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8. Foot and Ankle MCQs

Practice Set 136 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 2701

Topic: 8. Foot and Ankle

A 30-year-old man who sustained a tibial fracture with a peroneal nerve palsy 2 years ago now has a drop foot and weak eversion of the foot. He reports success with stretching exercises, but he catches his toes when his foot tires. Examination reveals that the foot is plantigrade and supple. What is the next most appropriate step in management?

Foot & Ankle 2006 Practice Questions: Set 1 (Solved) - Figure 9

. Posterior tibial tendon transfer to the cuboid
. Anterior tibial tendon transfer to the cuboid
. Achilles tendon lengthening
. Ankle-foot orthosis with dorsiflexion assist
. Nerve grafting

Correct Answer & Explanation

. Ankle-foot orthosis with dorsiflexion assist

Explanation

The patient has a supple plantigrade foot that would benefit from a drop foot brace to prevent catching of the toes. Tendon transfer should not be considered until the patient has undergone bracing. Achilles tendon lengthening is not necessary because the foot is plantigrade and flexible. Nerve grafting is not indicated because of the length of time the peroneal nerve palsy has been present. Dehne R: Congenital and acquired neurologic disorders, in Mann RA, Coughlin MJ (eds): Surgery of the Foot and Ankle, ed 7. St Louis, MO, Mosby, 1999, vol 1, pp 552-553.

Question 2702

Topic: 8. Foot and Ankle

A 32-year-old laborer reports left ankle pain and deformity. History reveals that he sustained a left ankle fracture 2 years ago and was treated with closed reduction and casting. Radiographs are shown in Figures 25a through 25c. What is the most appropriate management?

. Bracing and physical therapy
. Intra-articular injection of steroids into the ankle joint, bracing, and physical therapy
. Intra-articular injection of hyaluronic acid product into the ankle joint, bracing, and physical therapy
. Ankle fusion
. Corrective osteotomy of the fibula and medial malleolus with reconstruction of the syndesmosis if unstable

Correct Answer & Explanation

. Corrective osteotomy of the fibula and medial malleolus with reconstruction of the syndesmosis if unstable

Explanation

Corrective osteotomy of fibular malunions, with appropriate lengthening, even in the presence of early arthritis, has been shown to decrease ankle pain and increase stability. Reduction and bone grafting of the medial malleolar nonunion is also needed. There is no evidence supporting the use of intra-articular steroids or hyaluronic acid in the ankle joint. Lateral talar displacement of even 1 mm has been reproducibly shown to decrease tibiotalar contact by 40% to 42%, causing a predisposition to arthritis. Weber D, Friederich NF, Muller W: Lengthening osteotomy of the fibula for post-traumatic malunion: Indication, technique and results. Int Orthop 1998;22:149-152. Lloyd J, Elsayed S, Hariharan K, et al: Revisiting the concept of talar shift in ankle fractures. Foot Ankle Int 2006;27:793-796. Offierski CM, Graham JD, Hall JH, et al: Later revision of fibular malunion in ankle fractures. Clin Orthop Relat Res 1982;171:145-149.

Question 2703

Topic: 8. Foot and Ankle

A 35-year-old woman who runs long distance has had posterior calf tenderness for the past 3 months. A clinical photograph is shown in Figure 10a, and MRI scans are shown in Figures 10b and 10c. Management at this point should consist of

. a non-weight-bearing cast for 4 weeks.
. eccentric calf stretching and physical therapy.
. a cortisone injection.
. tendon debridement.
. tendon debridement and augmentation.

Correct Answer & Explanation

. eccentric calf stretching and physical therapy.

Explanation

The initial treatment for peritendinitis should consist of calf stretching in an eccentric mode and physical therapy. In a recent study, this treatment has been found superior to surgical debridement in nonextensive peritendinitis and pantendinitis. A non-weight-bearing cast, while useful in reducing inflammation, will result in calf atrophy and poorly organized collagen repair. Cortisone is contraindicated because of the danger of tendon damage. Tendon debridement at this stage is not indicated. Alfredson H, Pietila T, Jansson P, Lorentzon R: Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med 1998;26:360-366.

