Menu

8. Foot and Ankle MCQs

Practice Set 121 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 2401

Topic: Forefoot

A 60-year-old female presents with dorsal midfoot pain and stiffness in her great toe. Radiographs show a preserved plantar joint space but significant dorsal osteophytes and joint space narrowing at the first MTP joint. She has pain at the extremes of motion but not in the mid-range. What is the most appropriate surgical management if conservative care fails?

. First MTP arthrodesis
. Keller arthroplasty
. Dorsal cheilectomy
. First MTP total joint arthroplasty
. Akin osteotomy

Correct Answer & Explanation

. Dorsal cheilectomy

Explanation

This patient has Grade 2 hallux rigidus according to the Coughlin and Shurnas classification (preserved plantar joint space, pain only at extremes of motion, prominent dorsal osteophytes). The standard surgical treatment for Grades 1 and 2, when conservative measures fail, is a dorsal cheilectomy. Arthrodesis is generally reserved for advanced disease (Grades 3 and 4) with diffuse pain throughout the range of motion and global joint space loss.

Question 2402

Topic: Midfoot & Hindfoot

In a patient with Stage II posterior tibial tendon dysfunction (PTTD), tearing or attenuation of the spring ligament complex is frequently observed. Which component of the spring ligament complex is the thickest, most frequently torn, and acts as the primary static stabilizer of the talonavicular joint?

. Plantar calcaneonavicular ligament
. Superomedial calcaneonavicular ligament
. Inferocalcaneonavicular ligament
. Bifurcate ligament
. Dorsal talonavicular ligament

Correct Answer & Explanation

. Superomedial calcaneonavicular ligament

Explanation

The spring ligament complex (calcaneonavicular ligament) has three main components: superomedial, inferoplantar, and medioplantar. The superomedial calcaneonavicular ligament is the thickest and most crucial static stabilizer of the talar head. It is the component most frequently attenuated or torn in conjunction with posterior tibial tendon dysfunction (acquired flatfoot deformity).

Question 2403

Topic: 8. Foot and Ankle

A 24-year-old football player sustains a hyperplantarflexion injury to his foot resulting in a subtle Lisfranc injury. During surgical exploration, you identify a tear of the primary Lisfranc ligament. What are the correct anatomical attachments of this ligament?

. Medial cuneiform to the base of the first metatarsal
. Medial cuneiform to the base of the second metatarsal
. Intermediate cuneiform to the base of the second metatarsal
. Lateral cuneiform to the base of the third metatarsal
. Cuboid to the base of the fourth metatarsal

Correct Answer & Explanation

. Medial cuneiform to the base of the second metatarsal

Explanation

The Lisfranc ligament is an interosseous ligament that connects the lateral aspect of the medial cuneiform to the medial aspect of the base of the second metatarsal. It is the primary and strongest stabilizer of the second tarsometatarsal joint; notably, there is no direct intermetatarsal ligament between the first and second metatarsal bases.

Question 2404

Topic: Midfoot & Hindfoot

A 26-year-old male presents with a grossly deformed foot after a fall from a ladder. Radiographs reveal a medial subtalar dislocation without associated fractures. Which of the following structures is most likely to block closed reduction of this specific dislocation pattern?

. Posterior tibial tendon
. Flexor hallucis longus
. Extensor digitorum brevis
. Peroneus brevis tendon
. Anterior tibial tendon

Correct Answer & Explanation

. Extensor digitorum brevis

Explanation

In a medial subtalar dislocation, the foot is displaced medially, forcing the talar head to protrude laterally. The structures that commonly block closed reduction of a medial subtalar dislocation include the extensor digitorum brevis (EDB) muscle, the extensor retinaculum, or the talonavicular joint capsule impinging on the talar head. Conversely, in a lateral subtalar dislocation, the posterior tibial tendon (PTT) frequently blocks reduction by looping around the medially prominent talar neck.

Question 2405

Topic: Midfoot & Hindfoot
A 58-year-old diabetic female with peripheral neuropathy presents with a warm, swollen, and erythematous left foot. Radiographs demonstrate coalescing of previously seen fracture fragments, absorption of fine bone debris, and early sclerosis of the midfoot bones. According to the Eichenholtz classification of Charcot arthropathy, which stage does this represent?
. Stage 0
. Stage I
. Stage II
. Stage III
. Stage IV

Correct Answer & Explanation

. Stage II

Explanation

The Eichenholtz classification divides Charcot arthropathy into three main clinical/radiographic stages (plus Stage 0). Stage 0 represents clinical inflammation with normal radiographs. Stage I (Development/Fragmentation) is characterized by acute inflammation, osteopenia, joint subluxation, and bony fragmentation/debris. Stage II (Coalescence) is marked by decreased inflammation, absorption of fine debris, early sclerosis, and fusion of fragments. Stage III (Reconstruction/Remodeling) shows decreased sclerosis and remodeling of bone ends.

Question 2406

Topic: 8. Foot and Ankle

In recent randomized controlled trials comparing operative versus nonoperative management for acute Achilles tendon ruptures, when utilizing early functional rehabilitation protocols for both groups, which of the following correctly describes the outcomes?

. Nonoperative management has a significantly higher re-rupture rate but similar wound complications.
. Operative management has a significantly lower re-rupture rate and similar wound complications.
. Both groups have equivalent re-rupture rates, but nonoperative management has significantly lower soft-tissue complications.
. Nonoperative management results in significantly decreased plantar flexion strength at 2 years.
. Operative management is contraindicated in patients under 30 years old.

Correct Answer & Explanation

. Operative management has a significantly lower re-rupture rate and similar wound complications.

Explanation

Recent high-quality RCTs have demonstrated that when an early functional rehabilitation protocol (including early weight-bearing in a functional orthosis) is utilized, the re-rupture rates between operative and nonoperative management are statistically equivalent. However, operative management continues to carry a higher risk of soft-tissue complications, such as infection and wound breakdown.

Question 2407

Topic: Midfoot & Hindfoot
A 30-year-old male falls from a height and sustains a Hawkins Type III fracture of the talar neck. Which of the following best describes the pathomechanics and vascular risk associated with this specific injury pattern?
. Nondisplaced fracture with a 0-10% risk of avascular necrosis (AVN).
. Fracture with subtalar subluxation/dislocation only, and a 20-50% risk of AVN.
. Fracture with subtalar and tibiotalar dislocations, and a risk of AVN approaching 80-100%.
. Fracture with subtalar, tibiotalar, and talonavicular dislocations, with AVN risk of 10-20%.
. Fracture of the talar head with normal subtalar alignment and <5% risk of AVN.

Correct Answer & Explanation

. Fracture with subtalar and tibiotalar dislocations, and a risk of AVN approaching 80-100%.

Explanation

The Hawkins classification for talar neck fractures: Type I is nondisplaced (AVN 0-15%). Type II involves subtalar subluxation/dislocation (AVN 20-50%). Type III involves dislocation of both the subtalar and tibiotalar joints (extruded talar body), with an AVN risk near 100%. Type IV (added by Canale/Kelly) involves subtalar, tibiotalar, and talonavicular dislocation.

Question 2408

Topic: 8. Foot and Ankle

The Lower Extremity Assessment Project (LEAP) study prospectively evaluated thousands of patients with severe lower extremity trauma. Which of the following was a primary conclusion of the LEAP study regarding the presence of an insensate plantar foot at the time of initial clinical presentation?

. It is an absolute indication for primary amputation.
. It guarantees the patient will develop chronic regional pain syndrome if limb salvage is attempted.
. It reliably predicts the failure of free tissue transfer.
. It is not a reliable prognostic indicator for long-term functional outcome and should not be a sole indication for amputation.
. It requires primary posterior tibial nerve grafting to attempt limb salvage.

Correct Answer & Explanation

. It is not a reliable prognostic indicator for long-term functional outcome and should not be a sole indication for amputation.

Explanation

Historically, an insensate plantar foot at presentation was considered an absolute indication for amputation. However, the LEAP study definitively demonstrated that initial absence of plantar sensation is not predictive of long-term functional outcome, and many patients regain sensation or function well regardless. Therefore, it is no longer considered an absolute indication for primary amputation.

Question 2409

Topic: 8. Foot and Ankle

A 22-year-old collegiate football player sustains a high-energy axial load to a plantarflexed foot. Weight-bearing radiographs demonstrate a 3 mm diastasis between the base of the first and second metatarsals. There is no evidence of compartment syndrome. What is the most appropriate definitive management?

. Non-weight bearing cast for 6 weeks
. Immediate closed reduction and casting in equinus
. Open reduction and internal fixation (ORIF) or primary arthrodesis of the medial column
. Corticosteroid injection into the Lisfranc joint followed by a rigid orthosis
. Isolated screw fixation from the medial cuneiform to the third metatarsal

Correct Answer & Explanation

. Open reduction and internal fixation (ORIF) or primary arthrodesis of the medial column

Explanation

A 3 mm diastasis between the 1st and 2nd metatarsal bases indicates an unstable Lisfranc injury. Because the interosseous ligament is disrupted, anatomic reduction is essential. In an active athletic patient with a purely ligamentous or displaced bony Lisfranc injury >2mm, operative intervention (ORIF or primary arthrodesis) is required to restore anatomy and prevent post-traumatic midfoot collapse and arthritis.

Question 2410

Topic: Midfoot & Hindfoot
A 50-year-old obese female presents with a progressive flatfoot deformity. Clinically, she has pain along the medial ankle and is unable to perform a single-leg heel rise on the affected side. Weight-bearing radiographs show uncovering of the talonavicular joint, but clinical examination reveals the hindfoot deformity remains fully flexible and correctable. What stage of posterior tibial tendon dysfunction (PTTD) does this represent?
. Stage I
. Stage II
. Stage III
. Stage IV
. Stage V

Correct Answer & Explanation

. Stage III

Explanation

Johnson and Strom classification of PTTD: Stage I is tenosynovitis with pain and swelling, but normal alignment and a positive single-leg heel rise. Stage II involves tendinosis/rupture with a flexible flatfoot deformity and inability to perform a single-leg heel rise. Stage III is characterized by a rigid, fixed flatfoot deformity (fixed hindfoot valgus). Stage IV (added by Myerson) involves deltoid ligament compromise leading to rigid ankle valgus.

Question 2411

Topic: 8. Foot and Ankle
A 32-year-old man sustains a Hawkins Type III talar neck fracture following a motor vehicle collision. Which of the following vascular structures, representing the primary blood supply to the talar body, is most likely disrupted in this injury?
. Artery of the tarsal canal
. Artery of the tarsal sinus
. Deltoid branches
. Dorsalis pedis branches
. Medial plantar artery

Correct Answer & Explanation

. Artery of the tarsal canal

Explanation

The artery of the tarsal canal, a branch of the posterior tibial artery, supplies the majority of the blood to the talar body. In a Hawkins Type III fracture (fracture of the talar neck with dislocation of both the subtalar and tibiotalar joints), the blood supply from the artery of the tarsal canal, artery of the tarsal sinus, and branches of the neck are disrupted, leading to a near 100% risk of avascular necrosis (AVN).

Question 2412

Topic: Midfoot & Hindfoot
A 58-year-old poorly controlled diabetic patient presents with a swollen, erythematous, and warm left foot. Radiographs demonstrate joint effusion, soft tissue edema, osteopenia, and periarticular fragmentation with early subluxation. According to the Eichenholtz classification of Charcot arthropathy, which stage does this represent?
. Stage 0 (Prodromal)
. Stage I (Fragmentation)
. Stage II (Coalescence)
. Stage III (Consolidation)
. Stage IV (Remodeling)

Correct Answer & Explanation

. Stage I (Fragmentation)

Explanation

Eichenholtz Stage I is the Developmental or Fragmentation stage. It is characterized clinically by a red, hot, swollen foot and radiographically by joint effusion, bone fragmentation, debris formation, and subluxation/dislocation. Stage II (Coalescence) shows absorption of debris and early fusion, while Stage III (Consolidation) shows remodeling and stable deformity.

Question 2413

Topic: 8. Foot and Ankle

According to the Lauge-Hansen classification, in a pronation-external rotation (PER) ankle injury, what is the first anatomic structure to fail?

. Anterior inferior tibiofibular ligament (AITFL)
. Deltoid ligament or medial malleolus
. Interosseous membrane
. Posterior inferior tibiofibular ligament (PITFL)
. Fibular collateral ligament

Correct Answer & Explanation

. Deltoid ligament or medial malleolus

Explanation

In the Lauge-Hansen system, the first word denotes the position of the foot, and the second denotes the force applied. For Pronation-External Rotation (PER): Stage 1 is rupture of the deltoid ligament or a transverse medial malleolus fracture. Stage 2 is rupture of the AITFL. Stage 3 is a high fibular fracture (above the syndesmosis). Stage 4 is rupture of the PITFL or a posterior malleolus fracture.

Question 2414

Topic: 8. Foot and Ankle

A 32-year-old recreational basketball player sustains an acute, closed Achilles tendon rupture. In discussing treatment options, what is the most scientifically supported advantage of open surgical repair compared to conservative management with functional rehabilitation?

. Lower risk of deep vein thrombosis
. Lower risk of sural nerve injury
. Lower rate of tendon re-rupture
. Lower risk of superficial infection
. Decreased need for functional bracing

Correct Answer & Explanation

. Lower rate of tendon re-rupture

Explanation

Historically and in recent meta-analyses, the primary advantage of surgical repair for an Achilles tendon rupture is a significantly lower rate of re-rupture compared to non-operative treatment. However, this comes at the cost of higher surgical complications, such as wound infection, skin breakdown, and potential sural nerve injury.

Question 2415

Topic: 8. Foot and Ankle

The stability of the midfoot relies heavily on the Lisfranc ligament complex. The primary Lisfranc ligament is an interosseous band that connects which two specific osseous structures?

. Lateral aspect of the medial cuneiform to the medial base of the first metatarsal
. Lateral aspect of the medial cuneiform to the medial base of the second metatarsal
. Medial aspect of the middle cuneiform to the lateral base of the second metatarsal
. Cuboid to the base of the fourth metatarsal
. Navicular to the medial cuneiform

Correct Answer & Explanation

. Lateral aspect of the medial cuneiform to the medial base of the second metatarsal

Explanation

The Lisfranc ligament is a strong interosseous ligament extending obliquely from the lateral aspect of the medial cuneiform to the medial base of the second metatarsal. There is no direct ligamentous connection between the bases of the first and second metatarsals, making the Lisfranc ligament critical for midfoot stability.

Question 2416

Topic: 8. Foot and Ankle

A 40-year-old male is brought to the trauma bay after a high-energy knee dislocation. The knee was reduced prior to arrival. Pulses are palpable and symmetric to the contralateral limb, but the Ankle-Brachial Index (ABI) is 0.8. What is the next most appropriate step in management?

. Discharge with a hinged knee brace locked in extension
. Duplex ultrasound of the lower extremity
. CT angiography of the lower extremity
. Immediate surgical exploration of the popliteal artery
. Serial ABI measurements every 4 hours for 24 hours

Correct Answer & Explanation

. CT angiography of the lower extremity

Explanation

In the setting of a knee dislocation, an ABI < 0.9 is highly suspicious for a vascular injury (specifically popliteal artery intimal tear or occlusion) despite palpable pulses. The gold standard next step is advanced imaging, currently most commonly a CT angiogram, to definitively evaluate the vascular tree.

