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8. Foot and Ankle MCQs

Practice Set 185 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 3681

Topic: 8. Foot and Ankle

Following a severe crush injury to the foot, a patient develops a clinically suspected compartment syndrome. Which of the following is the most appropriate initial surgical approach to release the 9 compartments of the foot?

. A single dorsal incision over the second metatarsal
. A single plantar incision in the midline
. Dual dorsal incisions over the 2nd and 4th metatarsals with a medial utility incision
. A lateral calcaneal extensile incision
. Bilateral medial and lateral peri-malleolar incisions

Correct Answer & Explanation

. Dual dorsal incisions over the 2nd and 4th metatarsals with a medial utility incision

Explanation

The foot contains 9 anatomical compartments. Complete fasciotomy is typically achieved via two dorsal longitudinal incisions (over the 2nd and 4th metatarsals) and a medial utility incision to ensure adequate release of all compartments.

Question 3682

Topic: Midfoot & Hindfoot

In young, active patients with purely ligamentous Lisfranc injuries, which surgical intervention has been shown to yield the best long-term functional outcomes and lowest reoperation rates?

. Closed reduction and percutaneous pinning
. Dorsal bridge plating across the midfoot
. Primary arthrodesis of the first, second, and third tarsometatarsal joints
. Open reduction and internal fixation with transarticular screws
. Flexible fixation utilizing suture button constructs exclusively

Correct Answer & Explanation

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

Explanation

Recent studies demonstrate that primary arthrodesis of the 1st, 2nd, and 3rd TMT joints yields better functional outcomes and lower reoperation rates than ORIF for purely ligamentous Lisfranc injuries.

Question 3683

Topic: Midfoot & Hindfoot

A 25-year-old sustains a lateral subtalar dislocation after a fall from a height. A closed reduction in the emergency department is unsuccessful due to a soft tissue block. What is the most likely anatomic structure preventing reduction?

. Peroneus brevis tendon
. Flexor hallucis longus tendon
. Extensor digitorum brevis muscle
. Posterior tibial tendon
. Anterior tibial tendon

Correct Answer & Explanation

. Posterior tibial tendon

Explanation

In a lateral subtalar dislocation, the talar head is displaced medially and can become buttonholed through the posterior tibial tendon, blocking closed reduction. Medial dislocations are typically blocked by the EDB or extensor retinaculum.

Question 3684

Topic: 8. Foot and Ankle

A 35-year-old sustains a high-energy ankle injury. Radiographs reveal a Bosworth fracture-dislocation. What is the defining anatomic characteristic of this specific injury pattern?

. Proximal fibular fragment locked behind the posterior tubercle of the tibia
. Distal tibia locked anterior to the talar dome
. Calcaneus subluxated laterally relative to the talus
. Cuboid dislocated plantar to the navicular
. Medial malleolus entrapped within the medial clear space

Correct Answer & Explanation

. Proximal fibular fragment locked behind the posterior tubercle of the tibia

Explanation

A Bosworth fracture-dislocation is a rare injury where the proximal fibular fragment entraps behind the posterior tibial tubercle. It is notoriously irreducible by closed means and requires emergent ORIF.

Question 3685

Topic: 8. Foot and Ankle

According to the Lauge-Hansen classification system, what is the initial stage (Stage I) of a pronation-external rotation (PER) ankle fracture?

. Rupture of the anterior inferior tibiofibular ligament
. Rupture of the deltoid ligament or transverse medial malleolus fracture
. Spiral fracture of the proximal fibula
. Rupture of the posterior inferior tibiofibular ligament
. Disruption of the interosseous membrane

Correct Answer & Explanation

. Rupture of the deltoid ligament or transverse medial malleolus fracture

Explanation

According to the Lauge-Hansen classification, the first stage of a pronation-external rotation (PER) injury is failure of the medial structures. This manifests as either a deltoid ligament rupture or a medial malleolus fracture.

Question 3686

Topic: 8. Foot and Ankle

A 24-year-old presents with severe lateral ankle pain after landing off-balance during a snowboard jump. Plain radiographs are equivocal, but a CT scan reveals a "snowboarder's fracture" (lateral process of the talus). What is the most common mechanism of injury for this fracture?

. Plantarflexion and inversion
. Dorsiflexion and inversion
. Plantarflexion and eversion
. Dorsiflexion and eversion
. Pure axial loading

Correct Answer & Explanation

. Dorsiflexion and inversion

Explanation

Fractures of the lateral process of the talus (snowboarder's fractures) typically occur from a forced dorsiflexion and inversion mechanism. They are frequently misdiagnosed as lateral ankle sprains and best visualized on CT.

Question 3687

Topic: 8. Foot and Ankle

A 24-year-old football player presents with midfoot pain after a forced plantarflexion injury. Weight-bearing radiographs reveal a 3 mm diastasis between the base of the first and second metatarsals. What is the most appropriate management?

