8. Foot and Ankle MCQs

During a hallux valgus correction, a surgeon successfully reduces the IMA to 8 degrees and the MTP joint is congruent. However, the patient's great toe remains deviated laterally into valgus due to an interphalangeal angle of 20 degrees. Which of the following is the most appropriate next step?

A 60-year-old male presents with dorsal foot pain and limited first MTP joint dorsiflexion. Radiographs reveal dorsal osteophytes with preserved joint space. He is diagnosed with early hallux rigidus. Which surgical procedure is most appropriate?

The Scarf osteotomy for hallux valgus correction is relatively contraindicated in patients with which of the following characteristics?

A patient presents with a recurrent hallux valgus deformity 2 years after a distal chevron osteotomy. The IMA is now 18 degrees and the first MTP joint is subluxated. The medial eminence is flush. What is the most appropriate revision strategy?

When performing a distal metatarsal osteotomy for hallux valgus, preserving the blood supply to the metatarsal head is paramount to prevent avascular necrosis (AVN). The primary blood supply to the first metatarsal head enters at which location?

A 42-year-old female develops avascular necrosis of the first metatarsal head complicated by severe secondary osteoarthritis following a distal chevron osteotomy and lateral release. She complains of unrelenting pain with ambulation. What is the most appropriate definitive management?

To minimize the risk of avascular necrosis during a distal chevron osteotomy, the surgeon should strictly avoid extensive stripping of which capsular structures?

A 45-year-old female presents with a painful bunion. Clinical examination reveals hypermobility of the first tarsometatarsal (TMT) joint. Weight-bearing radiographs demonstrate an Intermetatarsal Angle (IMA) of 18 degrees and a Hallux Valgus Angle (HVA) of 42 degrees. Which of the following procedures is most appropriate to address this deformity?

A 32-year-old female presents with mild bunion pain. Radiographs demonstrate an IMA of 11 degrees, an HVA of 22 degrees, but an abnormally increased Distal Metatarsal Articular Angle (DMAA) of 20 degrees. Which of the following osteotomies is most appropriate to specifically correct the DMAA?

To minimize the risk of avascular necrosis (AVN) of the first metatarsal head during a distal chevron osteotomy, the surgeon must be careful to preserve its primary blood supply. Which of the following vascular structures provides the most critical blood supply to the first metatarsal head?

A 65-year-old female with severe, long-standing rheumatoid arthritis presents with an HVA of 55 degrees, an IMA of 20 degrees, and fixed dorsal subluxations of the 2nd through 5th MTP joints with severe plantar pain. Which of the following surgical procedures is the gold standard for this patient?

A 28-year-old female presents with medial great toe pain. Radiographs reveal a congruent 1st MTP joint, an IMA of 8 degrees, an HVA of 14 degrees, and a Hallux Valgus Interphalangeus (HVI) angle of 22 degrees. What is the most appropriate surgical intervention?

During a Scarf osteotomy for moderate hallux valgus, the bone cuts are made in a Z-configuration along the diaphysis of the first metatarsal. Which of the following is a well-described, specific biomechanical complication associated with this osteotomy geometry?

A 55-year-old male presents with chronic right knee pain and a progressive varus deformity. A full-length standing radiograph is obtained, as shown below. The mechanical axis of the lower limb is measured to pass 25 mm medial to the center of the knee joint. Based on Paley's foundational geometry, what is the most accurate interpretation of this finding?

A 58-year-old male presents with chronic right knee pain, worse with ambulation. Physical examination reveals a noticeable 'bow-legged' appearance. A full-length standing anteroposterior radiograph of the lower extremity is obtained, as shown below.

A patient presents with a severe post-traumatic tibial deformity characterized by both proximal varus and distal valgus angulation.

When planning a multi-level correction for this multi-apical deformity using Paley's principles, how should the CORAs be established?

A surgeon is performing a proximal tibial osteotomy for a 15-degree varus correction using a circular fixator. A concomitant fibular osteotomy is required to allow unhindered correction.

To minimize the risk of peroneal nerve injury, what is the most appropriate location and technique for the fibular osteotomy?

For a planned distal tibial varus correction, the surgeon wishes to minimize stretching of the medial soft tissues and prefers a closing wedge technique. Where must the Axis of Correction of Angulation (ACA) be positioned?

During preoperative planning for a lower extremity deformity, the orthopedic surgeon draws a line from the center of the femoral head to the center of the ankle mortise on a full-length, weight-bearing standing radiograph. This line represents the: