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8. Foot and Ankle MCQs

Practice Set 178 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 3541

Topic: 8. Foot and Ankle

A 22-year-old basketball player complains of a snapping sensation at the posterolateral ankle when cutting. Examination reveals subluxation of the peroneal tendons over the lateral malleolus with resisted active dorsiflexion and eversion. What is the primary pathomechanical defect in this condition?

. Tear of the calcaneofibular ligament
. Avulsion of the superior peroneal retinaculum
. Hypertrophy of the peroneal tubercle
. Rupture of the peroneus brevis tendon
. Insufficiency of the inferior extensor retinaculum

Correct Answer & Explanation

. Avulsion of the superior peroneal retinaculum

Explanation

Peroneal tendon subluxation is primarily caused by an injury or avulsion of the superior peroneal retinaculum (SPR) from its fibular attachment. Surgical management often involves repairing the SPR and deepening the fibular groove.

Question 3542

Topic: 8. Foot and Ankle

A 22-year-old rugby player sustains an external rotation injury to his right ankle. Evaluation reveals a syndesmotic sprain. During the sequential failure of the distal tibiofibular syndesmosis from this mechanism, which structure is typically injured first?

. Interosseous ligament
. Anterior inferior tibiofibular ligament (AITFL)
. Posterior inferior tibiofibular ligament (PITFL)
. Transverse tibiofibular ligament
. Deltoid ligament

Correct Answer & Explanation

. Anterior inferior tibiofibular ligament (AITFL)

Explanation

In external rotation injuries of the ankle, the anterior inferior tibiofibular ligament (AITFL) is typically the first syndesmotic structure to rupture. If the rotational force continues, it is followed by the tearing of the interosseous ligament and finally the PITFL.

Question 3543

Topic: 8. Foot and Ankle

A 31-year-old man sustains an acute traumatic knee dislocation following a motorcycle collision. After closed reduction, his Ankle-Brachial Index (ABI) is 0.85. What is the most appropriate next step in management?

. Immediate surgical exploration of the popliteal artery
. CT angiography of the lower extremity
. Observation and repeat ABI in 4 hours
. Duplex ultrasonography of the popliteal vein
. Application of a hinged knee brace and discharge

Correct Answer & Explanation

. CT angiography of the lower extremity

Explanation

An Ankle-Brachial Index (ABI) < 0.9 following a knee dislocation is highly suspicious for a vascular injury. CT angiography is the standard next step to definitively localize and characterize popliteal artery injuries before surgical intervention.

Question 3544

Topic: 8. Foot and Ankle

A 45-year-old recreational basketball player experiences a "pop" in his posterior ankle followed by weakness in plantar flexion. He is diagnosed with an acute Achilles tendon rupture. If he elects to undergo open surgical repair, which of the following is the most commonly reported significant complication compared to nonoperative management?

. Higher rate of tendon rerupture
. Increased risk of sural nerve injury
. Increased risk of deep vein thrombosis
. Decreased plantar flexion strength
. Higher rate of wound healing complications

Correct Answer & Explanation

. Higher rate of wound healing complications

Explanation

Surgical repair of the Achilles tendon is associated with a significantly lower rerupture rate compared to traditional nonoperative management. However, operative intervention carries a higher risk of soft-tissue and wound healing complications, including infection.

Question 3545

Topic: 8. Foot and Ankle

A 13-year-old boy presents with vague midfoot pain and frequent ankle sprains. Examination reveals rigid pes planus and limited subtalar motion. Radiographs show a "C-sign" on the lateral view. What is the most likely diagnosis?

. Calcaneonavicular coalition
. Talocalcaneal coalition
. Accessory navicular
. Vertical talus
. Kohler disease

Correct Answer & Explanation

. Talocalcaneal coalition

Explanation

The "C-sign" on a lateral radiograph is a classic finding representing the continuous bony outline of the medial talar dome and the sustentaculum tali, highly indicative of a talocalcaneal coalition.

Question 3546

Topic: 8. Foot and Ankle
A 14-year-old boy sustains a twisting injury to his ankle while playing soccer. Radiographs reveal a Salter-Harris III fracture of the anterolateral aspect of the distal tibia epiphysis. Avulsion of this fragment is caused by tension from which of the following structures?
. Anterior talofibular ligament (ATFL)
. Calcaneofibular ligament (CFL)
. Anterior inferior tibiofibular ligament (AITFL)
. Posterior inferior tibiofibular ligament (PITFL)
. Deltoid ligament

Correct Answer & Explanation

. Anterior inferior tibiofibular ligament (AITFL)

Explanation

A Tillaux fracture is a Salter-Harris III fracture of the anterolateral distal tibial epiphysis. It is caused by an avulsion force from the anterior inferior tibiofibular ligament (AITFL) during external rotation of the foot.

Question 3547

Topic: 8. Foot and Ankle

A 13-year-old boy presents with a rigid flatfoot, recurrent ankle sprains, and deep hindfoot pain. Radiographs demonstrate a continuous 'C-sign' on the lateral view. This radiographic finding is pathognomonic for which of the following conditions?