Question 2417

Topic: 8. Foot and Ankle
A 28-year-old male presents after a knee dislocation (Schenck KD-III). The knee is successfully reduced in the emergency department. His dorsalis pedis and posterior tibial pulses are palpable but slightly diminished compared to the contralateral side. His ankle-brachial index (ABI) is calculated to be 0.85. What is the most appropriate next step in management?
. Immediate exploration by vascular surgery
. Duplex ultrasonography
. CT Angiography (CTA)
. Observation and repeat ABI in 4 hours
. Application of a knee-spanning external fixator

Correct Answer & Explanation

. CT Angiography (CTA)

Explanation

An ABI < 0.9 in the setting of a knee dislocation is highly sensitive for an occult vascular injury and mandates advanced vascular imaging, most commonly CT Angiography (CTA). Immediate exploration is reserved for hard signs of vascular injury (e.g., expanding hematoma, absent pulses post-reduction). Observation alone is inappropriate with an abnormal ABI.

Question 2418

Topic: 8. Foot and Ankle

A 30-year-old male is brought to the trauma bay after a motorcycle crash. He has a grossly deformed knee consistent with a multiligamentous knee dislocation, which is immediately reduced. Following reduction, symmetric pedal pulses are palpable. The Ankle-Brachial Index (ABI) is measured as 0.85 on the injured side and 1.0 on the uninjured side. What is the next best step in management?

. Immediate surgical exploration of the popliteal artery.
. CT angiography of the lower extremity.
. Serial physical examinations and duplex ultrasound in 24 hours.
. Application of a spanning external fixator and discharge with close follow-up.

Correct Answer & Explanation

. CT angiography of the lower extremity.

Explanation

In the setting of a knee dislocation, vascular injury (specifically to the popliteal artery) is a major concern. 'Hard signs' of vascular injury (expanding hematoma, absent pulses, pulsatile bleeding) warrant immediate surgical exploration. If hard signs are absent but the Ankle-Brachial Index (ABI) is less than 0.90 (as in this case with an ABI of 0.85), a vascular injury is suspected, and advanced imaging with a CT angiogram (CTA) is indicated. An ABI > 0.90 typically allows for observation and serial exams.

Question 2419

Topic: 8. Foot and Ankle
A 28-year-old male sustains an acute knee dislocation (Schenck KD III) during a football game. The knee is reduced in the emergency department, and palpable dorsalis pedis and posterior tibial pulses are present. An ankle-brachial index (ABI) is measured at 0.85. What is the most appropriate next step in management?
. Discharge with a knee immobilizer and close outpatient follow-up
. Serial ABI measurements every 4 hours for 24 hours
. Formal CT angiography (CTA) of the lower extremity
. Immediate surgical exploration of the popliteal artery
. MRI of the knee to evaluate ligamentous injury before vascular workup

Correct Answer & Explanation

. Formal CT angiography (CTA) of the lower extremity

Explanation

In the setting of a knee dislocation, an ABI of less than 0.9 is a hard indication for advanced vascular imaging, typically a CT angiogram (CTA), to rule out a popliteal artery injury, even if palpable pulses are present. Serial ABIs are appropriate only if the initial ABI is >0.9.

Question 2420

Topic: Midfoot & Hindfoot
A 30-year-old male sustains a Hawkins Type III talar neck fracture. Which of the following best describes the articulations subluxated or dislocated in this injury pattern?
. Subtalar joint only
. Tibiotalar joint only
. Subtalar, tibiotalar, and talonavicular joints
. Subtalar and tibiotalar joints
. Talonavicular joint only

Correct Answer & Explanation

. Subtalar, tibiotalar, and talonavicular joints

Explanation

The Hawkins classification describes talar neck fractures. Type I is non-displaced. Type II involves subtalar subluxation/dislocation. Type III involves dislocation of the subtalar, tibiotalar, and talonavicular joints (extruded talar body). Type IV adds talonavicular subluxation/dislocation to a Type III, though a true Type III intrinsically often involves disruption of all three surrounding articulations of the body. Type III has an avascular necrosis (AVN) rate approaching 100%.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page