity, meticulous joint preparation is required. Which of the following joints has the highest reported rate of nonunion following this procedure?

Following a successful isolated ankle arthrodesis, patients typically exhibit altered gait kinematics to compensate for the lack of tibiotalar motion. Where does the majority of compensatory sagittal plane motion occur during gait?

A 45-year-old patient undergoes an isolated tibiotalar arthrodesis for post-traumatic arthritis.

Based on the altered biomechanics shown postoperatively, which adjacent joint is at the highest risk of developing progressive symptomatic osteoarthritic changes over the next 10 years?

A 38-year-old patient requires a subtalar arthrodesis following a malunited calcaneus fracture. To prevent locking of the transverse tarsal joints and subsequent severe gait dysfunction, the subtalar joint should be fused in which of the following alignments?

An orthopaedic surgeon performs an isolated talonavicular arthrodesis for severe isolated degenerative joint disease. Based on standard in vivo kinematic studies, what effect will this isolated fusion have on the motion of the subtalar joint?

What is the optimal recommended position for a tibiotalar (ankle) arthrodesis to maximize postoperative function and gait mechanics?

A 55-year-old male presents with end-stage ankle arthritis and inquires about a total ankle arthroplasty (TAA). Which of the following preoperative patient characteristics is considered an absolute contraindication to performing a TAA?

A 48-year-old manual laborer is undergoing a tibiotalar arthrodesis for post-traumatic osteoarthritis. To optimize his post-operative gait mechanics and minimize adjacent joint stress, what is the most appropriate position for the ankle fusion?

A 62-year-old female presents with significant pain over the first metatarsophalangeal (MTP) joint. Radiographs show Coughlin and Shurnas Grade 3 hallux rigidus with less than 10 degrees of dorsiflexion. She has failed conservative management. Which of the following surgical interventions provides the most reliable long-term pain relief and functional improvement for this patient?

Ten years following a successful isolated tibiotalar arthrodesis, a 55-year-old male develops new, progressive hindfoot pain exacerbated by walking on uneven ground. Radiographs are obtained. Degenerative changes in which of the following joints are the most common cause of this new presentation?

A 45-year-old male presents with severe lateral hindfoot pain and difficulty fitting into shoes three years after a non-operatively treated intra-articular calcaneus fracture. Examination reveals subfibular impingement, and radiographs demonstrate subtalar arthritis with significant loss of calcaneal height. What is the most appropriate surgical intervention?

A 35-year-old male sustains a crush injury to his foot after a heavy object falls on it. He complains of severe midfoot pain and inability to bear weight. Physical examination reveals swelling and ecchymosis over the dorsum of the foot, tenderness at the tarsometatarsal joints, and subtle widening of the interval between the first and second toes. Plain radiographs are equivocal, but a weight-bearing radiograph shows diastasis between the medial cuneiform and the base of the second metatarsal. What is the most appropriate definitive management?