Menu

8. Foot and Ankle MCQs

Practice Set 168 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 3341

Topic: 8. Foot and Ankle

In a patient with Charcot-Marie-Tooth disease, the classic cavovarus foot deformity is primarily driven by specific muscle imbalances. Which of the following accurately describes the primary deforming forces?

. Strong tibialis anterior overpowering a weak peroneus longus
. Strong peroneus longus overpowering a weak tibialis anterior
. Strong peroneus brevis overpowering a weak posterior tibialis
. Strong extensor digitorum longus overpowering the intrinsic foot muscles
. Weak flexor hallucis longus overpowering a strong extensor hallucis longus

Correct Answer & Explanation

. Strong peroneus longus overpowering a weak tibialis anterior

Explanation

In Charcot-Marie-Tooth, the peroneus longus outpowers the weaker tibialis anterior, causing plantarflexion of the first ray and forefoot pronation. The posterior tibialis also overpowers the weaker peroneus brevis, driving the hindfoot into varus.

Question 3342

Topic: 8. Foot and Ankle

A 45-year-old recreational athlete sustains an acute mid-substance Achilles tendon rupture. If he chooses operative repair over non-operative functional rehabilitation, what is the most significant relative risk associated with his choice?

. Higher rate of deep vein thrombosis
. Higher rate of re-rupture
. Increased rate of soft-tissue and wound complications
. Decreased plantarflexion strength at 1 year
. Higher risk of contralateral Achilles rupture

Correct Answer & Explanation

. Increased rate of soft-tissue and wound complications

Explanation

Operative repair of acute Achilles ruptures carries a significantly higher risk of wound complications and infection (up to 5-10%). Recent literature demonstrates that early functional rehabilitation has re-rupture rates comparable to operative management.

Question 3343

Topic: Forefoot

A 45-year-old female presents with a painful bunion. Weight-bearing radiographs reveal a Hallux Valgus Angle (HVA) of 38 degrees and an Intermetatarsal Angle (IMA) of 17 degrees. The first tarsometatarsal joint is hypermobile. Which of the following is the most appropriate surgical management?

. Distal chevron osteotomy
. Modified McBride procedure
. Keller resection arthroplasty
. First tarsometatarsal (Lapidus) arthrodesis
. Akin osteotomy alone

Correct Answer & Explanation

. First tarsometatarsal (Lapidus) arthrodesis

Explanation

For severe hallux valgus (IMA > 15 degrees) especially with first ray hypermobility, a proximal procedure like a Lapidus (first TMT arthrodesis) is required. Distal osteotomies cannot adequately correct an IMA of this magnitude.

Question 3344

Topic: 8. Foot and Ankle

A 14-year-old boy presents with a rigid flatfoot and recurrent ankle sprains. A lateral radiograph reveals a distinct "C-sign". This radiographic finding is pathognomonic for which of the following conditions?

. Calcaneonavicular coalition
. Talocalcaneal coalition
. Talonavicular coalition
. Accessory navicular syndrome
. Vertical talus

Correct Answer & Explanation

. Talocalcaneal coalition

Explanation

The 'C-sign' on a lateral radiograph represents the continuous outline of the medial outline of the talar dome and the inferior outline of the sustentaculum tali. It is highly indicative of a talocalcaneal (middle facet) coalition.

Question 3345

Topic: 8. Foot and Ankle

A 55-year-old female presents with medial ankle pain, a flexible planovalgus foot, and inability to perform a single-leg heel rise. During surgical reconstruction for her Stage II adult acquired flatfoot deformity, which tendon is most commonly transferred to augment the dysfunctional primary tendon?

. Peroneus brevis
. Tibialis anterior
. Flexor hallucis longus
. Flexor digitorum longus
. Extensor hallucis longus

Correct Answer & Explanation

. Flexor digitorum longus

Explanation

Stage II adult acquired flatfoot deformity (posterior tibial tendon insufficiency) is typically treated with a Flexor Digitorum Longus (FDL) transfer to the navicular, often combined with a medializing calcaneal osteotomy.

Question 3346

Topic: 8. Foot and Ankle

A 60-year-old male with end-stage ankle osteoarthritis is considering a Total Ankle Arthroplasty (TAA). Which of the following represents an absolute contraindication to this procedure?

