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8. Foot and Ankle MCQs

Practice Set 14 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 261

Topic: Midfoot & Hindfoot

Which of the following radiographic findings is the hallmark of Eichenholtz Stage 1 (developmental stage) Charcot arthropathy of the foot?

. Coalescence of bone fragments
. Subchondral osteopenia only
. Fragmentation and osseous debris
. Resolution of soft tissue swelling
. Osteophyte formation and sclerosis

Correct Answer & Explanation

. Fragmentation and osseous debris

Explanation

Eichenholtz Stage 1 is the fragmentation or developmental stage, characterized clinically by severe inflammation and radiographically by periarticular fragmentation, debris, and joint subluxation or dislocation. Stage 2 is coalescence, and Stage 3 is reconstruction/consolidation.

Question 262

Topic: 8. Foot and Ankle

The primary stabilizing ligament of the Lisfranc joint complex connects which of the following osseous structures?

. Medial cuneiform to the base of the first metatarsal
. Medial cuneiform to the medial base of the second metatarsal
. Middle cuneiform to the base of the second metatarsal
. Lateral cuneiform to the cuboid
. Navicular to the medial cuneiform

Correct Answer & Explanation

. Medial cuneiform to the medial base of the second metatarsal

Explanation

The Lisfranc ligament is a strong interosseous ligament that runs from the lateral aspect of the medial cuneiform to the medial aspect of the base of the second metatarsal. It is the primary stabilizer of the second tarsometatarsal joint.

Question 263

Topic: 8. Foot and Ankle

Which ligament is the primary stabilizing structure of the Lisfranc joint complex?

. The dorsal ligament connecting the first and second metatarsal bases
. The plantar ligament connecting the medial cuneiform to the base of the second metatarsal
. The interosseous ligament connecting the first and second cuneiforms
. The dorsal ligament connecting the lateral cuneiform to the third metatarsal
. The spring ligament

Correct Answer & Explanation

. The plantar ligament connecting the medial cuneiform to the base of the second metatarsal

Explanation

The Lisfranc ligament is a strong plantar interosseous ligament that connects the medial cuneiform to the base of the second metatarsal. There is no direct ligamentous connection between the bases of the first and second metatarsals, making this area inherently vulnerable to injury.

Question 264

Topic: Midfoot & Hindfoot

A 55-year-old diabetic patient presents with a swollen, erythematous, and warm foot with no systemic signs of infection. Radiographs show fragmentation, joint subluxation, and extensive osseous debris in the midfoot. According to the Eichenholtz classification, what is the most appropriate initial management?

. Immediate open reduction and internal fixation
. Total contact casting and strict non-weight bearing
. Intravenous antibiotics and surgical debridement
. Midfoot arthrodesis with robust hardware
. Below-knee amputation

Correct Answer & Explanation

. Total contact casting and strict non-weight bearing

Explanation

The patient is in Eichenholtz Stage I (Developmental/Fragmentation) of Charcot arthropathy. The gold standard of initial management is immediate immobilization with a total contact cast and strict non-weight bearing until the active inflammatory phase subsides.

Question 265

Topic: Forefoot

The normal value for the hallux valgus angle is:

. 0° to 5°
. 10° to 20°
. 5° to 10°
. 30° to 40°
. 20° to 30°

Correct Answer & Explanation

. 10° to 20°

Explanation

The angle between the first metatarsal and its proximal phalanx is normally one of mild (10° to 20°) valgus. It is not normal for it to be too straight. An increase in this angle beyond this value is often noted by the patient as a bunion.

Question 266

Topic: 8. Foot and Ankle

A 13-year-old girl is seen in clinic for bunion. She is asymptomatic but has a hallux valgus angle of 29°, an intermetatarsal angle of 15°, and a medial prominence over the first metatarsal head. The family asks whether anything can be done to prevent future problems with the foot. You recommend:

. Osteotomy of the first metatarsal base
. Hemiepiphyseodesis of the medial physis of the first metatarsal
. Double osteotomy of the first metatarsal
. Mitchell osteotomy
. Shoe modifications if symptoms develop

Correct Answer & Explanation

. Shoe modifications if symptoms develop

Explanation

Bunions may often be treated conservatively, and it is impossible to predict which ones will later develop symptoms. Surgical reconstruction of bunions in adolescents has a higher rate of recurrence than in adults in many reported series. For all of these reasons, nonoperative treatment is preferred for asymptomatic patients.

Question 267

Topic: 8. Foot and Ankle

Which of the following tendons is not usually contracted in a patient with untreated vertical talus:

. Anterior tibialis
. Posterior tibialis
. Peroneus brevis
. Extensor digitorum longus
. Achilles

Correct Answer & Explanation

. Posterior tibialis

Explanation

A vertical talus is a fixed dorsolateral dislocation of the talonavicular joint. The forefoot is in calcaneus and the hindfoot is in equinus. Therefore, all of the tendons listed except for the posterior tibialis are contracted.

