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8. Foot and Ankle MCQs

Practice Set 10 of 353

This practice set contains high-yield board review questions covering key concepts in 8. Foot and Ankle. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 181

Topic: 8. Foot and Ankle

Which of the following rays is most commonly used to treat patients with macrodactyly of the foot:

. First
. Second
. Third
. Fourth
. Fifth

Correct Answer & Explanation

. Second

Explanation

The second ray is most commonly used to treat patients with macrodactyly of the foot. The third ray is the next most commonly used ray in treating patients with macrodactyly of the foot.

Question 182

Topic: 8. Foot and Ankle

Macrodactyly of the foot commonly displays which of the following patterns of overgrowth:

. Greatest dorsally and distally
. Greatest plantarly and distally
. Greatest plantarly and proximally
. Greatest laterally and distally
. Greatest medially and proximally

Correct Answer & Explanation

. Greatest plantarly and distally

Explanation

Macrodactyly displays overgrowth that is greatest plantarly and distally. Plantar overgrowth causes the sole to become convex plantarly and the toes to become dorsiflexed.

Question 183

Topic: 8. Foot and Ankle

A 14-year-old girl presents with a swollen foot. She had sustained a contusion to the dorsum of her foot for 4 weeks. Her temperature is 99.2° F. Her foot is tender to touch. She is able to dorsiflex and plantarflex her toes. Radiographs are normal. The best treatment is:

. Physical therapy
. Ankle block
. Sciatic block
. Ankle joint aspiration
. Blood culture

Correct Answer & Explanation

. Physical therapy

Explanation

This patient demonstrates signs of early reflex sympathetic dystrophy. She may later develop osteopenia, a positive bone scan, and contracture. Physical therapy is the best treatment for reflex sympathetic dystrophy in this case because it will increase the patients range of movement and her tolerance to touch. Multimodality therapy is also required to treat reflex sympathetic dystrophy. Analgesics may be appropriate treatment for the patient and can be supplemented by antidepressants, if needed. Repeated regional block treatment is recommended for patients with established cases of reflex sympathetic dystrophy.

Question 184

Topic: 8. Foot and Ankle

The bone graft used in the Grice procedure for the treatment of neurogenic valgus feet should be placed:

. Between the cuboid and calcaneus
. Among the metatarsal bones
. In the sinus tarsi parallel to the axis of the tibia
. In the calcaneus after the osteotomy
. None of the above

Correct Answer & Explanation

. In the sinus tarsi parallel to the axis of the tibia

Explanation

In 1945, Grice developed the use of subtalar extra-articular arthrodesis as a treatment for paralytic valgus feet. Grice demonstrated that blocking the tarsal sinus opening prevents the calcaneus from rotating posterolaterally and thus blocks the heel of a foot from shifting into the valgus position. A bone block must be placed at such an angle in the tarsal sinus that when posterolateral migration of the calcaneus is attempted, the graft compresses. If a graft is placed too far forward, then the posterolateral movement of the calcaneus increases insertional distance between blocked areas, the graft collapses, and the foot goes into valgus.

Question 185

Topic: 8. Foot and Ankle
A 10-year-old boy steps on a nail. The nail is promptly removed and inspected in the emergency department. No evidence of foreign material is found in the patient's foot. One week later, the boy develops increased pain and swelling in his foot with inability to bear weight. Plain films show no abnormality. The appropriate next step of treatment would be:
. Irrigation and debridement of the foot
. Magnetic resonance imaging (MRI) of the foot
. Bone scan
. Computed tomography scan
. Repair of flexor tendon laceration

Correct Answer & Explanation

. Magnetic resonance imaging (MRI) of the foot

Explanation

Penetrating injuries to the sole of the foot commonly inoculate bacteria to the deep spaces of the foot. Pseudomonas, other gram-negative organisms, and Staphylococcus are examples of bacteria that commonly can become inoculated. An MRI would help to localize the site and stage of the infection. The MRI determines whether the surgeon should aspirate the infection and treat it with antibiotics or operatively debride the infection. Pseudomonas often requires debridement.

Question 186

Topic: 8. Foot and Ankle

A 4-year-old boy is brought to the doctor for evaluation of his feet. His mother is concerned that he has no arch. He does not have any pain in his feet, and there are no calluses on the plantar surface. Radiographs of one of the feet are shown below. You recommend:

. Open reduction of the talocalcaneal joint
. Calcaneal slide osteotomy
. Calcaneal neck lengthening
. Medial arch support
. Observation

Correct Answer & Explanation

. Observation

Explanation

The radiographs demonstrate a normal appearance of a foot in a young child. The angle between the talus and calcaneus is increased at this age. The arch in a young child is not as well developed as in an older child. The navicular has not ossified yet. No treatment is needed.