Question 2704

Topic: 8. Foot and Ankle

A 47-year-old man ruptured his left patellar tendon and twisted his right ankle in a fall. Initial radiographs of the ankle are unremarkable. One week following repair of the left patellar tendon, he reports increased pain with weight bearing in his right ankle. A follow-up radiograph is shown in Figure 38. Management of the ankle injury should consist of

Trauma Board Review 2000: High-Yield MCQs (Set 4) - Figure 1

. functional rehabilitation with range of motion and strengthening.
. reduction and screw fixation of the syndesmosis.
. closed reduction and a long leg cast.
. repair of the talofibular ligaments.
. fibular osteotomy and plate fixation.

Correct Answer & Explanation

. reduction and screw fixation of the syndesmosis.

Explanation

The radiograph reveals disruption of the syndesmosis with lateral displacement of the talus and widening of the medial ankle clear space. No fibular fracture is noted, although radiographs of the entire tibia and fibula are necessary to rule out a more proximal fibula fracture. There is clear instability of the syndesmosis, and surgical stabilization is needed, either by direct repair of the ligaments or more commonly with surgical stabilization of the fibula to the tibia with screws. Functional rehabilitation and early range of motion are indicated with anterior-lateral ankle sprains but not with true instability of the syndesmosis. In anterior syndesmotic injuries in which there are no signs of instability on plain radiographs or with stressing, cast immobilization and protected weight bearing until tenderness subsides is warranted. Long leg cast immobilization is unlikely to be adequate in maintaining reduction of the syndesmosis. Repair of the talofibular ligaments or fibular osteotomy does not address the pathology at the syndesmosis. Chronic syndesmotic disruption is likely to lead to chronic ankle pain and early arthrosis. Wuest TK: Injuries to the distal lower extremity syndesmosis. J Am Acad Orthop Surg 1997;5:172-181.

Question 2705

Topic: 8. Foot and Ankle

Examination of a 45-year-old man with Charcot-Marie-Tooth disease reveals a cavus foot, a tight Achilles tendon, and forefoot callus formation. Radiographs reveal advanced degenerative changes in the hindfoot. Shoe wear modifications have failed to provide relief. Treatment should now consist of

Foot & Ankle 2000 Practice Questions: Set 1 (Solved) - Figure 13

. triple arthrodesis.
. Achilles tendon lengthening and Steindler stripping.
. calcaneal osteotomy.
. multiple metatarsal osteotomies.
. midfoot osteotomy.

Correct Answer & Explanation

. triple arthrodesis.

Explanation

The patient has the typical end stage residuals from long-standing Charcot-Marie-Tooth disease. Initial management consisting of shoe wear modifications and orthotic devices is preferred, but these are not successful when the disease process has progressed. Surgical correction with calcaneal osteotomy or Achilles tendon lengthening and Steindler stripping is not indicated in the presence of significant hindfoot arthritis. Because this patient has findings consistent with hindfoot arthritis, a triple arthrodesis with correction of the cavus deformity is the preferred treatment. Roper BA, Tibrewal SB: Soft tissue surgery in Charcot-Marie-Tooth disease. J Bone Joint Surg Br 1989;71:17-20.

Question 2706

Topic: 8. Foot and Ankle

Figures 3a and 3b show the inversion stress radiographs of a patient's ankle. What is the most likely ligament injury pattern?

. Calcaneofibular alone
. Posterior talofibular alone
. Posterior talofibular and deltoid
. Anterior talofibular and deltoid
. Anterior talofibular and calcaneofibular

Correct Answer & Explanation

. Anterior talofibular and calcaneofibular

Explanation

The radiographic findings show 30 degrees of talar tilt (severe) and 10 mm of anterior translation that typically involves laxity of both of the major lateral ligaments of the ankle (anterior talofibular and calcaneofibular). There is no evidence of deltoid laxity. Harper MC: Stress radiographs in the diagnosis of lateral instability of the ankle and hindfoot. Foot Ankle 1992;13:435-438.

Question 2707

Topic: 8. Foot and Ankle

A 19-year-old woman has had a painful prominence on the lateral border of her fifth metatarsal head since she was a young girl. Nonsurgical management, including the use of a wide toe box shoe, has failed to provide relief. Examination reveals a callus over the lateral prominence and on the plantar portion as well. A clinical photograph and a radiograph are shown in Figures 34a and 34b. Treatment should consist of

. chevron osteotomy of the fifth metatarsal head, with capsular plication and release of the medial collateral ligament.
. metatarsal head excision with soft-tissue interposition.
. "floating" distal oblique osteotomy.
. oblique biplanar diaphyseal fifth metatarsal osteotomy.
. proximal crescentic osteotomy of the fifth metatarsal base.