. Age greater than 55 years
. Body Mass Index (BMI) of 32
. History of a malunited fibula fracture
. Charcot neuroarthropathy of the ankle
. Adjacent subtalar joint arthritis

Correct Answer & Explanation

. Charcot neuroarthropathy of the ankle

Explanation

Active infection, Charcot neuroarthropathy, and severe avascular necrosis of the talus are absolute contraindications to total ankle arthroplasty due to unacceptably high failure and complication rates.

Question 3347

Topic: 8. Foot and Ankle

When evaluating an anteroposterior (AP) radiograph of a normal foot, which of the following anatomic relationships defines the proper alignment of the Lisfranc joint complex?

. The medial border of the second metatarsal aligns with the medial border of the middle cuneiform
. The medial border of the third metatarsal aligns with the lateral border of the lateral cuneiform
. The lateral border of the first metatarsal aligns with the lateral border of the medial cuneiform
. The lateral border of the fourth metatarsal aligns with the medial border of the cuboid
. The medial border of the fifth metatarsal aligns with the lateral border of the cuboid

Correct Answer & Explanation

. The medial border of the second metatarsal aligns with the medial border of the middle cuneiform

Explanation

Normal anatomic alignment on an AP radiograph requires that the medial border of the second metatarsal base perfectly aligns with the medial border of the middle cuneiform. Any step-off suggests a Lisfranc injury.

Question 3348

Topic: 8. Foot and Ankle

A 20-year-old track athlete complains of vague, aching dorsal midfoot pain. A CT scan reveals a nondisplaced dorsal cortical fracture in the middle third of the tarsal navicular. What is the most appropriate initial management?

. Weight-bearing as tolerated in a controlled ankle motion (CAM) boot for 4 weeks
. Strict non-weight-bearing in a short leg cast for 6 to 8 weeks
. Immediate open reduction and internal fixation with a compression screw
. Ultrasound-guided corticosteroid injection and return to play
. Extracorporeal shockwave therapy (ESWT) and immediate athletic activity

Correct Answer & Explanation

. Strict non-weight-bearing in a short leg cast for 6 to 8 weeks

Explanation

Nondisplaced stress fractures of the tarsal navicular carry a high risk of nonunion due to the watershed blood supply in the central third. The standard of care is 6-8 weeks of strict non-weight-bearing in a cast.

Question 3349

Topic: 8. Foot and Ankle

A 16-year-old female ballet dancer presents with progressive pain and swelling over the dorsal aspect of the second metatarsophalangeal (MTP) joint. Radiographs demonstrate flattening, sclerosis, and fragmentation of the second metatarsal head. What is the most likely diagnosis?

. Kohler disease
. Sever disease
. Freiberg infraction
. Morton neuroma
. Stress fracture of the metatarsal neck

Correct Answer & Explanation

. Freiberg infraction

Explanation

Freiberg infraction is a localized avascular necrosis of the metatarsal head, most commonly affecting the second metatarsal. It typically presents in adolescent females, particularly those involved in high-impact activities like dance.

Question 3350

Topic: 8. Foot and Ankle

A skier presents with lateral ankle pain and a "snapping" sensation behind the lateral malleolus after catching an edge, which forced his ankle into sudden dorsiflexion and inversion. Which retinacular structure is most likely disrupted in this acute subluxation event?

. Inferior extensor retinaculum
. Superior peroneal retinaculum
. Inferior peroneal retinaculum
. Flexor retinaculum
. Superior extensor retinaculum

Correct Answer & Explanation

. Superior peroneal retinaculum

Explanation

Acute peroneal tendon subluxation typically results from sudden dorsiflexion and forced inversion/eversion. This strips or tears the Superior Peroneal Retinaculum (SPR) off its fibular attachment.

Question 3351

Topic: 8. Foot and Ankle

A 55-year-old male presents with a painful, stiff great toe. Examination reveals a palpable dorsal prominence and pain primarily at the extremes of dorsiflexion. Radiographs show dorsal osteophytosis of the first metatarsal head but preserved joint space (Coughlin and Shurnas Grade 2). If conservative management fails, what is the best surgical option?

