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A 45-year-old male presents with complaints that his left foot "slaps" on the floor when he tries to ambulate. He reports a remote history of playing rugby 7 months ago when an opposing player fell on his plantarflexed left ankle. He denies constitutional symptoms. On physical examination he has weak dorsiflexion and increased fatigue with walking. He is able to achieve 15 degrees of passive dorsiflexion with the knee in full extension and 20 degrees of dorsiflexion with his knee in 90 degrees of flexion. A sagittal T2 MRI is shown in Figure A and axial MRI images are shown in Figures B and C. Which of the following is the MOST appropriate next step in management?
Surgical reconstruction with posterior tibial tendon transfer and gastrocnemius recession
MRI of the proximal tibiofibular joint for evaluation of ganglion cyst and EMG of the peroneal nerve
Primary surgical repair with gastrocnemius recession
Chest CT, skeletal survey, hematology profile, and referral to an orthopaedic oncologist for biopsy of the mass
Surgical reconstruction with plantaris tendon interposition augmentation
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