Correct Answer & Explanation

. oblique biplanar diaphyseal fifth metatarsal osteotomy.

Explanation

The type of deformity described is a type 2 bunionette. There is often a congenital component to this deformity. The bowing of the fifth shaft differentiates a large intermetatarsal angle from a type 3 deformity. A distal chevron osteotomy corrects 1 degree in the intermetatarsal angle for every 1-mm shift. Because of limitations in the width of the fifth metatarsal neck, the allowable shift is generally 3 to 4 mm. This shift will not compensate for the large intermetatarsal angle. The floating osteotomy has a high rate of delayed union/nonunion and a low satisfaction rate. Metatarsal head excision has a high complication rate, including severe shortening, transfer metatarsalgia, stiffness, and pain. A more proximal procedure is necessary to correct the large intermetatarsal angle and the lateral bowing. The osteotomy of choice is a diaphyseal shaft osteotomy. Because this patient has a plantar callosity and a lateral callosity, the osteotomy is angled superiorly to elevate the fifth shaft with the shift, eliminating overload of the plantar metatarsal head and subsequent callus formation. Shereff MJ, Yang QM, Kummer FJ, Frey CC, Greenidge N: Vascular anatomy of the fifth metatarsal. Foot Ankle 1991;11:350-353. Coughlin MJ: Treatment of bunionette deformity with longitudinal diaphyseal osteotomy with distal soft tissue repair. Foot Ankle 1991;11:195-203.

Question 2708

Topic: 8. Foot and Ankle

A 67-year-old woman has had pain in the area of the metatarsal heads and toes bilaterally for the past 18 months. She describes a diffuse discomfort and a constant burning sensation. She notes that the area feels swollen. Examination reveals that her pulses are normal, and there is no frank swelling or focal tenderness. What is the most likely diagnosis?

. Peripheral vascular disease
. Morton's neuroma
. Stress fracture
. Peripheral neuropathy
. Freiberg's infraction

Correct Answer & Explanation

. Peripheral neuropathy

Explanation

Patients with peripheral neuropathy will often initially see an orthopaedic surgeon and report symptoms of burning, numb, dead, or wooden feet. A simple diagnostic evaluation with a tuning fork (to test vibratory sensibility) or use of the Semmes-Weinstein monofilaments will help make the diagnosis. Mizel MS, Miller RA, Scioli MW (eds): Orthopaedic Knowledge Update: Foot and Ankle 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1998, pp 113-121.

Question 2709

Topic: 8. Foot and Ankle

A 69-year-old man reports pain over his bunion while wearing shoes and pain in the joint with push-off when barefoot. Nonsurgical management has failed to provide relief. Radiographs are shown in Figures 8a and 8b. What is the surgical procedure of choice?

. First metatarsophalangeal arthrodesis
. Distal chevron osteotomy and bunionectomy with closing wedge osteotomy and soft-tissue release
. Bunionectomy with proximal metatarsal osteotomy
. Bunionectomy with first metatarsal cuneiform fusion
. Bunionectomy with proximal phalanx osteotomy and distal chevron osteotomy

Correct Answer & Explanation

. First metatarsophalangeal arthrodesis

Explanation

Arthrodesis is indicated for severe bunion and hallux valgus deformities, but particularly with extensive degenerative disease of the first metatarsophalangeal joint. The other bunionectomy procedures have different indications, none of which include symptomatic first metatarsophalangeal degenerative disease. Richardson EG(ed): Orthopaedic Knowledge Update: Foot and Ankle 3. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2004, pp 3-15.

Question 2710

Topic: 8. Foot and Ankle

A 35-year-old woman with type 1 diabetes mellitus has been treated for the past 2 years at a wound care center for persistent bilateral fifth metatarsal head ulcers. Management has consisted of shoe wear modifications, treatment with multiple enzymatic ointments, and a fifth metatarsal head resection on the left side. Physical examination reveals intact pulses, minimal ankle dorsiflexion, neutral hindfoot, and a persistent ulcer under the fifth metatarsal heads. What treatment will best help heal the ulcers?