. Cheilectomy
. First MTP joint arthrodesis
. Total joint arthroplasty
. Resection of the base of the proximal phalanx (Keller)
. First TMT arthrodesis (Lapidus)

Correct Answer & Explanation

. Cheilectomy

Explanation

For mild to moderate hallux rigidus (Grades 1 and 2) with preserved joint space and pain primarily from dorsal impingement, a cheilectomy (resection of the dorsal osteophyte and 30% of the dorsal metatarsal head) provides excellent relief.

Question 3352

Topic: 8. Foot and Ankle

A 62-year-old poorly controlled diabetic male presents with a red, hot, swollen right foot. He is afebrile with a normal WBC count, though ESR is mildly elevated. Radiographs reveal acute fragmentation and subluxation of the midfoot joints. What is the most appropriate initial management?

. Immediate intravenous antibiotics and surgical debridement
. Total contact casting and strict non-weight-bearing
. Primary midfoot arthrodesis
. Below-knee amputation
. Incision and drainage of the midfoot joints

Correct Answer & Explanation

. Total contact casting and strict non-weight-bearing

Explanation

The presentation is classic for acute Eichenholtz Stage I Charcot neuroarthropathy. The mainstay of initial treatment is offloading with a total contact cast until the acute inflammatory phase resolves and the bones consolidate.

Question 3353

Topic: 8. Foot and Ankle

A 45-year-old patient undergoes an isolated, complete endoscopic plantar fascia release for recalcitrant plantar fasciitis. Postoperatively, she develops a new, aching pain on the outer border of her foot. Which biomechanical complication is most likely responsible for her new symptoms?

. Medial column overload
. Lateral column overload
. Tarsal tunnel syndrome
. Dorsal midfoot exostosis
. Acquired claw toes

Correct Answer & Explanation

. Lateral column overload

Explanation

A complete release of the plantar fascia disrupts the windlass mechanism, leading to a decrease in arch height. This frequently shifts peak plantar pressures laterally, causing lateral column overload and lateral midfoot pain.

Question 3354

Topic: Ankle Trauma & Sports

A 35-year-old female sustains a twisting injury to her leg. Radiographs reveal an isolated, displaced fracture of the proximal third of the fibula. To prevent a missed diagnosis of a Maisonneuve injury, which structure must be thoroughly evaluated clinically and radiographically?

. Distal tibiofibular syndesmosis
. Spring ligament complex
. Bifurcate ligament
. Anterior talofibular ligament (ATFL)
. Calcaneofibular ligament (CFL)

Correct Answer & Explanation

. Distal tibiofibular syndesmosis

Explanation

A Maisonneuve fracture results from a pronation-external rotation force that tears the medial structures (or medial malleolus), disrupts the syndesmosis, and propagates proximally to fracture the proximal fibula.

Question 3355

Topic: Midfoot & Hindfoot
A 60-year-old female presents with severe lateral hindfoot pain and a fixed flatfoot deformity. Examination demonstrates rigid hindfoot valgus and rigid forefoot abduction, consistent with Stage III adult-acquired flatfoot deformity. What is the most appropriate surgical intervention?
. Flexor digitorum longus (FDL) transfer to the navicular
. Medializing calcaneal osteotomy alone
. Triple arthrodesis
. Gastrocnemius recession and spring ligament repair
. Isolated talonavicular arthrodesis

Correct Answer & Explanation

. Triple arthrodesis

Explanation

Stage III adult-acquired flatfoot deformity is defined by a rigid, non-reducible deformity with fixed hindfoot valgus and forefoot abduction. Joint-sparing procedures are contraindicated; the standard of care is a triple arthrodesis.

Question 3356

Topic: 8. Foot and Ankle

A 16-year-old boy with a history of frequent ankle sprains is diagnosed with Charcot-Marie-Tooth disease. He presents with a progressive cavovarus foot deformity. Which of the following best describes the primary muscle imbalance responsible for the forefoot valgus component of his deformity?

