Menu

8. Foot and Ankle MCQs

Practice Set 177 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 3521

Topic: 8. Foot and Ankle

Historically, what is the primary biomechanical and clinical advantage of operative repair for acute Achilles tendon ruptures when compared to traditional cast immobilization?

. Lower rate of deep vein thrombosis
. Lower rate of re-rupture
. Decreased risk of sural nerve injury
. Lower overall complication rate
. Prevention of Achilles tendinosis

Correct Answer & Explanation

. Lower rate of re-rupture

Explanation

Traditionally, operative repair of the Achilles tendon has been favored for a lower re-rupture rate compared to strict cast immobilization, though modern functional rehabilitation protocols have narrowed this gap. Operative management is associated with higher risks of wound complications.

Question 3522

Topic: 8. Foot and Ankle

A 25-year-old alpine skier sustains a forced dorsiflexion and eversion injury to the ankle. She reports a painful snapping sensation over the lateral malleolus. Which anatomic structure is most likely compromised?

. Anterior talofibular ligament
. Calcaneofibular ligament
. Superior peroneal retinaculum
. Inferior extensor retinaculum
. Achilles tendon paratenon

Correct Answer & Explanation

. Superior peroneal retinaculum

Explanation

The superior peroneal retinaculum (SPR) is the primary restraint to peroneal tendon subluxation. Injury to the SPR through forced dorsiflexion and eversion results in the tendons snapping over the lateral malleolus.

Question 3523

Topic: 8. Foot and Ankle
During a modified Broström-Gould procedure for chronic lateral ankle instability, adjacent tissue is mobilized and sutured to the distal fibula to augment the repair of the anterior talofibular and calcaneofibular ligaments. Which specific structure is utilized for this augmentation?
. Superior extensor retinaculum
. Inferior extensor retinaculum
. Superior peroneal retinaculum
. Inferior peroneal retinaculum
. Plantaris tendon

Correct Answer & Explanation

. Inferior extensor retinaculum

Explanation

The Gould modification of the Broström procedure involves mobilizing the lateral root of the inferior extensor retinaculum and suturing it to the fibula. This provides additional reinforcement to the primary ligament repair.

Question 3524

Topic: 8. Foot and Ankle

Recent meta-analyses comparing operative versus non-operative management of acute Achilles tendon ruptures utilizing modern functional rehabilitation protocols demonstrate that operative management is associated with:

. A significantly higher rate of tendon re-rupture
. A lower rate of deep vein thrombosis
. A higher rate of soft-tissue complications and infections
. Decreased plantarflexion strength at 1-year follow-up
. Faster return to basic activities of daily living

Correct Answer & Explanation

. A higher rate of soft-tissue complications and infections

Explanation

When early functional rehabilitation protocols are utilized, there is no significant difference in re-rupture rates between operative and non-operative management of acute Achilles ruptures. However, operative management consistently carries a higher risk of soft-tissue complications, including wound breakdown and infection.

Question 3525

Topic: 8. Foot and Ankle

A 24-year-old runner presents with chronic ankle pain following multiple severe ankle sprains. MRI demonstrates a wafer-shaped osteochondral lesion on the anterolateral aspect of the talar dome. Based on typical injury mechanics, this specific lesion is most likely the result of which mechanism?

. Plantarflexion and inversion
. Dorsiflexion and inversion
. Dorsiflexion and eversion
. Plantarflexion and eversion
. Axial load in a neutral position

Correct Answer & Explanation

. Dorsiflexion and inversion

Explanation

Anterolateral talar dome lesions are typically trauma-related, shallow (wafer-shaped), and caused by a dorsiflexion and inversion injury (remember the mnemonic DIAL: Dorsiflexion Inversion = Anterior Lateral). Posteromedial lesions are often deeper, cup-shaped, and caused by plantarflexion and inversion (PIMP).

Question 3526

Topic: 8. Foot and Ankle

A 32-year-old male sustains a high-energy knee dislocation. After closed reduction in the emergency department, his pedal pulses are symmetric and capillary refill is brisk. The Ankle-Brachial Index (ABI) is measured at 0.85. What is the most appropriate next step in management?

. Discharge with closely scheduled outpatient follow-up
. Application of a spanning external fixator and recheck ABI in 24 hours
. Perform a CT angiogram of the lower extremity
. Observation with serial clinical vascular exams every 4 hours
. Immediate operative exploration of the popliteal artery

Correct Answer & Explanation

. Perform a CT angiogram of the lower extremity

Explanation

An ABI of less than 0.90 after a knee dislocation is highly sensitive for an occult vascular injury, even in the presence of palpable pedal pulses. This finding mandates further advanced vascular imaging, such as a CT angiogram, to definitively rule out a popliteal artery intimal tear.

Question 3527

Topic: 8. Foot and Ankle

A 28-year-old soccer player sustains an ankle injury resulting from forceful inversion and dorsiflexion. MRI reveals an osteochondral lesion of the talus. Based on the mechanism of injury, where is this lesion most likely located?

