Menu

8. Foot and Ankle MCQs

Practice Set 165 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 3281

Topic: 8. Foot and Ankle

A 48-year-old man presents with an Achilles tendon tear that occurred 8 weeks ago but was misdiagnosed as an ankle sprain. MRI demonstrates a complete Achilles tendon rupture with a 5.5 cm gap. What is the most appropriate surgical management?

. Primary end-to-end repair with heavy nonabsorbable suture
. V-Y advancement flap or turndown flap with flexor hallucis longus (FHL) transfer
. Endoscopic repair using ring forceps
. Percutaneous Achilles tendon lengthening
. Gastrocnemius recession

Correct Answer & Explanation

. V-Y advancement flap or turndown flap with flexor hallucis longus (FHL) transfer

Explanation

Chronic Achilles ruptures with large gaps (>3-5 cm) cannot be primarily repaired. They require biologic augmentation such as a V-Y advancement or turndown flap, typically combined with an FHL transfer to restore plantarflexion strength.

Question 3282

Topic: Forefoot

A 35-year-old woman presents with a symptomatic hallux valgus deformity. Examination reveals hypermobility of the first tarsometatarsal (TMT) joint. Radiographs show a hallux valgus angle of 40 degrees and an intermetatarsal angle of 18 degrees. Which of the following procedures is most appropriate?

. Distal chevron osteotomy
. First metatarsophalangeal (MTP) arthrodesis
. First tarsometatarsal (TMT) arthrodesis (Lapidus procedure)
. Keller resection arthroplasty
. Akin osteotomy only

Correct Answer & Explanation

. First tarsometatarsal (TMT) arthrodesis (Lapidus procedure)

Explanation

The Lapidus procedure (first TMT arthrodesis) is indicated for moderate to severe hallux valgus deformities, especially in the setting of first ray hypermobility, as it addresses the instability at the apex of the deformity.

Question 3283

Topic: 8. Foot and Ankle

A patient with bilateral cavovarus feet undergoes a Coleman block test. When the lateral border of the foot is placed on the block and the first metatarsal is allowed to drop off, the hindfoot varus corrects to neutral. What does this physical examination finding indicate?

. The hindfoot varus is rigid and requires a triple arthrodesis.
. The varus is driven by a plantarflexed first ray, and a dorsiflexion osteotomy of the 1st metatarsal is indicated.
. The tibialis posterior tendon is ruptured.
. There is an isolated fixed subtalar joint contracture.
. A lateralizing calcaneal osteotomy is the sole required treatment.

Correct Answer & Explanation

. The varus is driven by a plantarflexed first ray, and a dorsiflexion osteotomy of the 1st metatarsal is indicated.

Explanation

The Coleman block test evaluates hindfoot flexibility in cavovarus deformities. If the hindfoot corrects to neutral when the first ray drops, the hindfoot is flexible, and the deformity is driven by a plantarflexed first ray, treatable with a 1st metatarsal dorsiflexion osteotomy.

Question 3284

Topic: Forefoot

A 68-year-old woman with a history of generalized osteoarthritis presents with significant pain and stiffness in her big toe. Radiographs show absent joint space, marked osteophytosis, and subchondral sclerosis at the first metatarsophalangeal (MTP) joint. She has failed shoe modifications and NSAIDs. What is the gold standard surgical treatment?

. Cheilectomy
. First MTP joint arthrodesis
. First MTP joint arthroplasty with a silastic implant
. Moberg osteotomy
. Keller resection arthroplasty

Correct Answer & Explanation

. First MTP joint arthrodesis

Explanation

The patient has end-stage (Grade 3/4) hallux rigidus. The gold standard surgical treatment providing the most reliable long-term pain relief and functional outcome is a first MTP joint arthrodesis.

Question 3285

Topic: 8. Foot and Ankle

A 55-year-old overweight man presents with chronic, severe posterior heel pain. Examination reveals a prominent pump bump. MRI shows a massive intratendinous calcification and tendinosis involving 60% of the insertional Achilles tendon. During surgical debridement, more than 50% of the tendon footprint must be excised. What is the most appropriate additional step in the procedure?

. Primary end-to-end repair
. Augmentation with a flexor hallucis longus (FHL) tendon transfer
. Application of a synthetic mesh wrap
. Gastrocnemius recession alone
. Calcaneal closing wedge osteotomy

Correct Answer & Explanation

. Augmentation with a flexor hallucis longus (FHL) tendon transfer

Explanation

In insertional Achilles tendinopathy, if surgical debridement requires detachment or excision of >50% of the Achilles insertion, an FHL tendon transfer is indicated to augment repair and provide blood supply and plantarflexion strength.

Question 3286

Topic: 8. Foot and Ankle

A 32-year-old man presents to the emergency department after a twisting injury to his leg. Examination shows tenderness over the medial ankle and the proximal fibula. Radiographs reveal an isolated proximal third fibula shaft fracture and a widened medial clear space. What ligamentous structure is critically torn extending from the ankle to the proximal fibula?

. Calcaneofibular ligament
. Anterior talofibular ligament
. Interosseous membrane
. Spring ligament
. Bifurcate ligament

Correct Answer & Explanation

. Interosseous membrane

Explanation

This is a Maisonneuve fracture. The injury pattern typically involves a rupture of the medial structures (deltoid or medial malleolus) and disruption of the syndesmosis, which extends proximally through the interosseous membrane to exit as a proximal fibula fracture.

Question 3287

Topic: 8. Foot and Ankle

The Achilles tendon is highly susceptible to rupture in a specific 'watershed' region due to a relative zone of hypovascularity. Where is this region anatomically located?

. At the direct insertion into the calcaneus
. 2 to 6 cm proximal to the calcaneal insertion
. At the musculotendinous junction of the medial gastrocnemius
. 10 to 12 cm proximal to the calcaneal insertion
. At the origin of the soleus muscle

Correct Answer & Explanation

. 2 to 6 cm proximal to the calcaneal insertion

Explanation

The Achilles tendon has a watershed zone of poor vascularity located 2 to 6 cm proximal to its calcaneal insertion. This relative ischemia makes it the most common site for degenerative changes and acute ruptures.

Question 3288

Topic: 8. Foot and Ankle

A 28-year-old man requires operative fixation for a syndesmotic injury after a pronation-external rotation ankle fracture. When comparing dynamic flexible fixation (suture-button) to static fixation (syndesmotic screws), recent literature suggests which of the following regarding flexible fixation?

. Higher rates of hardware breakage requiring reoperation
. Lower rates of syndesmotic malreduction and slightly better functional scores
. Significantly worse functional outcomes at 2 years
. Requires routine removal before weight-bearing
. Increased risk of late tibiofibular synostosis

Correct Answer & Explanation

. Lower rates of syndesmotic malreduction and slightly better functional scores

Explanation

Dynamic flexible fixation (suture-button constructs) for syndesmosis injuries is associated with lower rates of malreduction, no need for routine hardware removal, and slightly superior functional outcomes compared to rigid screw fixation.

Question 3289

Topic: 8. Foot and Ankle

A 28-year-old male presents with a severe ankle injury after a fall. Radiographs reveal a fracture-dislocation that is irreducible by closed means. It is identified as a Bosworth fracture-dislocation. Which anatomical event prevents closed reduction in this injury pattern?

. Interposition of the posterior tibial tendon
. Entrapment of the proximal fibular fragment behind the posterior tibial tubercle
. Interposition of the deltoid ligament in the medial clear space
. Buttonholing of the medial malleolus through the extensor retinaculum
. Entrapment of the peroneal tendons in the syndesmosis

Correct Answer & Explanation

. Entrapment of the proximal fibular fragment behind the posterior tibial tubercle

Explanation

A Bosworth fracture-dislocation is characterized by the proximal fragment of the fibula becoming entrapped behind the posterior tubercle of the tibia, requiring open reduction.

Question 3290

Topic: 8. Foot and Ankle

A 45-year-old man presents with a 3-month history of plantar flexion weakness following a 'pop' in his calf. MRI shows an Achilles tendon rupture with a 5 cm gap. What is the most appropriate surgical management?