. Non-weight-bearing cast for 6 weeks
. Closed reduction and percutaneous pinning
. Open reduction and rigid internal fixation
. Primary arthrodesis of the first, second, and third tarsometatarsal joints
. Cam boot for 4 weeks and progressive weight-bearing

Correct Answer & Explanation

. Open reduction and rigid internal fixation

Explanation

This patient has a subtle Lisfranc injury with instability (diastasis >2mm). Open reduction and internal fixation is the standard of care to restore anatomic alignment and provide stability, though primary arthrodesis may be considered for purely ligamentous injuries in some scenarios.

Question 3688

Topic: 8. Foot and Ankle

When utilizing the extensile lateral approach for open reduction and internal fixation of a displaced intra-articular calcaneus fracture, which anatomic structure is at greatest risk of iatrogenic injury during flap elevation?

. Sural nerve
. Superficial peroneal nerve
. Deep peroneal nerve
. Tibial nerve
. Saphenous nerve

Correct Answer & Explanation

. Sural nerve

Explanation

The extensile lateral approach to the calcaneus involves creating a full-thickness subperiosteal flap. The sural nerve is at significant risk of injury during the vertical limb incision and flap retraction.

Question 3689

Topic: 8. Foot and Ankle

A 35-year-old skier presents with acute medial ankle pain and swelling. Ankle radiographs show a widened medial clear space but no medial malleolus fracture. Proximal tibia/fibula radiographs show a proximal third fibula fracture. What is the mechanism of this specific injury pattern?

. Supination-Adduction
. Supination-External Rotation
. Pronation-Abduction
. Pronation-External Rotation
. Axial loading

Correct Answer & Explanation

. Pronation-External Rotation

Explanation

A Maisonneuve fracture (proximal fibula fracture with medial ankle/syndesmotic injury) occurs via a Pronation-External Rotation mechanism according to the Lauge-Hansen classification. The energy travels from the medial side, through the syndesmosis, and exits proximally in the fibula.

Question 3690

Topic: 8. Foot and Ankle

The Lisfranc ligament is critical for midfoot stability. Which of the following accurately describes the anatomic attachments of the Lisfranc ligament?

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

Correct Answer & Explanation

. Medial cuneiform to the base of the second metatarsal

Explanation

The Lisfranc ligament is a strong interosseous ligament that runs obliquely from the lateral aspect of the medial cuneiform to the medial aspect of the base of the second metatarsal, providing key stabilization to the midfoot.

Question 3691

Topic: 8. Foot and Ankle

A 40-year-old equestrian falls from a horse, landing with the foot in forced plantarflexion and abduction. Radiographs show a crushed and shortened cuboid with lateral column collapse. Which of the following is the most appropriate surgical treatment principle?

. Talonavicular arthrodesis
. Primary cuboid excision and isolated lateral column shortening
. Restoration of lateral column length with open reduction, bone grafting, and fixation
. Medial column shortening to match the lateral column
. First metatarsophalangeal arthrodesis

Correct Answer & Explanation

. Restoration of lateral column length with open reduction, bone grafting, and fixation

Explanation

A "nutcracker" fracture of the cuboid results in lateral column shortening. Treatment requires restoring the lateral column length to prevent late midfoot abduction deformity, typically via open reduction, structural bone grafting, and plate fixation.

Question 3692

Topic: 8. Foot and Ankle

Recent prospective randomized trials comparing nonoperative management with early functional rehabilitation versus operative repair for acute Achilles tendon ruptures have demonstrated which of the following?

. Significantly higher re-rupture rates in the nonoperative group
. Higher deep infection rates in the nonoperative group
. Similar functional outcomes and re-rupture rates between both groups
. Significantly increased plantarflexion strength in the nonoperative group
. Increased incidence of sural nerve injury in the nonoperative group

Correct Answer & Explanation

. Similar functional outcomes and re-rupture rates between both groups

Explanation

Recent high-quality level I evidence shows that with modern functional rehabilitation protocols (early weight-bearing in a boot), nonoperative and operative treatments of acute Achilles tendon ruptures yield similar functional outcomes and comparable re-rupture rates.

Question 3693

Topic: 8. Foot and Ankle

A 24-year-old skier catches an edge and forcefully dorsiflexes her inverted ankle. She notes a painful snapping sensation behind the lateral malleolus. Physical exam reveals a palpable clunk behind the fibula with active ankle eversion. Which of the following anatomic structures is primarily injured?

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

Correct Answer & Explanation

. Superior peroneal retinaculum

Explanation

Acute peroneal tendon subluxation or dislocation is typically caused by forceful dorsiflexion and inversion, leading to a tear or avulsion of the superior peroneal retinaculum (SPR) from the posterior ridge of the distal fibula.

Question 3694

Topic: 8. Foot and Ankle

A 35-year-old construction worker falls from a height and sustains a highly comminuted talar body fracture with complete extrusion of the talar body through an open wound. What is the most appropriate definitive management of the extruded talar body if it can be thoroughly debrided and cleansed?

