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8. Foot and Ankle MCQs

Practice Set 17 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 321

Topic: 8. Foot and Ankle

Development of hindfoot arthritis following total ankle replacement is seen in:

. 0% of patients
. <25% of patients
. 50% of patients
. 75% of patients
. >75% of patients

Correct Answer & Explanation

. <25% of patients

Explanation

Although it is felt that the retention of some degree of ankle motion with ankle replacement can help prevent the development of hindfoot arthritis, in a 9-year follow-up study nearly 25% of patients still had radiographic signs of arthritis.

Question 322

Topic: Midfoot & Hindfoot

Isolated subtalar arthrodesis:

. Increases transverse tarsal joint over time
. Decreases talonavicular motion less than calcaneocuboid motion
. Decreased talonavicular joint motion but increases calcaneocuboid joint motion
. Decreases talonavicular motion more than calcaneocuboid motion
. Increases subtalar motion

Correct Answer & Explanation

. Decreases talonavicular motion more than calcaneocuboid motion

Explanation

Subtalar fusion decreased talonavicular motion more so than calcaneocuboid motion in this cadaver study. Isolated talonavicular fusion is the most influential of the hindfoot joints, locking hindfoot motion.

Question 323

Topic: Midfoot & Hindfoot

Which injury is likely to have a worse clinical outcome:

. A purely ligamentous Lisfranc injury
. A Lisfranc fracture-dislocation Purely ligamentous Lisfranc injuries have a worse clinical outcome than injuries associated with bony fractures.

Correct Answer & Explanation

. A purely ligamentous Lisfranc injury

Explanation

Question 324

Topic: 8. Foot and Ankle

C urrently recommended indications for surgical management of hallux rigidus with an arthrodesis include:

. Positive axial grind test on preoperative clinical examination
. >50% of the cartilage on the metatarsal head remaining
. Osteophytes over the dorsolateral head of the first metatarsal
. Osteophytes over the dorsal aspect of the proximal phalanx
. Normal first metatarsophalangeal joint motion

Correct Answer & Explanation

. >50% of the cartilage on the metatarsal head remaining

Explanation

Coughlin and colleagues recommend that when pain with axial grind testing of the metatarsophalangeal joint is present or >50% loss of articular cartilage occurs intraoperatively, then first metatarsophalangeal arthrodesis should be performed.

Question 325

Topic: 8. Foot and Ankle

The main blood supply to the talar body is from the:

. Peroneal artery
. Dorsalis pedis artery
. Artery of the tarsal canal
. Artery of the sinus tarsi
. 1st dorsal metatarsal artery

Correct Answer & Explanation

. Artery of the tarsal canal

Explanation

The main blood supply to the body of the talus is the artery of the tarsal canal, which is a branch off the posterior tibial artery. The dorsalis pedis and the artery of the sinus tarsi supply the talar head.

Question 326

Topic: 8. Foot and Ankle

Treatment of significant loss of height and posttraumatic arthritis following nonoperative treatment of calcaneus fractures should include:

. Subtalar distraction bone block arthrodesis
. C orrective osteotomy
. Tibiotalocalcaneal arthrodesis
. C ustom Arizona ankle brace with heel lift
. C ustom orthotics with lateral heel posting

Correct Answer & Explanation

. Subtalar distraction bone block arthrodesis

Explanation

Management of late loss of height following calcaneus fracture is best addressed by a distraction arthrodesis of the subtalar joint using a wedge- shaped structural bone graft.

Question 327

Topic: 8. Foot and Ankle

Following triple arthrodesis, ankle range of motion is:

. Unaffected
. Increased
. Decreased
. Improves over time
. Increases initially, but then returns to preoperative levels

Correct Answer & Explanation

. Decreased

Explanation

This clinical study following triple arthrodesis patients for 10 years showed a 27% loss of ankle plantarflexion but no loss of dorsiflexion.

Question 328

Topic: 8. Foot and Ankle

A Moberg procedure for hallux rigidus is:

. An oblique first metatarsal shortening osteotomy
. An ostectomy of the medial eminence of the metatarsal
. A medial closing wedge osteotomy of the proximal phalanx
. A dorsal closing wedge osteotomy of the proximal phalanx
. A lateral closing wedge osteotomy of the proximal phalanx

Correct Answer & Explanation

. A dorsal closing wedge osteotomy of the proximal phalanx

Explanation

The Moberg procedure involves a dorsal closing wedge osteotomy of the proximal phalanx. This sets the hallux higher off the floor, allowing for easier toe-off with less dorsal impingement during gait.