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

Correct Answer & Explanation

. Talocalcaneal coalition

Explanation

The 'C-sign' is a continuous C-shaped arc formed by the medial outline of the talar dome and the posterior outline of the sustentaculum tali. It is highly indicative of a talocalcaneal coalition.

Question 3548

Topic: 8. Foot and Ankle

A patient presents with a foot drop and an inability to evert the foot following a proximal fibular fracture. Sensation is decreased over the anterolateral leg and dorsum of the foot. Which nerve is injured?

. Deep peroneal nerve
. Superficial peroneal nerve
. Common peroneal nerve
. Tibial nerve
. Saphenous nerve

Correct Answer & Explanation

. Common peroneal nerve

Explanation

The common peroneal nerve wraps around the fibular neck and innervates both the anterior (deep peroneal) and lateral (superficial peroneal) compartments. Injury results in foot drop and loss of eversion.

Question 3549

Topic: 8. Foot and Ankle

During a tarsal tunnel release, the surgeon identifies the structures passing posterior to the medial malleolus. Moving from anterior to posterior, what is the correct order of the structures?

. Tibialis posterior, flexor digitorum longus, posterior tibial artery, tibial nerve, flexor hallucis longus
. Tibialis posterior, flexor hallucis longus, posterior tibial artery, tibial nerve, flexor digitorum longus
. Flexor digitorum longus, tibialis posterior, posterior tibial artery, tibial nerve, flexor hallucis longus
. Tibialis anterior, flexor digitorum longus, posterior tibial artery, tibial nerve, flexor hallucis longus
. Flexor hallucis longus, tibial nerve, posterior tibial artery, flexor digitorum longus, tibialis posterior

Correct Answer & Explanation

. Tibialis posterior, flexor digitorum longus, posterior tibial artery, tibial nerve, flexor hallucis longus

Explanation

The mnemonic "Tom, Dick, And Very Nervous Harry" describes the order from anterior to posterior. The structures are Tibialis posterior, flexor Digitorum longus, posterior tibial Artery/Vein, tibial Nerve, and flexor Hallucis longus.

Question 3550

Topic: 8. Foot and Ankle

A 35-year-old man sustained a Hawkins type II talar neck fracture and underwent open reduction and internal fixation 8 weeks ago. A plain radiograph of the ankle today demonstrates a subchondral radiolucent band in the dome of the talus. What does this finding indicate?

. Imminent hardware failure
. Post-traumatic osteoarthritis
. Avascular necrosis of the talar body
. Intact vascularity to the talar body
. Infection of the tibiotalar joint

Correct Answer & Explanation

. Intact vascularity to the talar body

Explanation

The Hawkins sign is a subchondral radiolucency seen 6-8 weeks post-injury, indicating active bone resorption and subchondral osteopenia. This physiological process requires an intact blood supply, thereby essentially ruling out avascular necrosis of the talar body.

Question 3551

Topic: 8. Foot and Ankle

A 30-year-old woman presents with midfoot pain after falling from a horse with her foot caught in the stirrup. Radiographs show a small bony avulsion in the space between the medial and middle cuneiforms. This 'fleck sign' represents an avulsion of a ligament that connects the medial cuneiform to which structure?

. Navicular
. First metatarsal base
. Second metatarsal base
. Cuboid
. Middle cuneiform

Correct Answer & Explanation

. Second metatarsal base

Explanation

The Lisfranc ligament is a stout intra-articular ligament that connects the lateral aspect of the medial cuneiform to the medial aspect of the base of the second metatarsal. A 'fleck sign' indicates an avulsion of this critical stabilizing ligament.

Question 3552

Topic: Midfoot & Hindfoot
A 28-year-old male sustains a Hawkins type III fracture of the talar neck. Which of the following accurately describes the associated dislocations and the approximate risk of avascular necrosis (AVN)?
. Subtalar dislocation only; 20% AVN risk
. Subtalar and tibiotalar dislocation; 50% AVN risk
. Subtalar, tibiotalar, and talonavicular dislocation; nearly 100% AVN risk
. Tibiotalar dislocation only; 10% AVN risk
. Talonavicular dislocation only; 80% AVN risk

Correct Answer & Explanation

. Subtalar, tibiotalar, and talonavicular dislocation; nearly 100% AVN risk

Explanation

A Hawkins type III talar neck fracture involves displacement with dislocation of the subtalar, tibiotalar, and often talonavicular joints. Because all major blood supplies to the talar body are disrupted, the risk of AVN is exceptionally high, approaching 90-100%.

Question 3553

Topic: 8. Foot and Ankle

During the extensile lateral approach for open reduction and internal fixation of a displaced intra-articular calcaneus fracture, which nerve is at greatest risk of iatrogenic injury in the distal portion of the incision?

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

Correct Answer & Explanation

. Sural nerve

Explanation

The sural nerve crosses the lateral border of the foot and is at risk during the distal extent of the extensile lateral approach to the calcaneus. Careful full-thickness flap elevation is required to protect it.

Question 3554

Topic: 8. Foot and Ankle

A 22-year-old college football player sustains a purely ligamentous Lisfranc injury. Weight-bearing radiographs show a 4 mm diastasis between the first and second metatarsal bases. What is the most widely supported definitive surgical treatment for this specific injury pattern?