. Discard the talar body and perform primary tibiocalcaneal arthrodesis
. Discard the talar body and perform a Blair fusion
. Reimplant the talar body and perform internal fixation
. Implant a custom 3D-printed talar prosthesis immediately
. Place an antibiotic spacer in the void and plan for delayed fusion

Correct Answer & Explanation

. Reimplant the talar body and perform internal fixation

Explanation

Current literature suggests that even in the setting of open extrusion, a thoroughly debrided and cleansed native talus should be reimplanted and stabilized. Reimplantation provides the best functional potential and preserves bone stock, with acceptable rates of infection.

Question 3695

Topic: 8. Foot and Ankle

A 27-year-old gymnast sustains a hyper-plantarflexion midfoot injury. Radiographs reveal a fracture-dislocation at the Chopart joint. This joint is composed of which two articulations?

. Talonavicular and calcaneocuboid
. Tarsometatarsal and intercuneiform
. Subtalar and talonavicular
. Calcaneocuboid and cuboid-metatarsal
. Talocalcaneal and tibiotalar

Correct Answer & Explanation

. Talonavicular and calcaneocuboid

Explanation

The Chopart joint, or transverse tarsal joint, serves as the transition between the hindfoot and midfoot. It is comprised of the talonavicular and calcaneocuboid articulations.

Question 3696

Topic: 8. Foot and Ankle

A 30-year-old active male presents with midfoot pain after an axial load injury to a plantarflexed foot. Weight-bearing radiographs demonstrate 4 mm of widening between the medial cuneiform and the base of the second metatarsal, with no associated fractures.

According to recent literature, what is the most appropriate surgical management for this patient?

. Closed reduction and percutaneous pinning
. Open reduction and internal fixation (ORIF) with transarticular screws
. Primary arthrodesis of the first, second, and third tarsometatarsal joints
. Dorsal bridge plating without joint decortication
. Suture button suspensionplasty

Correct Answer & Explanation

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

Explanation

Recent Level I evidence demonstrates that primary arthrodesis yields superior functional outcomes and lower reoperation rates compared to ORIF for purely ligamentous Lisfranc injuries. ORIF is typically reserved for primarily bony Lisfranc fracture-dislocations.

Question 3697

Topic: 8. Foot and Ankle

A 42-year-old weekend warrior sustains an acute Achilles tendon rupture. He elects for non-operative management. What rehabilitation protocol modification has been shown to result in re-rupture rates comparable to operative management?

. Strict non-weight-bearing in a cast for 8 weeks
. Early functional rehabilitation with protected early weight-bearing in equinus
. Casting in maximal dorsiflexion for 4 weeks followed by weight-bearing
. Immediate full weight-bearing without a boot
. Use of corticosteroid injections to accelerate healing

Correct Answer & Explanation

. Early functional rehabilitation with protected early weight-bearing in equinus

Explanation

Functional rehabilitation featuring early weight-bearing in an equinus cast or boot significantly reduces the re-rupture rate in non-operative management, making it comparable to surgical repair. Prolonged immobilization leads to worse functional outcomes.

Question 3698

Topic: 8. Foot and Ankle
A 35-year-old male sustains a Hawkins Type III talar neck fracture. Which of the following blood vessels is the primary vascular supply to the talar body and is at greatest risk of disruption in this injury?
. Artery of the tarsal sinus
. Artery of the tarsal canal
. Deltoid branch of the posterior tibial artery
. Dorsalis pedis artery
. Peroneal artery

Correct Answer & Explanation

. Artery of the tarsal canal

Explanation

The artery of the tarsal canal, a branch of the posterior tibial artery, supplies the majority of the talar body. It forms an anastomotic sling with the artery of the tarsal sinus (branch of the dorsalis pedis) beneath the talar neck.

Question 3699

Topic: 8. Foot and Ankle

During an extensile lateral approach for the open reduction and internal fixation of a displaced intra-articular calcaneus fracture, a nerve is at risk of iatrogenic injury at the proximal and distal extents of the incision. Which nerve is this?

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

Correct Answer & Explanation

. Sural nerve

Explanation

The sural nerve is at highest risk during the extensile lateral approach to the calcaneus. It runs posterior to the fibula, crosses the lateral border of the Achilles tendon, and runs parallel to the lateral border of the foot.

Question 3700

Topic: 8. Foot and Ankle

A 20-year-old collegiate track athlete complains of vague dorsal midfoot pain that worsens with sprinting. Plain radiographs are normal. A subsequent CT scan reveals an incomplete dorsal cortical fracture line in the navicular. What is the most appropriate initial management?

. Open reduction and internal fixation with a compression screw
. Non-weight-bearing in a short leg cast for 6 weeks
. Weight-bearing in a controlled ankle motion (CAM) boot for 4 weeks
. Bone stimulator and continued full weight-bearing
. Primary talonavicular arthrodesis

Correct Answer & Explanation

. Non-weight-bearing in a short leg cast for 6 weeks

Explanation

Incomplete navicular stress fractures are best treated initially with strict non-weight-bearing in a cast for 6 to 8 weeks. Surgery (ORIF) is generally reserved for complete, displaced fractures or cases that fail conservative management.

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