Question 268

Topic: 8. Foot and Ankle
A 9-year-old boy is seen because of pain medially, in the arch of the foot. His ankle dorsiflexion is limited to 10° with the knee extended. Radiograph shows an accessory navicular, which corresponds to the point of his tenderness. You recommend:
. Excision of the accessory navicular
. Excision of the accessory navicular with advancement of the posterior tibialis tendon
. Evans procedure (lateral column lengthening)
. Tendoachilles lengthening
. Activity restriction, stretching, arch support

Correct Answer & Explanation

. Activity restriction, stretching, arch support

Explanation

Accessory navicular is seen in 10% to 14% of normal children. Sometimes, it becomes symptomatic in juveniles or adolescents, but this usually resolves by skeletal maturity. Conservative treatment, such as activity restriction, arch support, and stretching the Achilles if tight, will usually alleviate symptoms.

Question 269

Topic: Midfoot & Hindfoot
Which of the following disorders is due to a defect in anterior horn cells:
. Charcot-Marie-Tooth
. Duchenne dystrophy
. Friedreich's ataxia
. Spinal muscular atrophy
. Rett syndrome

Correct Answer & Explanation

. Spinal muscular atrophy

Explanation

Charcot-Marie-Tooth disease is due to a defect in peripheral nerves; Duchenne muscular dystrophy is due to a defect in dystrophin, affecting the muscle cell membrane; Friedreich ataxia is a degeneration of the spinocerebellar tracts. Rett syndrome is due to a defect in MECP-2 protein, affecting the brain. Only spinal muscular atrophy is due to a defect in anterior horn cells.

Question 270

Topic: 8. Foot and Ankle

Which of the following procedures is most likely to correct idiopathic toe walking with a single treatment:

. Stretching program
. Ankle foot orthosis
. Stretching cast
. Botulinum toxin injection
. Percutaneous tendoachilles lengthening

Correct Answer & Explanation

. Percutaneous tendoachilles lengthening

Explanation

Percutaneous tendoachilles lengthening is most likely to resolve idiopathic toe walking in a single treatment. The other methods have a higher likelihood of persistent toe walking.

Question 271

Topic: 8. Foot and Ankle

A 25-year-old athlete sustains a hyperplantarflexion injury to his midfoot. Weight-bearing radiographs show a 3mm diastasis between the base of the first and second metatarsals. Which of the following best describes the anatomy of the Lisfranc ligament?

. Connects the first metatarsal to the second metatarsal
. Connects the medial cuneiform to the base of the second metatarsal
. Connects the intermediate cuneiform to the base of the second metatarsal
. Connects the medial cuneiform to the base of the first metatarsal
. Connects the navicular to the medial cuneiform

Correct Answer & Explanation

. Connects the medial cuneiform to the base of the second metatarsal

Explanation

The Lisfranc ligament is a stout interosseous ligament that connects the lateral aspect of the medial cuneiform to the medial aspect of the base of the second metatarsal. It is critical for the stability of the tarsometatarsal articulation.

Question 272

Topic: Midfoot & Hindfoot
A 55-year-old patient with poorly controlled type 2 diabetes presents with a swollen, erythematous right foot. Radiographs show fragmentation, periarticular debris, and subluxation at the tarsometatarsal joints. Which Eichenholtz stage describes these findings?
. Stage 0
. Stage I
. Stage II
. Stage III
. Stage IV

Correct Answer & Explanation

. Stage I

Explanation

Eichenholtz Stage I (Development/Fragmentation) of Charcot arthropathy is characterized by acute inflammation, bone fragmentation, joint subluxation, and debris. Stage II is coalescence, and Stage III is reconstruction.

Question 273

Topic: Midfoot & Hindfoot

A 55-year-old diabetic patient presents with a warm, swollen, erythematous left foot. Radiographs show no fractures or joint subluxation. MRI demonstrates diffuse marrow edema. If this represents the earliest stage of Charcot arthropathy, it is classified in the Eichenholtz system as:

. Stage 0
. Stage 1
. Stage 2
. Stage 3
. Stage 4

Correct Answer & Explanation

. Stage 0

Explanation

Eichenholtz Stage 0 represents the pre-radiographic stage of Charcot arthropathy, characterized by clinical signs of inflammation and MRI changes, but normal plain radiographs. Stage 1 is fragmentation, Stage 2 is coalescence, and Stage 3 is consolidation.

Question 274

Topic: 8. Foot and Ankle

A dorsal approach has which of the following characteristics with regard to a posteromedial approach in the surgical treatment of congenital vertical talus:

. The dorsal approach requires a more extensive dissection.
. The dorsal approach has a lower risk of avascular necrosis of the talus.
. The dorsal approach requires plication of the talonavicular capsule.
. The dorsal approach has a higher risk of redislocation.
. The dorsal approach requires a longer tourniquet time.

Correct Answer & Explanation

. The dorsal approach has a lower risk of avascular necrosis of the talus.