Question 187

Topic: 8. Foot and Ankle

A 13-year-old girl is brought to the office for evaluation of her feet. During gait, she has a foot progression angle of 45° outward on each side. Her transmalleolar axis is 20° outward on each side. Her hips have internal rotation in extension of 40° and external rotation in extension of 40°. Her clinically estimated anteversion is 20°. She has popliteal angles of 20° bilaterally and full knee extension during swing. Standing radiographs of the feet are presented. Which factor is most likely to be the cause of her toeing- out:

. Femoral retroversion
. External tibial torsion
. Dynamic knee torsion
. Forefoot abduction
. Tight hamstrings

Correct Answer & Explanation

. Forefoot abduction

Explanation

This patient has significant forefoot abduction demonstrated on the standing foot radiographs. The femoral anteversion of 20° is within normal limits for age. The transmalleolar and popliteal angles are also within normal limits. There is no evidence of dynamic knee torsion as a factor in alignment of children.

Question 188

Topic: 8. Foot and Ankle

After being dragged by an automobile, a 7-year-old child sustained injuries to his foot (Slide). Following reconstructive surgery, he is most likely to be left with a permanent deficit in which of the following:

. Ankle inversion
. Ankle eversion
. Ankle dorsiflexion
. Growth of the distal tibia
. Growth of the navicular

Correct Answer & Explanation

. Ankle dorsiflexion

Explanation

This patient sustained a dorsal degloving injury. The anterior tibialis tendon is gone, as are some of the toe dorsiflexors. The anterior tibial function is difficult to reconstruct, even after tendon transfer, because of scarring at the insertion site.

Question 189

Topic: 8. Foot and Ankle

A 14-year-old boy presents with frequent ankle sprains and a rigid, painful flatfoot. Lateral radiographs demonstrate a distinct "C sign". Which of the following is the most appropriate imaging modality to best characterize the anatomical extent of this suspected pathology?

. Ultrasound
. Technetium-99m bone scan
. Computed Tomography (CT)
. Magnetic Resonance Imaging (MRI)
. Fluoroscopy

Correct Answer & Explanation

. Computed Tomography (CT)

Explanation

The "C sign" is indicative of a talocalcaneal tarsal coalition. A CT scan of the foot and ankle is the gold standard imaging modality to characterize the location, extent, and osseous nature of tarsal coalitions.

Question 190

Topic: 8. Foot and Ankle

A newborn is evaluated for bilateral "rocker-bottom" foot deformities. Radiographs with forced plantar flexion show that the navicular remains dorsally dislocated on the talar neck. What is the fundamental pathology of this condition?

. Equinus contracture of the Achilles tendon only
. Rigid dorsal dislocation of the navicular on the talus
. Plantar medial subluxation of the talonavicular joint
. Tethering of the anterior tibial tendon
. Bony coalition between the talus and calcaneus

Correct Answer & Explanation

. Rigid dorsal dislocation of the navicular on the talus

Explanation

The clinical presentation and radiographic failure of the navicular to reduce with forced plantarflexion defines congenital vertical talus. Its hallmark is a rigid dorsal dislocation of the navicular on the head/neck of the talus.

Question 191

Topic: 8. Foot and Ankle

Which of the following physical findings is uncommon in a patient with a unilateral untreated clubfoot:

. Thin calf
. Loss of prominence of the heel
. Plantar-medial prominence of the talus in the foot
. Medial midfoot crease
. Decreased length of the foot

Correct Answer & Explanation

. Plantar-medial prominence of the talus in the foot

Explanation

In a patient with unilateral untreated clubfoot, certain findings are apparent when compared with the unaffected foot. Common findings include a thinner calf, shorter-appearing foot, loss of heel prominence, and a medial midfoot crease. The talus is prominent anterolaterally in the foot but not on the plantar-medial side.

Question 192

Topic: 8. Foot and Ankle

Which of the following radiographic findings is present in a varus foot:

. Increased parallelism of the talus and calcaneus on lateral film
. Superimposition of the anterior portions of the talus and calcaneus on the lateral film
. Increased divergence of the talus and calcaneus on the anteroposterior film
. Increased abduction of the forefoot on the hindfoot
. Increased superimposition of the metatarsal heads on lateral film

Correct Answer & Explanation

. Increased parallelism of the talus and calcaneus on lateral film

Explanation

Plain radiographs of a foot that is in varus show increased parallelism of the talus and the calcaneus on both the anteroposterior and lateral films. There is decreased superimposition of the talus, the calcaneus, and the metatarsal heads. By contrast, in a valgus foot, there is increased divergence on both the anteroposterior and lateral films.

Question 193

Topic: 8. Foot and Ankle

Which radiographic finding on a lateral foot view is pathognomonic for congenital vertical talus?

. Talonavicular dislocation that reduces on forced plantarflexion
. Rigid dorsal dislocation of the navicular on the talus that fails to reduce on plantarflexion
. Decreased talocalcaneal angle
. Plantarflexed positioning of the calcaneus
. Dorsal subluxation of the cuboid on the calcaneus

Correct Answer & Explanation

. Rigid dorsal dislocation of the navicular on the talus that fails to reduce on plantarflexion

Explanation

Congenital vertical talus is characterized by a rigid, irreducible dorsal dislocation of the navicular on the head of the talus. A forced plantarflexion lateral radiograph confirms the inability to reduce the talonavicular joint.