. Plastizote orthotics with a metatarsal pad and a cutout under the fifth metatarsal head
. Hyperbaric oxygen and prolonged non-weight-bearing
. A healing shoe that completely alleviates any weight bearing on the forefoot
. A gastrocnemius release and supportive wound care
. A transmetatarsal amputation

Correct Answer & Explanation

. A gastrocnemius release and supportive wound care

Explanation

The patient likely has a significant Achilles contracture that causes her to always bear more weight on her forefoot. A gastrocnemius recession takes the ankle out of plantar flexion and she will be able to return to a normal gait and reduce the pressures on her forefoot. A forefoot amputation is a salvage option. The other choices are appropriate; however, the patient has had this problem for 2 years and she has already had multiple attempts at shoe wear modification. Laughlin RT, Calhoun JH, Mader JT: The diabetic foot. J Am Acad Orthop Surg 1995;3:218-225.

Question 2711

Topic: 8. Foot and Ankle

A 50-year-old man with no history of trauma reports new-onset back pain after doing some yard work the previous day. He reports pain radiating down his leg posteriorly and into the first dorsal web space of his foot. MRI scans are shown in Figures 3a through 3c. What nerve root is affected?

. Left L4
. Right L4
. Left L5
. Right L5
. Left S1

Correct Answer & Explanation

. Left L5

Explanation

The MRI scans clearly show an extruded L4-5 disk that is affecting the L5 nerve root on the left side. In addition, the L5 nerve root has a cutaneous distribution in the first dorsal web space. S1 affects the lateral foot. L4 affects the medial calf.

Question 2712

Topic: 8. Foot and Ankle

A 35-year-old runner has pain beneath the second metatarsophalangeal joint. He reports that he has significantly decreased his running distance since the onset of the pain. He denies any history of trauma or injury to the foot. A radiograph is shown in Figure 14. Initial management should consist of

Foot & Ankle 2000 Practice Questions: Set 1 (Solved) - Figure 33

. resectional arthroplasty.
. metatarsophalangeal joint arthrodesis.
. dorsal closing wedge osteotomy.
. physical therapy.
. a rigid steel shank shoe with a rocker bottom sole.

Correct Answer & Explanation

. a rigid steel shank shoe with a rocker bottom sole.

Explanation

The presence of the relatively long second metatarsal, along with the close approximation of the second and third metatarsal heads, are consistent with second metatarsophalangeal tenosynovitis. The hallmark of initial management is conservative. Modalities include taping, nonsteroidal anti-inflammatory drugs, metatarsal pads, and cortisone injections. Trepman and Yeo combined the use of a cortisone injection with a rocker bottom sole. Mizel and Michelson reported their results using an extended rigid steel shank shoe along with a cortisone injection. Trepman E, Yeo SJ: Nonoperative treatment of metatarsophalangeal joint synovitis. Foot Ankle Int 1995;16:771-777.

Question 2713

Topic: 8. Foot and Ankle

A 29-year-old man reports severe knee instability and popliteal pain. History reveals that he had polio of the left lower extremity as a child and has been brace-free his entire life. Examination reveals that he walks with 40 degrees of knee hyperextension and has a fixed ankle equinus deformity of 30 degrees. He has no active motors about the knee or ankle. Which of the following methods will provide knee stability and pain relief?

. Knee-ankle-foot orthosis with locking joints
. Knee and ankle fusion
. Soft-tissue release of the ankle and a locked knee orthosis
. Soft-tissue release of the ankle and a knee-ankle-foot orthosis with a locked ankle and drop-lock knee joint
. Ankle fusion and a knee-ankle-foot orthosis

Correct Answer & Explanation

. Soft-tissue release of the ankle and a knee-ankle-foot orthosis with a locked ankle and drop-lock knee joint

Explanation

The ankle equinus allows the patient to keep his weight-bearing line anterior to the axis of the hyperextended knee joint. With time, pain has developed because of continued stretching and now incompetence of the posterior capsule of the knee joint. Several soft-tissue and bony procedures have been designed to provide knee stability in this situation; however, the results have been either short-lived or inconsistent. Tenodeses, capsular plications, and bony blocks have had limited success and generally fail over time. Current orthotic technology makes soft-tissue release and orthotic control the most predictable option. To decrease the hyperextension moment on the knee joint, the ankle deformity also must be corrected. The most predictable method of achieving stability and diminished pain during walking is with soft-tissue release of the ankle and a knee-ankle-foot orthosis with a locked ankle and drop-lock knee joint.