Question 329

Topic: 8. Foot and Ankle

The distinguishing factor in a Hawkins type 4 talar neck fracture is:

. The presence of an incongruent ankle joint
. The presence of a talonavicular dislocation
. The presence of an incongruent subtalar joint
. The presence of an associated talar body fracture
. The presence of an associated talar body fracture

Correct Answer & Explanation

. The presence of an incongruent subtalar joint

Explanation

Hawkins type 1 fractures are nondisplaced. Hawkins type 2 fractures have an incongruent subtalar joint. Hawkins type 3 fractures have an incongruent ankle and subtalar joint. Hawkins type 4 fractures have the above injuries and incongruent talo-navicular joint.

Question 330

Topic: 8. Foot and Ankle
The optimal position for ankle arthrodesis is:
. 5° plantarflexion, 5° valgus, 5° external rotation
. Neutral flexion, 5° valgus, 5° external rotation
. Neutral flexion, 0° varus/valgus, 5° external rotation
. Neutral flexion, 5° valgus, 5° internal rotation
. 5° dorsiflexion, 5° valgus, 5° external rotation

Correct Answer & Explanation

. Neutral flexion, 5° valgus, 5° external rotation

Explanation

The optimal position for ankle arthrodesis is neutral flexion, 5° valgus, and 5° external rotation. Historically, surgeons thought that women should be fused in some amount of equinus to better allow them to wear heeled shoes. However, this can increase the development of neighboring joint arthritis and also create a knee recurvatum deformity when ambulating barefoot. Currently it is recommended that all patients are fused in neutral dorsi-/plantarflexion.

Question 331

Topic: Midfoot & Hindfoot

Isolated talonavicular fusion:

. Decreases subtalar motion by 25%
. Decreases subtalar motion by 50%
. Locks subtalar motion
. Has no effect on subtalar motion
. Decreases subtalar motion by 10%

Correct Answer & Explanation

. Locks subtalar motion

Explanation

This cadaver study examined the motion that remained in the hindfoot joints following sequential immobilization of the talonavicular, subtalar, and calcaneo-cuboid joints. Fixing the talo-navicular joint virtually locked all subtalar motion.

Question 332

Topic: Ankle Trauma & Sports
The distinction between a Lauge-Hansen supination-external rotation III injury and a Lauge-Hansen supination-external rotation IV injury is:
. A spiral oblique fracture of the lateral malleolus
. Anteroinferior tibiofibular ligament (AITFL) disruption
. Posteroinferior tibiofibular ligament (PITFL) disruption or posterior malleolus fracture
. Deltoid ligament disruption or medial malleolus fracture
. Anterior talo-fibular ligament disruption

Correct Answer & Explanation

. Deltoid ligament disruption or medial malleolus fracture

Explanation

The sequence of injury according to the Lauge-Hansen classification system in supination-external rotation injuries is AITFL disruption, spiral oblique fracture of the lateral malleolus, PITFL disruption or posterior malleolus fracture, and finally stage IV, which is a deltoid ligament disruption or medial malleolus fracture.

Question 333

Topic: 8. Foot and Ankle

Isolated subtalar fusion:

. Is not associated with development of ankle or transverse tarsal joint arthritis
. Is associated only with development of transverse joint arthritis, but the ankle joint is spared
. Is associated only with development of ankle arthritis, but the transverse tarsal joints are spared
. Is associated with the development of both ankle and transverse tarsal joint arthritis
. Is associated with knee joint degenerative arthritis

Correct Answer & Explanation

. Is associated with the development of both ankle and transverse tarsal joint arthritis

Explanation

In 48 subtalar fusions followed for 5 years, 36% of patients developed ankle arthritis and 41% of patients developed transverse tarsal joint arthritis.C orrect Answer: Is associated with the development of both ankle and transverse tarsal joint arthritis

Question 334

Topic: Midfoot & Hindfoot

Following anatomic open reduction and internal fixation of a Lisfranc fracture-dislocation:

. Development of tarsometatarsal arthritis will not occur.
. Tarsometatarsal arthritis may still arise in approximately 25% of patients.
. If tarsometatarsal arthritis develops, then subsequent arthrodesis is required.
. The screws should be routinely removed at 12 weeks.
. The screws should be routinely removed at 6 weeks.

Correct Answer & Explanation

. Tarsometatarsal arthritis may still arise in approximately 25% of patients.

Explanation

In a series of patients who underwent open reduction internal fixation of Lisfranc fracture dislocations, 25% of patients developed midfoot arthritis at final follow-up, but only half of these patients required eventual midfoot arthrodesis.