Question 194

Topic: 8. Foot and Ankle

A 14-year-old boy presents with painful, rigid flatfeet and recurrent ankle sprains. A "C sign" is distinctly visible on his lateral foot radiograph. What is the most likely diagnosis?

. Calcaneonavicular coalition
. Talocalcaneal coalition
. Cubonavicular coalition
. Talonavicular coalition
. Naviculocuneiform coalition

Correct Answer & Explanation

. Talocalcaneal coalition

Explanation

The C sign on a lateral foot radiograph represents a continuous bony bridge between the talar dome and the sustentaculum tali, strongly indicating a talocalcaneal coalition.

Question 195

Topic: 8. Foot and Ankle

Which specific radiographic view is most sensitive for diagnosing a calcaneonavicular coalition?

. Anteroposterior view of the foot
. Lateral view of the foot
. Harris axial view
. 45-degree internal oblique view of the foot
. Weight-bearing mortise view of the ankle

Correct Answer & Explanation

. 45-degree internal oblique view of the foot

Explanation

The 45-degree internal oblique radiograph of the foot is the best plain film view to visualize the anterior process of the calcaneus and the navicular, making it the most sensitive view for identifying a calcaneonavicular coalition.

Question 196

Topic: Midfoot & Hindfoot

A 12-year-old boy has bilateral cavovarus feet. A Coleman block test demonstrates a flexible hindfoot. In Charcot-Marie-Tooth disease, which primary muscle imbalance initiates the plantarflexed first ray?

. Strong tibialis anterior overriding a weak peroneus longus
. Strong peroneus longus overriding a weak tibialis anterior
. Strong tibialis posterior overriding a weak peroneus brevis
. Weak extensor hallucis longus with a strong flexor hallucis longus
. Weak gastrocnemius with a strong soleus

Correct Answer & Explanation

. Strong peroneus longus overriding a weak tibialis anterior

Explanation

In Charcot-Marie-Tooth disease, the typical muscle imbalance driving the cavus deformity is a strong peroneus longus overpowering a weak tibialis anterior, which severely plantarflexes the first ray.

Question 197

Topic: 8. Foot and Ankle

A newborn presents with a rigid rocker-bottom foot deformity. Radiographs reveal a dorsally dislocated navicular on the talus. On a forced plantarflexion lateral view, the talonavicular joint fails to reduce. What is the most likely diagnosis?

. Oblique talus
. Congenital vertical talus
. Untreated clubfoot
. Tarsal coalition
. Calcaneovalgus foot

Correct Answer & Explanation

. Congenital vertical talus

Explanation

Congenital vertical talus is characterized by rigid dorsal dislocation of the navicular on the talus. The inability to reduce this alignment on a maximum plantarflexion lateral radiograph distinguishes it from a flexible oblique talus.

Question 198

Topic: 8. Foot and Ankle

An 11-year-old boy presents with a rigid flatfoot and recurrent ankle sprains. Radiographs show a "long nose" or "anteater" sign on the lateral view. Which of the following is the most appropriate next step to confirm the suspected diagnosis?

. MRI of the hindfoot
. CT scan in the coronal plane
. CT scan in the axial plane
. 45-degree internal oblique radiograph of the foot
. Harris axial heel view

Correct Answer & Explanation

. 45-degree internal oblique radiograph of the foot

Explanation

The "anteater" sign is pathognomonic for a calcaneonavicular coalition. A 45-degree internal oblique radiograph of the foot is the best plain film view to directly visualize and confirm this specific condition.

Question 199

Topic: Midfoot & Hindfoot

A 4-year-old boy presents with bilateral flexible flatfeet. He has no pain, normal subtalar motion, and is able to perform a single-leg heel rise, during which the heel appropriately goes into varus. What is the most appropriate management?

. Custom rigid orthotics
. UCBL orthoses
. Bilateral subtalar arthroereisis
. Medial column lengthening
. Reassurance and observation

Correct Answer & Explanation

. Reassurance and observation

Explanation

Flexible, asymptomatic flatfeet in a young child represent a normal physiologic variant. Treatment is not indicated, and the best management is reassurance to the parents, as arch development continues up to age 10.

Question 200

Topic: Midfoot & Hindfoot

A 14-year-old male presents with deep posterior ankle pain during sports. Examination reveals decreased subtalar motion. Radiographs show a "C-sign" on the lateral view. Which anatomical structure is most commonly involved in this pathology?

. Anterior facet of the subtalar joint
. Middle facet of the subtalar joint
. Posterior facet of the subtalar joint
. Calcaneocuboid joint
. Talonavicular joint

Correct Answer & Explanation

. Middle facet of the subtalar joint

Explanation

The "C-sign" on a lateral radiograph is indicative of a talocalcaneal coalition. The middle facet of the subtalar joint is the most common anatomical site for this type of bony or cartilaginous bridge.

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