. Closed reduction and percutaneous pinning
. Open reduction and internal fixation with cortical screws
. Primary arthrodesis of the first, second, and third tarsometatarsal joints
. Non-weight-bearing cast for 8 weeks
. Flexible stabilization with a suture-button device

Correct Answer & Explanation

. Primary arthrodesis of the first, second, and third tarsometatarsal joints

Explanation

Evidence suggests that primary arthrodesis yields better long-term functional outcomes and lower reoperation rates compared to ORIF for purely ligamentous Lisfranc injuries. ORIF is generally preferred if there are large, stable bony avulsions.

Question 3555

Topic: Ankle Trauma & Sports

During internal fixation of a bimalleolar ankle fracture, the surgeon performs a 'Cotton test' pulling the fibula laterally. Which specific anatomic structure is this test primarily designed to evaluate?

. Deltoid ligament integrity
. Anterior talofibular ligament (ATFL) integrity
. Calcaneofibular ligament (CFL) integrity
. Syndesmotic (distal tibiofibular) integrity
. Spring ligament integrity

Correct Answer & Explanation

. Syndesmotic (distal tibiofibular) integrity

Explanation

The Cotton test (or hook test) involves applying lateral traction to the fibula using a bone hook. It is performed intraoperatively to assess the stability of the distal tibiofibular syndesmosis after medial and lateral bony fixation.

Question 3556

Topic: 8. Foot and Ankle

A 30-year-old man presents with a high-energy displaced proximal tibia fracture. The foot is warm, but pedal pulses are diminished. The calculated Ankle-Brachial Index (ABI) is 0.8. What is the most appropriate next step in management?

. Immediate surgical exploration of the popliteal artery in the operating room
. CT angiography of the affected lower extremity
. Application of a bridging external fixator and re-evaluation of pulses
. Observation and serial ABI measurements every 4 hours
. Immediate administration of systemic heparin

Correct Answer & Explanation

. CT angiography of the affected lower extremity

Explanation

An Ankle-Brachial Index (ABI) less than 0.9 in the setting of a high-energy knee or proximal tibia injury indicates a high suspicion for arterial injury. CT angiography is the indicated next step to identify the presence and level of vascular injury.

Question 3557

Topic: 8. Foot and Ankle

A 22-year-old football player sustains an ultra-low velocity knee dislocation that spontaneously reduces. His pedal pulses are palpable, but his Ankle-Brachial Index (ABI) is 0.8. What is the most appropriate next step in management?

. Immediate surgical exploration of the popliteal artery
. CT angiography of the lower extremity
. Observation and repeat ABI in 4 hours
. Application of a knee-spanning external fixator
. Duplex ultrasonography of the deep venous system

Correct Answer & Explanation

. CT angiography of the lower extremity

Explanation

In the setting of a knee dislocation, an ABI of < 0.9 is highly suspicious for a vascular injury and warrants an immediate CT angiogram. Palpable pulses do not rule out an intimal flap or pending vascular occlusion.

Question 3558

Topic: 8. Foot and Ankle

A 40-year-old man falls from a height and sustains a displaced, intra-articular calcaneus fracture. Which of the following surgical approaches is most commonly associated with wound healing complications and requires careful handling of the sural nerve?

. Medial approach
. Extensile lateral approach
. Sinus tarsi approach
. Plantar approach
. Posterior Achilles-splitting approach

Correct Answer & Explanation

. Extensile lateral approach

Explanation

The extensile lateral approach for calcaneus fractures is associated with a high rate of wound breakdown and places the sural nerve at risk. Careful full-thickness flap elevation and subperiosteal dissection are required to minimize these risks.

Question 3559

Topic: 8. Foot and Ankle

A 24-year-old man sustains a multiligamentous knee injury with a suspected spontaneous reduction of a knee dislocation. Pulses are palpable but asymmetric, and his ankle-brachial index (ABI) is measured at 0.8. What is the next most appropriate step in management?

. Observation and serial exams every 4 hours
. Immediate surgical exploration without imaging
. CT angiography of the lower extremity
. Duplex ultrasound of the popliteal fossa
. Intra-articular pressure monitoring

Correct Answer & Explanation

. CT angiography of the lower extremity

Explanation

An ABI < 0.9 in the setting of a knee dislocation is highly sensitive for an occult popliteal artery injury. The patient should undergo emergent CT angiography to define the vascular lesion and consult vascular surgery.

Question 3560

Topic: Midfoot & Hindfoot
A 30-year-old man falls from a height and sustains a Hawkins Type III fracture of the talar neck. What is the approximate risk of developing avascular necrosis (AVN) of the talar body?
. 0-10%
. 15-30%
. 40-50%
. 80-100%
. Always 100%

Correct Answer & Explanation

. 80-100%

Explanation

A Hawkins Type III talar neck fracture involves dislocation of the talar body from both the subtalar and tibiotalar joints. This completely disrupts the major retrograde blood supplies, leading to an AVN risk approaching 80-100%.

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