Question 2714

Topic: 8. Foot and Ankle

A 60-year-old man reports that he has had shoe pressure pain over his right great toe for several years but has minimal discomfort when barefoot or in sandals. A clinical photograph and radiographs are shown in Figures 1a through 1c. Management should consist of

. cheilectomy.
. extra-depth shoes.
. steroid injection.
. arthrodesis.
. joint replacement arthroplasty.

Correct Answer & Explanation

. extra-depth shoes.

Explanation

Some patients have minimal symptoms associated with hallux rigidus despite significant radiographic evidence of osteoarthritis. This patient's symptoms are primarily related to shoe pressure from the exostosis and can be managed with extra-depth shoe wear. Smith RW, Katchis SD, Ayson LC: Outcomes in hallux rigidus patients treated nonoperatively: A long-term follow-up study. Foot Ankle Int 2000;21:906-913.

Question 2715

Topic: 8. Foot and Ankle

Figures 25a and 25b show the radiographs of a 66-year-old man who has had a long history of bilateral painful flatfoot deformities. Examination reveals that his foot is partially correctable passively, albeit with discomfort, and he has an Achilles tendon contracture. An ankle-foot orthosis has failed to provide relief. Treatment should now consist of

. UCBL orthoses.
. triple arthrodesis with Achilles tendon lengthening.
. medial calcaneal osteotomy with posterior tibial tendon reconstruction and flexor digitorum longus tendon transfer.
. medial calcaneal osteotomy with posterior tibial tendon reconstruction, flexor digitorum longus tendon transfer, and lateral column lengthening.
. gastrocnemius lengthening and serial casting.

Correct Answer & Explanation

. triple arthrodesis with Achilles tendon lengthening.

Explanation

The patient has a pronounced deformity with pain and degenerative arthritis; therefore, triple arthrodesis is the treatment of choice. Gastrocnemius or Achilles tendon lengthening may be a necessary adjunct to the triple arthrodesis, but alone is inadequate to allow for correction. Because the ankle-foot orthosis has failed to provide relief, a UCBL is not likely to help. Osteotomy procedures are designed for lesser deformities and well-preserved joints. Nunley JA, Pfeffer GB, Sanders RW, et al (eds): Advanced Reconstruction: Foot and Ankle. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2004, pp 115-120.

Question 2716

Topic: 8. Foot and Ankle

A 21-year-old woman has a nontraumatic rupture of the Achilles tendon. Which of the following commonly prescribed medications has been associated with this condition?

. Ibuprofen
. Fluoroquinolones
. Bisphosphonates
. Metoprolol
. Simvistatin

Correct Answer & Explanation

. Fluoroquinolones

Explanation

Fluoroquinolones have been associated with increased rates of tendinitis, with special predilection for the Achilles tendon. Tenocytes in the Achilles tendon have exhibited degenerative changes when viewed microscopically after fluoroquinolone administration. Recent clinical studies have shown an increased relative risk of Achilles tendon rupture of 3.7. The other listed drugs have no known increase in tendon rupture rates nor tendinitis. van der Linden PD, van de Lei J, Nab HW, et al: Achilles tendinitis associated with fluoroquinolones. Br J Clin Pharmacol 1999;48:433-437. Bernard-Beaubois K, Hecquet C, Hayem G, et al: In vitro study of cytotoxicity of quinolones on rabbit tenocytes. Cell Biol Toxicol 1998;14:283-292.

Question 2717

Topic: 8. Foot and Ankle

An elite gymnast injured her ankle in an awkward dismount 36 hours ago. Examination reveals weakness on single leg step-up. A clinical photograph of the medial ankle is shown in Figure 15. Plain radiographs are normal. To help confirm the diagnosis, the next step in evaluation should consist of

Anatomy Board Review 2002: High-Yield MCQs (Set 2) - Figure 5

. MRI to assess for posterior tibialis tendon damage.
. enhanced CT to assess for an osteochondral fracture.
. tenography of the peroneal tendons to assess for tendon sheath tearing with subluxation.
. a bone scan to assess for occult fracture.
. arthroscopy of the ankle to assess for articular cartilage damage.

Correct Answer & Explanation

. MRI to assess for posterior tibialis tendon damage.

