8. Foot and Ankle MCQs

A 16-year-old male is noted to have a persistent right leg length discrepancy of 4 cm following a childhood physeal injury. On physical examination, which of the following is the most likely compensatory mechanism observed on the shorter right leg during the stance phase?

In the context of deformity planning, a patient is found to have a mechanical lateral distal tibial angle (mLDTA) of 75 degrees (normal 89 degrees), indicating a varus deformity of the distal tibia. Assuming a normal, flexible hindfoot, what is the expected compensatory position of the subtalar joint during weight-bearing?

During the correction of a severe, chronic fixed equinovarus deformity of the foot using a hexapod circular frame, the surgeon is planning the placement of the virtual hinge (axis of rotation). To avoid stretching the posterior tibial neurovascular bundle, where is the optimal placement for the axis of rotation?

A 48-year-old patient is undergoing preoperative planning for a sagittal plane knee deformity correction. The surgeon is following Dr. Paley's radiographic protocol. Which of the following is the MOST critical requirement for obtaining high-quality, diagnostic full-length lateral radiographs for this assessment?

A 62-year-old male presents with chronic knee pain and a feeling of instability, particularly during prolonged standing. Clinical examination reveals a mild genu recurvatum. Based on the principles outlined in the case, which of the following statements accurately describes the normal position and biomechanical significance of the sagittal mechanical axis of the lower extremity?

A 45-year-old male presents with a severe osseous genu recurvatum deformity following a malunited proximal tibia fracture. During the stance phase of gait, which of the following is the most common compensatory mechanism observed at the adjacent joints to maintain a plantigrade foot?

When performing a high tibial osteotomy (HTO) with gradual correction using a circular external fixator, a concomitant fibular osteotomy is generally required. To minimize the risk of iatrogenic injury to the common peroneal nerve, which location is preferred for the fibular osteotomy?

A patient presents with an apparent fixed flexion deformity (FFD) of the knee, yet clinical examination reveals normal intra-articular passive motion. Radiographs demonstrate a severe extra-articular distal femoral procurvatum deformity. According to Paley's principles, how does an osseous procurvatum deformity manifest clinically when the knee joint is fully extended?

A 28-year-old female presents with a significant osseous fixed flexion deformity of the knee secondary to a previously malunited distal femur fracture. Which of the following is a classic compensatory mechanism in the adjacent joints to maintain a level gaze and upright posture?

A 55-year-old male undergoes a proximal fibular osteotomy as part of a complex extra-articular tibial deformity correction. Postoperatively, the patient demonstrates a foot drop and decreased sensation over the dorsum of the foot. Which specific structure was most likely injured during the fibular osteotomy?

A patient with a severe osseous recurvatum deformity of the distal femur typically exhibits which of the following compensatory mechanisms to maintain a plantigrade foot and upright posture?

To identify the CORA of a procurvatum deformity in the mid-diaphysis of the tibia, which of the following methods is used?

A 25-year-old male is undergoing 5 cm of tibial lengthening via distraction osteogenesis. At week four, he develops an equinus contracture of the ankle despite aggressive physical therapy. What is the most appropriate next step in management to prevent long-term morbidity?

A 45-year-old patient has a mechanical axis deviation (MAD) of 35 mm lateral to the knee center. The Mechanical Lateral Distal Femoral Angle (mLDFA) is 81 degrees, and the Medial Proximal Tibial Angle (MPTA) is 87 degrees. The Joint Line Convergence Angle (JLCA) is 1 degree. Where is the primary source of the deformity?

Using Paley's malalignment test, you drop a plumb line from the center of the femoral head to the center of the ankle. The line passes 20 mm medial to the center of the knee joint. The MPTA is 80 degrees, and the mLDFA is 88 degrees. Which of the following describes the deformity?

In deformity planning for a patient with severe osteoarthritis and a varus knee, the Joint Line Convergence Angle (JLCA) is measured at 6 degrees (opening laterally). What does this abnormal JLCA primarily indicate in this clinical scenario?

A 21-year-old female undergoes an acute medial closing wedge osteotomy for a severe valgus proximal tibial deformity. Immediately postoperatively, she exhibits a profound foot drop and inability to extend her great toe. Which peripheral nerve is at the highest risk during this specific deformity correction?

A 60-year-old patient with a long-standing varus knee deformity and LCL laxity is being considered for surgical intervention. The patient's previous surgeon had suggested an intentional overcorrection of the tibia into valgus via a high tibial osteotomy (HTO) to compensate for the lateral laxity. Based on the provided case, what is the primary reason this 'overcorrection fallacy' approach is fundamentally flawed and should be abandoned?

A patient with a varus knee deformity presents for evaluation.

Based on Paley's malalignment test, which anatomical landmark is used as the distal reference point to draw the mechanical axis of the entire lower extremity?

A 55-year-old male presents with long-standing bilateral genu varum, as depicted in the clinical image. He reports increasing medial knee pain and occasional lateral foot pain. According to Paley's principles of deformity correction, what is the most predictable compensatory mechanism the subtalar joint will employ in response to this proximal varus deformity?