. Anteromedial
. Anterolateral
. Posteromedial
. Posterolateral
. Central

Correct Answer & Explanation

. Anterolateral

Explanation

Anterolateral talar dome lesions are typically shallow, wafer-shaped, and caused by inversion and dorsiflexion trauma. Posteromedial lesions are typically deeper and caused by inversion and plantarflexion.

Question 3528

Topic: 8. Foot and Ankle

An 18-year-old football player sustains a syndesmotic "high" ankle sprain. Which of the following mechanisms of injury is most classically responsible for this pathology?

. Plantarflexion and inversion
. Direct blow to the anterior tibia
. Dorsiflexion and inversion
. External rotation of the foot relative to the tibia
. Hyper-plantarflexion

Correct Answer & Explanation

. External rotation of the foot relative to the tibia

Explanation

Syndesmotic ankle sprains most commonly occur due to external rotation of the foot on the tibia, which forcibly separates the distal tibiofibular joint.

Question 3529

Topic: 8. Foot and Ankle

A 25-year-old rugby player sustains an inversion and plantarflexion injury to his ankle. Which osteochondral lesion of the talus is most characteristically associated with this specific mechanism?

. Anterolateral, shallow, wafer-shaped lesion
. Anteromedial, deep, cup-shaped lesion
. Posterolateral, shallow, wafer-shaped lesion
. Posteromedial, deep, cup-shaped lesion
. Central talar dome cystic lesion

Correct Answer & Explanation

. Posteromedial, deep, cup-shaped lesion

Explanation

Plantarflexion and inversion injuries typically cause posteromedial talar dome lesions (DIAL a PIMP: Dorsiflexion/Inversion=AnteroLateral; Plantarflexion/Inversion=Posteromedial). These lesions are usually deep and cup-shaped.

Question 3530

Topic: 8. Foot and Ankle

A 35-year-old recreational athlete sustains an acute Achilles tendon rupture. In comparing surgical versus functional nonoperative management, surgical repair is historically associated with:

. A significantly higher rerupture rate
. A higher rate of wound complications and sural nerve injury
. Decreased plantarflexion strength
. Longer return to play time
. Higher rates of deep vein thrombosis

Correct Answer & Explanation

. A higher rate of wound complications and sural nerve injury

Explanation

Operative repair of acute Achilles ruptures lowers the rerupture rate compared to nonoperative casting but introduces surgical risks. The most common complications of surgery are wound breakdown and iatrogenic sural nerve injury.

Question 3531

Topic: Ankle Trauma & Sports
Which of the following physical examination tests is the most sensitive and specific for diagnosing an acute high ankle (syndesmotic) sprain?
. Anterior drawer test
. Talar tilt test
. External rotation stress test
. Thompson test
. Silfverskiöld test

Correct Answer & Explanation

. External rotation stress test

Explanation

The external rotation stress test is considered the most reliable clinical test for a syndesmotic injury. It reproduces pain over the anterior tibiofibular ligament and interosseous membrane by gapping the syndesmosis.

Question 3532

Topic: 8. Foot and Ankle

A 23-year-old lacrosse player sustains an inversion and external rotation injury to his ankle. Examination reveals tenderness over the anterior inferior tibiofibular ligament (AITFL) and a positive squeeze test. Non-weight-bearing radiographs appear normal. What is the most appropriate next step to evaluate for syndesmotic instability?

. Magnetic resonance imaging (MRI) of the ankle
. Gravity stress radiograph
. Computed tomography (CT) of the ankle
. Diagnostic ultrasound
. Bone scan

Correct Answer & Explanation

. Gravity stress radiograph

Explanation

A gravity stress radiograph (or external rotation stress radiograph) is the most appropriate next step to evaluate for dynamic syndesmotic instability when standard radiographs are normal. It is highly sensitive for detecting medial clear space widening indicative of deltoid and syndesmotic disruption.

Question 3533

Topic: 8. Foot and Ankle

A 24-year-old female presents with chronic ankle pain. Imaging shows an osteochondral lesion of the talus.

Regarding the typical characteristics of talar dome osteochondral lesions, which statement is true?

. Anterolateral lesions are typically deep and cup-shaped.
. Posteromedial lesions are typically deeper and less likely to have a history of trauma.
. Anterolateral lesions rarely displace and are generally asymptomatic.
. Posteromedial lesions are usually caused by a direct inversion and dorsiflexion injury.
. Anteromedial lesions are the most common variant.

Correct Answer & Explanation

. Posteromedial lesions are typically deeper and less likely to have a history of trauma.

Explanation

Medial talar dome lesions are typically posteromedial, deep, cup-shaped, and often non-traumatic in origin. Lateral lesions are typically anterolateral, shallow, wafer-shaped, and strongly associated with a history of trauma.