Explanation

Ecchymosis on the medial side of the ankle is distributed in the posterior tibialis tendon sheath location, posterior to the medial malleolus, and extending inferiorly to the tendon's attachment on the navicular. MRI is the imaging study of choice to determine the extent of tendon damage. MRI will also help assess the deltoid ligament. Bone scans and CT are helpful in identifying osteochondral fractures and occult fractures; however, these studies are not indicated for this patient. Peroneal tendons are located lateral on the ankle. Arthroscopy of the ankle joint would not be helpful in assessing the posterior tibial tendons. Lutter LD, Mizel MS, Pfeffer GB (eds): Orthopaedic Knowledge Update: Foot and Ankle. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 307-317.

Question 2718

Topic: 8. Foot and Ankle

A 23-year-old man has pain and a callus beneath the second metatarsal head. Initial management should consist of

Foot & Ankle Board Review 2000: High-Yield MCQs (Set 2) - Figure 20

. corn pads impregnated with salicylic acid.
. paring of the callus and an offloading orthosis.
. metatarsal dorsiflexion osteotomy.
. metatarsal head excision.
. plantar condylectomy.

Correct Answer & Explanation

. paring of the callus and an offloading orthosis.

Explanation

The initial treatment of metatarsalgia with or without the presence of an intractable keratosis should be conservative. Simple paring of the callus with elevation of the metatarsals may suffice. A prefabricated "off-the-shelf" orthosis or felt pad can be used before investing in a custom orthosis. The use of medicated pads can lead to greater amounts of keratosis and should be avoided. Mizel MS, Miller RA, Scioli MW (eds): Orthopaedic Knowledge Update: Foot and Ankle 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1998, pp 163-173.

Question 2719

Topic: 8. Foot and Ankle

An active 55-year-old man who felt a sudden pop in the left heel while playing tennis 6 months ago was diagnosed with an ankle sprain around the time of injury. He now reports calf atrophy and severe weakness with running. Examination reveals a palpable defect in the Achilles tendon and only trace passive ankle flexion when the calf is squeezed. At the time of surgery, an Achilles tendon defect of 6 cm cannot be approximated. Surgical management of the Achilles tendon should include

. a local fascia turndown flap, followed by immobilization in a plantar flexed short leg cast for 12 weeks.
. multiple nonabsorbable sutures to bridge the gap and immobilization in a plantar flexed short leg cast for 12 weeks.
. a pull out wire and strict immobilization for 12 weeks.
. closure of the paratenon with a tight running suture, followed by rehabilitation.
. release of the flexor hallucis longus tendon at the Knot of Henry, followed by transfer through the calcaneus either alone or in combination with a V-Y advancement of the gastrocnemius.

Correct Answer & Explanation

. release of the flexor hallucis longus tendon at the Knot of Henry, followed by transfer through the calcaneus either alone or in combination with a V-Y advancement of the gastrocnemius.

Explanation

Chronic or neglected Achilles tendon ruptures can present a surgical problem. Ideally, end-to-end apposition of tendon should be attempted, but this should be accomplished without placing the foot in marked equinus. A defect of greater than 5 cm requires the use of a tendon transfer either alone or in combination with a V-Y advancement of the gastrocnemius. Because of its proximity to the Achilles tendon and its strength as a plantar flexor, the flexor hallucis longus is an ideal choice for this task. Studies have shown that early active range-of-motion exercises after an Achilles tendon repair is beneficial for tendon healing and improved clinical outcomes. Myerson M: Achilles tendon ruptures. Instr Course Lect 1999;48:219-230.

Question 2720

Topic: 8. Foot and Ankle

Figure 24 shows an axial MRI scan of the ankle. The arrowhead is pointing to what structure?

Anatomy Board Review 2005: High-Yield MCQs (Set 2) - Figure 21

. Tibial nerve
. Flexor hallucis longus
. Tibialis posterior
. Peroneus longus
. Peroneus brevis

Correct Answer & Explanation

. Peroneus brevis

Explanation

The peroneus brevis is easily identified by its location behind the fibula and its distal muscle belly. Axial MRI images provide a reliable guide even when one of the peroneals is completely ruptured, subluxated out of the peroneal groove, or absent. Sarrafian SK: Anatomy of the Foot and Ankle: Descriptive, Topographic, Functional, ed 2. New York, NY, Lippincott, 1993, pp 234-235.

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