. Direct end-to-end repair with heavy sutures
. V-Y tendon advancement or FHL transfer
. Nonoperative management in a rigid short leg cast
. Plantaris autograft alone
. Gastrocnemius recession

Correct Answer & Explanation

. V-Y tendon advancement or FHL transfer

Explanation

For chronic Achilles ruptures with a gap greater than 3 to 4 cm, direct repair is usually impossible. V-Y advancement or flexor hallucis longus (FHL) transfer is required to bridge the defect.

Question 3291

Topic: 8. Foot and Ankle

A 50-year-old runner has chronic posterior heel pain. Imaging shows a Haglund deformity and insertional Achilles calcification. During surgery, more than 50% of the Achilles tendon insertion is detached to completely debride the calcific tendinosis. What additional procedure is recommended?

. Closing wedge calcaneal osteotomy
. Flexor digitorum longus (FDL) transfer
. Flexor hallucis longus (FHL) transfer
. Strayer procedure (gastrocnemius recession)
. Plantar fasciotomy

Correct Answer & Explanation

. Flexor hallucis longus (FHL) transfer

Explanation

When debridement of insertional Achilles tendinosis requires detaching more than 50% of the tendon footprint, augmenting the repair with an FHL transfer is recommended to prevent rupture.

Question 3292

Topic: 8. Foot and Ankle

A 22-year-old woman with Charcot-Marie-Tooth disease presents with a bilateral cavovarus foot deformity. On examination, her hindfoot varus corrects completely when the lateral foot is placed on a Coleman block. What does this indicate regarding her deformity?

. The hindfoot varus is rigid and requires a subtalar arthrodesis
. The hindfoot varus is flexible and driven by a rigid, plantarflexed first ray
. She has end-stage arthritis and requires a triple arthrodesis
. The tibialis posterior tendon is ruptured
. The Achilles tendon is over-lengthened

Correct Answer & Explanation

. The hindfoot varus is flexible and driven by a rigid, plantarflexed first ray

Explanation

The Coleman block test evaluates hindfoot flexibility. Correction of hindfoot varus when the first ray drops off the block indicates a flexible hindfoot driven by a plantarflexed first ray.

Question 3293

Topic: Midfoot & Hindfoot

A 55-year-old overweight woman complains of medial ankle pain and a collapsing arch. She is unable to perform a single-leg heel raise. Examination shows a flexible flatfoot deformity. Which surgical treatment is most appropriate after failure of conservative care?

. Triple arthrodesis
. Talonavicular arthrodesis
. Medial displacement calcaneal osteotomy with FDL transfer
. Subtalar arthrodesis
. Isolated FDL transfer to the navicular

Correct Answer & Explanation

. Medial displacement calcaneal osteotomy with FDL transfer

Explanation

Stage II adult acquired flatfoot deformity is characterized by a flexible deformity and posterior tibial tendon dysfunction. Joint-sparing procedures like medial displacement calcaneal osteotomy and FDL transfer are indicated.

Question 3294

Topic: Forefoot

A 45-year-old woman presents with a painful bunion. Radiographs reveal a hallux valgus angle (HVA) of 38 degrees, an intermetatarsal angle (IMA) of 16 degrees, and hypermobility of the first tarsometatarsal (TMT) joint. What is the most appropriate surgical option?

. Distal chevron osteotomy
. Proximal crescentic osteotomy
. Lapidus procedure (first TMT arthrodesis)
. Akin osteotomy alone
. Keller arthroplasty

Correct Answer & Explanation

. Lapidus procedure (first TMT arthrodesis)

Explanation

For a moderate-to-severe hallux valgus deformity combined with hypermobility of the first TMT joint, the Lapidus procedure provides excellent correction and stability to the medial column.

Question 3295

Topic: 8. Foot and Ankle

When managing a trimalleolar ankle fracture, what is a primary surgical indication for internal fixation of the posterior malleolus?

. Size greater than 5% of the articular surface
. Any articular displacement regardless of fragment size
. Persistent posterior subluxation of the talus after medial and lateral fixation
. Presence of a transverse medial malleolar fracture
. Presence of a low transverse fibula fracture

Correct Answer & Explanation

. Persistent posterior subluxation of the talus after medial and lateral fixation

Explanation

Fixation of the posterior malleolus is strongly indicated if there is persistent posterior talar subluxation or syndesmotic instability after fixing the medial and lateral malleoli.