. Overpull of the tibialis anterior relative to the peroneus longus
. Overpull of the peroneus brevis relative to the posterior tibial tendon
. Overpull of the peroneus longus relative to the tibialis anterior
. Weakness of the posterior tibial tendon relative to the peroneus brevis
. Overpull of the extensor hallucis longus relative to the flexor hallucis longus

Correct Answer & Explanation

. Overpull of the peroneus longus relative to the tibialis anterior

Explanation

In Charcot-Marie-Tooth disease, the tibialis anterior and peroneus brevis typically weaken first. The intact peroneus longus overpowers the weak tibialis anterior, plantarflexing the first ray and creating forefoot valgus.

Question 3357

Topic: 8. Foot and Ankle

A 55-year-old female presents with medial ankle pain and a progressive flatfoot deformity. Examination reveals a flexible hindfoot valgus and an inability to perform a single-leg heel raise. Weight-bearing radiographs demonstrate 45% uncovering of the talonavicular joint. What is the most appropriate surgical management?

. Isolated subtalar arthrodesis
. Medial displacement calcaneal osteotomy (MDCO) and Achilles lengthening
. Flexor digitorum longus (FDL) transfer and MDCO alone
. FDL transfer, MDCO, and lateral column lengthening
. Gastrocnemius recession and anterior tibial tendon transfer

Correct Answer & Explanation

. FDL transfer, MDCO, and lateral column lengthening

Explanation

The patient has Stage IIB adult acquired flatfoot deformity (flexible hindfoot valgus with significant forefoot abduction/TN uncovering >30%). Optimal treatment requires addressing both the posterior tibial tendon insufficiency and the profound forefoot abduction with FDL transfer, MDCO, and lateral column lengthening.

Question 3358

Topic: 8. Foot and Ankle

During a minimally invasive percutaneous repair of an acute Achilles tendon rupture, the surgeon must be cautious to avoid injuring the sural nerve. At the level of the lateral malleolus, what is the anatomic relationship of the sural nerve to the lateral border of the Achilles tendon?

. It lies 1 cm medial to the lateral border of the Achilles tendon
. It courses anterior to the peroneal tendons
. It is located lateral to the lateral border of the Achilles tendon
. It is located directly superficial to the central Achilles tendon
. It runs deep to the flexor hallucis longus tendon

Correct Answer & Explanation

. It is located lateral to the lateral border of the Achilles tendon

Explanation

The sural nerve courses distally and laterally, crossing lateral to the Achilles tendon approximately 10 cm proximal to its calcaneal insertion. During percutaneous or minimally invasive repair, it is highly vulnerable to entrapment by sutures passed laterally.

Question 3359

Topic: 8. Foot and Ankle

A 60-year-old male with end-stage post-traumatic ankle arthritis undergoes an isolated tibiotalar arthrodesis. To optimize his postoperative gait and prevent accelerated adjacent-joint arthrosis, what is the ideal position for the ankle fusion?

. 5 degrees of plantarflexion, 5 degrees of valgus, and 10 degrees of external rotation
. Neutral dorsiflexion, 0 to 5 degrees of valgus, and 5 to 10 degrees of external rotation
. 5 degrees of dorsiflexion, neutral coronal alignment, and internal rotation
. Neutral dorsiflexion, 5 degrees of varus, and 5 degrees of external rotation
. 5 degrees of plantarflexion, 5 degrees of varus, and neutral rotation

Correct Answer & Explanation

. Neutral dorsiflexion, 0 to 5 degrees of valgus, and 5 to 10 degrees of external rotation

Explanation

The optimal position for ankle arthrodesis is neutral dorsiflexion, 0-5 degrees of hindfoot valgus, and external rotation matching the contralateral limb (usually 5-10 degrees). Plantarflexion leads to vaulting and knee recurvatum, while varus limits subtalar compensation.

Question 3360

Topic: 8. Foot and Ankle

A 24-year-old gymnast sustains a midfoot injury. Weight-bearing radiographs reveal widening of the interval between the first and second metatarsals, and a 'fleck sign' is noted. Which of the following describes the correct anatomic attachments of the intact ligament that avulsed to create this sign?

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

Correct Answer & Explanation

. Medial cuneiform to the base of the second metatarsal

Explanation

The Lisfranc ligament connects the lateral aspect of the medial cuneiform to the medial base of the second metatarsal. The 'fleck sign' represents an avulsion fracture at the attachment site of this ligament.

Test Yourself

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

On this Page