Question 335

Topic: 8. Foot and Ankle

The maximal joint reactive force in the ankle is approximately:

. Two times body weight
. Three times body weight
. Five times body weight
. Seven times body weight
. Eight times body weight

Correct Answer & Explanation

. Five times body weight

Explanation

Stauffer and colleagues quantified ankle joint reactive force to be approximately 5 times body weight. This is a significant concern for prosthetic ankle arthroplasty because the implant surface area is relatively small over which these forces must be spread out.

Question 336

Topic: 8. Foot and Ankle

Hallux rigidus is associated with:

. Metatarsus primus elevatus
. First ray hypermobility
. Long first metatarsal
. Flat- or chevron-shaped metatarsal head
. Bipartate sesamoid

Correct Answer & Explanation

. Flat- or chevron-shaped metatarsal head

Explanation

In a large series of patients with hallux rigidus, risk factors were evaluated. The only factor that had a positive correlation with having hallux rigidus was the radiographic shape of the 1st metatarsal head. Metatarsus primus elevatus, first ray hypermobility, or long first metatarsal head were not significantly associated with hallux rigidus.

Question 337

Topic: 8. Foot and Ankle

A regimen of ankle bracing and supervised physical therapy:

. Has no beneficial effect on stage II posterior tibial tendon dysfunction
. Is helpful in relieving the pain symptoms associated with stage II posterior tibial tendon dysfunction but does not increase strength
. C an significantly relieve pain and increase strength in stage II posterior tibial tendon dysfunction
. Is only useful for postoperative rehabilitation after flexor digitorum longus tendon transfer and medial slide calcaneal osteotomy
. Prevents patients from requiring surgery in only 11% of cases

Correct Answer & Explanation

. C an significantly relieve pain and increase strength in stage II posterior tibial tendon dysfunction

Explanation

In a study performed by Alvarez and colleagues, 47 patients with stage I or II posterior tibial tendon dysfunction were treated nonoperatively with either a hinged ankle-foot orthosis or foot orthosis and a supervised physical therapy program. After 10 therapy visits, 83% of patients had successful subjective and functional outcomes. Eighty-nine percent of patients were satisfied with the outcome of nonoperative treatment. This included significant improvement in visual analog scale scores and increased strength, concentrically and eccentrically. In this study, 11% of patients failed conservative treatment and required surgery.

Question 338

Topic: 8. Foot and Ankle

The use of hyperbaric oxygen (HBO) in the treatment of problematic diabetic foot wounds has been shown to do all of the following except:

. To increase the healing rate
. To decrease the amputation rate
. To be potentially cost-effective when the costs of long-term care of a nonhealing wound and limb amputation are considered
. To be ineffective in changing the outcome of diabetic foot wounds
. To increase the juxta-wound pO2

Correct Answer & Explanation

. To be potentially cost-effective when the costs of long-term care of a nonhealing wound and limb amputation are considered

Explanation

A meta-analysis of 12 studies showed that healing rates increased from 48% to 76%, and amputation rates decreased from 45% to 19% with the use of hyperbaric oxygen (HBO) and local wound care. In randomized controlled trials, wound area decreased significantly and days to healing decreased significantly in patients treated with HBO. The juxta-wound pO2 was also significantly increased in the HBO-treatment group.

Question 339

Topic: 8. Foot and Ankle

The greatest insult to the vascular supply of the first metatarsal head during chevron bunionectomy with lateral release according to intraoperative laser Doppler blood flow measurements was:

. During the lateral release
. During the adductor tenotomy
. During the metatarsal osteotomy
. During the medial capsular release
. During skin incision

Correct Answer & Explanation

. During the medial capsular release

Explanation

Twenty patients were prospectively monitored with laser Doppler measurements of metatarsal head blood flow during chevron bunionectomy with lateral release. The greatest loss of blood flow occurred with the medial capsulotomy (45% decrease). The lateral release combined with the adductor tenotomy decreased the blood flow to the metatarsal head by 13%, and the metatarsal osteotomy decreased blood flow by an additional 13%. Total decrease in blood flow to the head was 71%. No patients developed avascular necrosis.

Question 340

Topic: Forefoot

The nonunion rate for the Lapidus procedure (first tarsometatarsal arthrodesis) for the treatment of moderate to severe hallux valgus is:

. 2%
. 7%
. 15%
. 20%
. 25%

Correct Answer & Explanation

. 7%

Explanation

In a prospective cohort study following 105 Lapidus bunionectomies for 3.7 years, the nonunion rate was found to be 6.7%. The American Orthopaedic Foot & Ankle Society scores improved significantly, and loss of correction over 3.7 years was less than 1° for intermetatarsal and hallux valgus angles.

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