Question 3296

Topic: 8. Foot and Ankle

Recent randomized controlled trials comparing nonoperative and operative treatment for acute Achilles tendon ruptures utilizing functional rehabilitation protocols have demonstrated which of the following?

. Higher re-rupture rate in the operative group
. Higher re-rupture rate in the nonoperative group with rigid casting
. No significant difference in re-rupture rates when functional rehabilitation is used
. Significantly greater plantarflexion strength in the nonoperative group
. Higher deep infection rate in the nonoperative group

Correct Answer & Explanation

. No significant difference in re-rupture rates when functional rehabilitation is used

Explanation

Modern functional rehabilitation protocols featuring early weight-bearing and motion have equalized the re-rupture rates between operative and nonoperative management of Achilles tendon ruptures.

Question 3297

Topic: 8. Foot and Ankle

A 25-year-old man injured his midfoot during a football game. Weight-bearing radiographs show 3 mm of widening between the base of the first and second metatarsals. What is the most appropriate treatment?

. Short leg walking cast for 6 weeks
. Rigid boot with immediate weight-bearing
. Open reduction and internal fixation or primary arthrodesis
. Closed reduction and percutaneous pinning
. Non-weight bearing cast for 4 weeks

Correct Answer & Explanation

. Open reduction and internal fixation or primary arthrodesis

Explanation

A Lisfranc injury demonstrating instability (widening >2 mm between the 1st and 2nd metatarsal bases) requires surgical stabilization via ORIF or primary arthrodesis.

Question 3298

Topic: 8. Foot and Ankle

An extensile lateral approach is planned for open reduction internal fixation of a displaced intra-articular calcaneus fracture. Which of the following nerves is at greatest risk of injury during this surgical approach?

. Sural nerve
. Superficial peroneal nerve
. Deep peroneal nerve
. Saphenous nerve
. Medial plantar nerve

Correct Answer & Explanation

. Sural nerve

Explanation

The sural nerve is highly vulnerable during the extensile lateral approach to the calcaneus. A full-thickness subperiosteal flap must be developed to protect it.

Question 3299

Topic: 8. Foot and Ankle

A 35-year-old male sustains an acute Achilles tendon rupture while playing basketball. He opts for nonoperative management. Which of the following functional rehabilitation protocols is associated with outcomes most comparable to surgical repair?

. Immediate full weight-bearing in a neutral brace
. Strict non-weight-bearing in a short leg cast for 6 weeks
. Early functional weight-bearing in a rigid boot with heel wedges, progressively lowering the plantarflexion angle
. Immobilization in full equinus for 8 weeks without weight-bearing
. Casting in 10 degrees of dorsiflexion for 4 weeks

Correct Answer & Explanation

. Early functional weight-bearing in a rigid boot with heel wedges, progressively lowering the plantarflexion angle

Explanation

Early functional weight-bearing protocols using a functional brace with heel lifts provide re-rupture rates comparable to surgical repair. This approach minimizes muscle atrophy and tendon lengthening while safely loading the healing tendon.

Question 3300

Topic: 8. Foot and Ankle

A 30-year-old male presents to the emergency department after a high-energy fall. Radiographs demonstrate a displaced fracture of the lateral malleolus with a complete posterior dislocation of the talus. Closed reduction is attempted but is unsuccessful, and a dimple sign is noted over the posterolateral ankle. What anatomical structure is most likely blocking reduction?

. The Achilles tendon
. The posterior tibial tendon
. The deltoid ligament
. The proximal fibular fragment trapped behind the posterior aspect of the tibia
. The flexor hallucis longus tendon

Correct Answer & Explanation

. The proximal fibular fragment trapped behind the posterior aspect of the tibia

Explanation

This presentation is highly characteristic of a Bosworth fracture-dislocation. The proximal fibular fragment becomes incarcerated behind the posterior tubercle of the tibia, making closed reduction impossible and necessitating urgent open reduction.

Test Yourself

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

On this Page