Explanation

The dorsal approach has not shown evidence of avascular necrosis, whereas the posteromedial approach has shown such changes at follow-up in as many as 40% of cases. The dorsal approach requires a less extensive dissection than the posteromedial approach. The dorsal approach does not require or permit plication of the talonavicular capsule, whereas the posteromedial approach does. The dorsal approach does not appear to have a higher rate of redislocation of the talonavicular joint than the posteromedial approach. The dorsal approach requires a shorter tourniquet time than the posteromedial approach.

Question 275

Topic: 8. Foot and Ankle

A patient with spina bifida has significant symmetrical calcaneus positioning of both ankles. This is most likely due to:

. Lack of ambulatory experience
. Braces that are set in too much dorsiflexion
. Motor level at L3
. Motor level at L5
. Motor level at S1

Correct Answer & Explanation

. Motor level at L5

Explanation

At motor level L5, dorsiflexors overpower plantarflexors to cause a calcaneus position. This condition occurs from muscle imbalance. Even with significant ambulation, it will persist. Brace properties do not cause fixed deformity. At L3, neither dorsiflexors nor plantarflexors of the ankle work. At S1, both dorsiflexors and plantarflexors are well innervated.

Question 276

Topic: Midfoot & Hindfoot

A 55-year-old patient with long-standing, poorly controlled diabetes mellitus presents with a severely swollen, erythematous, and warm but painless left foot. Skin integrity is completely intact. Radiographs show early fragmentation and debris at the midtarsal joints. What is the most appropriate initial management?

. Intravenous antibiotics
. Urgent surgical debridement
. Total contact casting
. Arthrodesis of the midfoot
. Below-knee amputation

Correct Answer & Explanation

. Total contact casting

Explanation

This patient presents with an acute (Eichenholtz Stage 0 or 1) Charcot arthropathy. The gold standard for initial management is strict offloading utilizing a total contact cast to prevent further deformity and allow the acute inflammatory phase to subside.

Question 277

Topic: 8. Foot and Ankle

A 24-year-old professional football player suffers a hyperplantarflexion injury to his midfoot. Weight-bearing radiographs reveal widening between the 1st and 2nd metatarsal bases and a "fleck sign" in the first intermetatarsal space. The bony avulsion fragment creating the fleck sign originates from which of the following structures?

. Base of the 2nd metatarsal
. Base of the 1st metatarsal
. Medial cuneiform
. Intermediate cuneiform
. Cuboid

Correct Answer & Explanation

. Base of the 2nd metatarsal

Explanation

The "fleck sign" represents an avulsion of the Lisfranc ligament. This strong interosseous ligament connects the lateral aspect of the medial cuneiform to the medial aspect of the base of the 2nd metatarsal, from which the fleck typically avulses.

Question 278

Topic: 8. Foot and Ankle

The Lisfranc ligament is a critical stabilizing structure for the midfoot. This ligament strictly connects which two osseous structures?

. Medial cuneiform to the base of the second metatarsal
. Middle cuneiform to the base of the second metatarsal
. Medial cuneiform to the base of the first metatarsal
. Cuboid to the base of the fourth metatarsal
. Navicular to the medial cuneiform

Correct Answer & Explanation

. Medial cuneiform to the base of the second metatarsal

Explanation

The Lisfranc ligament courses from the lateral aspect of the medial cuneiform to the medial base of the second metatarsal. There is no direct ligamentous connection between the first and second metatarsal bases.

Question 279

Topic: 8. Foot and Ankle

A 35-year-old recreational athlete sustains an acute Achilles tendon rupture. When comparing open operative repair to non-operative management utilizing early functional rehabilitation protocols, operative repair is historically associated with:

. A higher rate of re-rupture
. A lower rate of re-rupture but a higher wound complication risk
. Decreased postoperative plantarflexion strength
. A higher risk of deep vein thrombosis
. Longer overall immobilization times

Correct Answer & Explanation

. A lower rate of re-rupture but a higher wound complication risk

Explanation

Operative repair of the Achilles tendon traditionally reduces the risk of re-rupture compared to non-operative management but carries a significantly higher risk of complications such as wound breakdown and infection.

Question 280

Topic: 8. Foot and Ankle

During the evaluation of a 28-year-old runner with midfoot pain after a twisting injury, a weight-bearing AP radiograph of the foot reveals a small avulsion fracture fragment ('fleck sign') in the first intermetatarsal space. This finding represents an avulsion of the Lisfranc ligament from which of the following structures?

. Medial cuneiform
. Intermediate cuneiform
. Base of the first metatarsal
. Base of the second metatarsal
. Navicular

Correct Answer & Explanation

. Base of the second metatarsal

Explanation

The Lisfranc ligament connects the medial cuneiform to the base of the second metatarsal, providing critical midfoot stability. The pathognomonic 'fleck sign' represents an avulsion of this ligament specifically from the base of the second metatarsal.

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