Question 3534

Topic: 8. Foot and Ankle
A 26-year-old male sustains a high-energy knee dislocation (KD-III). Upon reduction in the trauma bay, his foot is warm and pink, but his ankle-brachial index (ABI) is calculated at 0.7. What is the most appropriate next step in management?
. Observation with serial vascular checks every 2 hours
. Duplex ultrasonography of the lower extremity
. CT angiography of the lower extremity
. Immediate surgical exploration of the popliteal fossa
. Fasciotomies of the lower leg

Correct Answer & Explanation

. CT angiography of the lower extremity

Explanation

An ABI less than 0.9 in the setting of a knee dislocation is highly suspicious for a popliteal artery injury. CT angiography is the standard next step to rapidly and precisely localize the vascular lesion prior to surgical intervention.

Question 3535

Topic: 8. Foot and Ankle

A 22-year-old gymnast presents with snapping over the lateral aspect of her ankle following a severe dorsiflexion-inversion injury. Exam reveals subluxation of the peroneal tendons over the lateral malleolus with resisted active dorsiflexion and eversion. This condition is primarily caused by an injury to which structure?

. Anterior talofibular ligament
. Calcaneofibular ligament
. Inferior peroneal retinaculum
. Superior peroneal retinaculum
. Spring ligament

Correct Answer & Explanation

. Superior peroneal retinaculum

Explanation

Peroneal tendon subluxation is caused by attenuation or tearing of the superior peroneal retinaculum (SPR), often accompanied by a shallow fibular groove. Surgical management typically involves SPR repair and fibular groove deepening.

Question 3536

Topic: 8. Foot and Ankle

A 19-year-old runner sustains an acute inversion ankle sprain. In the emergency department, anterior drawer testing is positive. Which ligament is the primary restraint to anterior translation of the talus in the ankle mortise when the foot is in plantarflexion?

. Anterior talofibular ligament
. Calcaneofibular ligament
. Posterior talofibular ligament
. Cervical ligament
. Deltoid ligament

Correct Answer & Explanation

. Anterior talofibular ligament

Explanation

The anterior talofibular ligament (ATFL) is the weakest of the lateral ankle ligaments and the first to tear during an inversion injury. It is the primary restraint to anterior translation of the talus, especially when the ankle is plantarflexed.

Question 3537

Topic: 8. Foot and Ankle

During a minimally invasive repair of an acute Achilles tendon rupture, the surgeon places percutaneous sutures in the proximal stump. Which of the following structures is at greatest risk of iatrogenic injury during this step?

. Tibial nerve
. Sural nerve
. Saphenous nerve
. Superficial peroneal nerve
. Flexor hallucis longus tendon

Correct Answer & Explanation

. Sural nerve

Explanation

The sural nerve crosses from medial to lateral and runs in close proximity to the lateral border of the Achilles tendon proximally. It is highly susceptible to entrapment during percutaneous or minimally invasive suture passage.

Question 3538

Topic: 8. Foot and Ankle

A 25-year-old hockey player sustains a rotational ankle injury. The external rotation stress test is positive.

Which ligament is typically the first to tear in a syndesmotic injury?

. Posterior inferior tibiofibular ligament
. Anterior inferior tibiofibular ligament
. Interosseous membrane
. Deltoid ligament
. Calcaneofibular ligament

Correct Answer & Explanation

. Anterior inferior tibiofibular ligament

Explanation

In an ankle syndesmosis injury, the anterior inferior tibiofibular ligament (AITFL) is typically the first to tear. This is followed sequentially by the interosseous ligament and finally the posterior inferior tibiofibular ligament (PITFL).

Question 3539

Topic: 8. Foot and Ankle

A 32-year-old runner presents with deep ankle pain. MRI reveals an osteochondral lesion of the talus. Compared to anterolateral lesions, posteromedial talar dome lesions are characteristically:

. Shallower and highly associated with trauma
. Deeper and highly associated with trauma
. Shallower and less likely to have a traumatic etiology
. Deeper and less likely to have a traumatic etiology
. Always asymptomatic

Correct Answer & Explanation

. Deeper and less likely to have a traumatic etiology

Explanation

Posteromedial osteochondral lesions of the talus are classically deeper, cup-shaped, and less frequently associated with a distinct history of trauma. Anterolateral lesions are usually shallower, wafer-shaped, and trauma-induced.

Question 3540

Topic: 8. Foot and Ankle
A 28-year-old male is brought to the emergency department after a motorcycle accident with a grossly unstable knee (KD-III). His ankle-brachial index (ABI) is 0.8. What is the most appropriate next step in management?
. Immediate operative exploration of the popliteal artery
. CT angiography of the lower extremity
. Duplex ultrasound of the lower extremity
. Observation and repeat ABI in 4 hours
. Application of a spanning external fixator before vascular assessment

Correct Answer & Explanation

. CT angiography of the lower extremity

Explanation

In the setting of a knee dislocation, an ABI less than 0.9 is highly concerning for a popliteal artery injury. This mandates advanced imaging, typically CT angiography, to accurately localize the vascular lesion before surgical intervention.

Test Yourself

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

On this Page