8. Foot and Ankle MCQs

A 70-year-old diabetic female presents with a displaced tongue-type calcaneus fracture with posterior skin blanching over the Achilles insertion. What is the most urgent orthopaedic intervention required?

A 45-year-old male sustains a severely comminuted, intra-articular calcaneal fracture. On the initial lateral radiograph, a pathognomonic "double density" sign is observed. Which of the following anatomical phenomena primarily accounts for this radiographic finding?

When performing an extensile lateral approach for the open reduction and internal fixation of a calcaneal fracture, creating a full-thickness "no-touch" subperiosteal flap is critical to minimize wound necrosis. Which artery provides the primary blood supply to the apex of this surgical flap?

In displaced intra-articular calcaneus fractures, the sustentaculum tali is often referred to as the 'constant fragment' because it remains anatomically aligned with the talus. Which of the following ligamentous structures is primarily responsible for maintaining this relationship?

The primary fracture line in an intra-articular calcaneus fracture typically occurs due to axial loading of the talus into the calcaneus. This primary line divides the calcaneus into two major fragments and runs in which of the following directions?

A patient with a poorly reduced calcaneus fracture develops chronic lateral hindfoot pain and a noticeable limp. Clinical examination and imaging reveal lateral wall 'blowout.' This specific deformity most commonly leads to impingement of which anatomical structure?

During the extensile lateral approach to the calcaneus, the vertical limb of the incision is made just lateral to the Achilles tendon, and the horizontal limb runs just superior to the glabrous skin of the heel. Which nerve is at greatest risk during the elevation of this full-thickness flap?

A 40-year-old construction worker is evaluated 2 years after non-operative management of a highly comminuted, displaced intra-articular calcaneus fracture. He complains of unremitting lateral hindfoot pain and stiffness. Radiographs show severe subtalar joint space narrowing, subchondral sclerosis, and osteophyte formation. What is the most appropriate definitive surgical intervention?

In the setting of a displaced intra-articular calcaneal fracture, the primary fracture line courses obliquely through the posterior facet. Which of the following fragments is considered the "constant fragment", and what structures maintain its anatomic relationship to the talus?

A 60-year-old diabetic patient presents with a closed, displaced tongue-type calcaneal fracture with significant tension and blanching of the posterior heel skin. What is the most appropriate next step in management?

A 20-year-old athlete is 3 days status post-medial deep posterior fasciotomy. The incision is clean and dry, and pain is well-controlled with oral medication. According to the immediate post-operative rehabilitation protocol outlined in the case, which of the following is the most appropriate instruction for this patient?

A 52-year-old female presents with chronic pain and progressive deformity of her second toe. She reports difficulty wearing shoes and a painful callosity under the second metatarsal head. Physical examination reveals dorsal subluxation of the second MTP joint and a positive vertical stress test. She has a history of hallux valgus deformity that was surgically corrected 5 years ago. Which of the following is the MOST likely primary contributing factor to her current second MTPJ instability?

A 48-year-old active female presents with a 6-month history of progressive pain and instability in her second MTP joint. MRI confirms a Grade 2 plantar plate tear. During surgical repair, the surgeon notes the tear is located at the proximal attachment of the plantar plate. This location is anatomically significant because the plantar plate most commonly tears where it attaches to which of the following structures?

A 60-year-old patient presents with a 9-month history of forefoot pain, worse with activity, and a feeling of "something shifting" in her second toe. On physical examination, the second toe is noted to be slightly dorsally elevated, and a painful callosity is present plantarly beneath the second metatarsal head. When performing the vertical stress test (Lachman test), the examiner stabilizes the metatarsal head and applies dorsal pressure to the proximal phalanx. An increase in dorsal translation compared to the adjacent toes is observed. Which of the following imaging findings would MOST directly correlate with this clinical finding and confirm the primary pathology?

A 55-year-old female has been undergoing conservative management for second MTPJ instability for 6 months, including custom orthotics, activity modification, and NSAIDs. Despite these measures, she continues to experience debilitating pain, has developed a progressive hammer toe deformity of the second toe, and reports significant difficulty with shoe wear and daily activities. Physical examination reveals an irreducible dorsal subluxation of the second MTP joint. Which of the following is the MOST compelling indication for operative intervention in this patient?

A 40-year-old male undergoes surgical repair for chronic second MTPJ instability with a significant plantar plate tear and a long second metatarsal. In addition to direct plantar plate repair, a Weil osteotomy is performed. What is the primary biomechanical purpose of performing a Weil osteotomy in this context?

A 35-year-old dancer develops progressive second MTPJ instability. Her condition is attributed to repetitive microtrauma and biomechanical overload. Understanding the dynamic stabilizers of the MTP joint is crucial. Which of the following intrinsic muscles primarily contributes to second MTPJ stability by pulling the toe into flexion and helps maintain the plantar plate's stable fulcrum?

A 58-year-old patient undergoes a second MTPJ plantar plate repair combined with a Weil osteotomy for a long second metatarsal. Six months post-operatively, she complains of new, persistent pain under the third metatarsal head, which was not present before surgery. Physical examination confirms tenderness and a new callosity under the third metatarsal head. This complication is MOST likely due to which of the following?

A 45-year-old patient is 3 weeks post-operative from a second MTPJ plantar plate repair with a Weil osteotomy and temporary K-wire fixation. The K-wire is still in place. According to the standard rehabilitation protocol described, which of the following activities is MOST appropriate for this patient at this stage?