AAOS Foot and Ankle Self-Assessment Examination Answer Book | Latest 2025/2026 Edition | American Academy of Orthopaedic Surgeons

FOOT AND ANKLE
2025

,1*Figures 1 and 2 are the T2-weighted MR image and AP radiograph of a 55-year-old laborer who
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sustains an ankle sprain after a fall from scaffolding. Initial films are read by radiology as normal.
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Despite an exhaustive 6-month course of immobilization; shoe modifications; and therapy, the patient
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continues to have activity-related lateral hindfoot pain, which has prevented him from returning to
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work. On examination, the patient has full eversion strength that is painless. Ankle range of motion is
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full and painless. No anterior drawer is observed. There is tenderness and mild swelling distal to the
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sinus tarsi. Sensation and motor are intact and the skin is otherwise unremarkable in appearance. An
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MRI is obtained. What is the next best step?
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,1- Referral for complex regional pain syndrome (CRPS) workup
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2- Lace-up ankle brace
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3- Excision of the superior anterior process of the calcaneus
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4-Arthroscopic Brostrom
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Correct answer : 3
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The patient has a nonunion of anterior process of the calcaneus. His symptoms are consistent with
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the examination and imaging findings, and he has failed nonsurgical treatment. Therefore, surgical
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excision of the nonunion fragment is indicated. No findings consistent with CRPS are seen in this
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patient. He has activity-related pain at a focal area and is without skin changes. A lace-up ankle brace
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is unlikely to provide substantial immobilization and pain control at the hindfoot. In addition, the
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patient has tried nonsurgical therapies without lasting improvement. The patient has complaints,
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examination, and imaging findings consistent with a single diagnosis. A lateral ankle stabilization
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procedure such as a Brostrom is not indicated because the patient has no instability on examination.
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, 2*Figure 1 is the T1-weighted lateral MR image and Figure 2 is the T2-weighted lateral MR image of
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a 25-year-old woman with ankle pain for the last year that is associated with walking down stairs
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and playing sports. No known injury has been identified. The ankle pain has been managed with
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rest, therapy for range of motion, and a period of immobilization. Intra-articular steroid injection
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provided limited relief of symptoms. What is the best next step?
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