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8. Foot and Ankle MCQs

Practice Set 188 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 3741

Topic: 8. Foot and Ankle

A 58-year-old man with poorly controlled diabetes presents with a red, hot, swollen right foot for 2 weeks. He denies trauma or skin ulceration. Radiographs show soft tissue swelling but no bony destruction or periosteal reaction. Inflammatory markers are within normal limits. What is the most appropriate initial management?

. Intravenous broad-spectrum antibiotics
. Total contact casting and strict non-weight-bearing
. Incision and drainage of the midfoot
. Magnetic resonance imaging (MRI) of the foot
. Prophylactic midfoot arthrodesis

Correct Answer & Explanation

. Total contact casting and strict non-weight-bearing

Explanation

The clinical presentation is highly suspicious for acute Eichenholtz stage 0 Charcot arthropathy. In the absence of an ulcer or systemic signs of infection, the gold standard for initial management is strict immobilization and offloading with a total contact cast to prevent subsequent bony destruction.

Question 3742

Topic: 8. Foot and Ankle

A 45-year-old runner is prescribed levofloxacin for pneumonia. He subsequently experiences an acute Achilles tendon rupture. What is the proposed mechanism by which fluoroquinolones induce tendinopathy and tendon rupture?

. Upregulation of matrix metalloproteinases (MMPs) and decreased type I collagen synthesis
. Direct inhibition of cross-linking between collagen fibrils
. Ischemic necrosis secondary to microvascular thrombosis
. Accumulation of advanced glycation end-products (AGEs)
. Competitive inhibition of vitamin C-dependent prolyl hydroxylase

Correct Answer & Explanation

. Upregulation of matrix metalloproteinases (MMPs) and decreased type I collagen synthesis

Explanation

Fluoroquinolones have a direct toxic effect on tenocytes, leading to an upregulation of matrix metalloproteinases (MMPs) and decreased synthesis of type I collagen and proteoglycans. This degradation of the extracellular matrix severely weakens the tendon.

Question 3743

Topic: 8. Foot and Ankle

During a minimally invasive repair of an acute Achilles tendon rupture, the sural nerve is at greatest risk of iatrogenic injury at what location relative to the calcaneal tuberosity?

. 2 cm proximal to the tuberosity
. 6 cm proximal to the tuberosity
. 10 cm proximal to the tuberosity
. 14 cm proximal to the tuberosity
. 18 cm proximal to the tuberosity

Correct Answer & Explanation

. 2 cm proximal to the tuberosity

Explanation

The sural nerve crosses from the posterolateral to the lateral border of the Achilles tendon approximately 10 to 12 cm proximal to its insertion. Percutaneous or minimally invasive sutures placed at this level pose the highest risk of iatrogenic nerve entrapment.

Question 3744

Topic: 8. Foot and Ankle

A surgeon is performing an open release of the tarsal tunnel. Based on the anatomical arrangement of structures passing posterior to the medial malleolus, what structure lies immediately posterior to the flexor digitorum longus (FDL) tendon?

. Tibialis posterior tendon
. Flexor hallucis longus tendon
. Posterior tibial artery
. Tibial nerve
. Posterior tibial vein

Correct Answer & Explanation

. Tibialis posterior tendon

Explanation

The contents of the tarsal tunnel from anterior to posterior are the Tibialis posterior tendon, FDL tendon, Posterior tibial Artery, Vein, Nerve, and FHL tendon (Tom, Dick, AND Very Nervous Harry). The artery is immediately posterior to the FDL tendon.

Question 3745

Topic: 8. Foot and Ankle

A patient suffers a traumatic dislocation of the knee resulting in injury to the common peroneal nerve. If the deep peroneal branch fails to recover, the patient will exhibit weakness in dorsiflexion and sensory loss over which specific area?

. Plantar aspect of the first toe
. Dorsal aspect of the first web space
. Lateral aspect of the foot
. Medial aspect of the longitudinal arch
. Dorsal aspect of the lateral three toes

Correct Answer & Explanation

. Plantar aspect of the first toe

Explanation

The deep peroneal nerve provides motor innervation to the anterior compartment of the leg (dorsiflexion) and sensory innervation to the dorsal aspect of the first web space. The superficial peroneal nerve supplies the dorsum of the foot outside the first web space.

Question 3746

Topic: 8. Foot and Ankle

Tarsal tunnel syndrome can lead to entrapment of the terminal branches of the tibial nerve. The medial plantar nerve innervates which of the following groups of intrinsic foot muscles?

. Abductor hallucis, flexor hallucis brevis, flexor digitorum brevis, first lumbrical
. Abductor digiti minimi, quadratus plantae, second lumbrical
. Dorsal interossei, plantar interossei, adductor hallucis
. Flexor digiti minimi brevis, lateral three lumbricals
. Extensor digitorum brevis, extensor hallucis brevis

Correct Answer & Explanation

. Abductor hallucis, flexor hallucis brevis, flexor digitorum brevis, first lumbrical

Explanation

The medial plantar nerve provides motor innervation to four intrinsic muscles: the abductor hallucis, flexor digitorum brevis, flexor hallucis brevis, and the first lumbrical. It is analogous to the median nerve in the hand.

Question 3747

Topic: Midfoot & Hindfoot

A 45-year-old runner with chronic heel pain undergoes surgical release. The surgeon targets the first branch of the lateral plantar nerve. This nerve courses between which two muscles?

. Abductor hallucis and quadratus plantae
. Flexor digitorum brevis and plantar fascia
. Abductor digiti minimi and flexor digiti minimi brevis
. Tibialis posterior and flexor digitorum longus
. Quadratus plantae and adductor hallucis

Correct Answer & Explanation

. Abductor hallucis and quadratus plantae

Explanation

The first branch of the lateral plantar nerve (Baxter's nerve) runs between the deep fascia of the abductor hallucis and the medial belly of the quadratus plantae before innervating the abductor digiti minimi.

Question 3748

Topic: 8. Foot and Ankle

During a minimally invasive Achilles tendon repair, the sural nerve is at greatest risk of iatrogenic injury at which location relative to the Achilles tendon?

. It crosses from medial to lateral 10 cm proximal to the insertion
. It is adjacent to the lateral border of the tendon at its insertion
. It crosses from midline to lateral 10 cm proximal to the insertion
. It crosses from lateral to midline 5 cm proximal to the insertion
. It remains 2 cm medial to the tendon throughout its course

Correct Answer & Explanation

. It crosses from medial to lateral 10 cm proximal to the insertion

Explanation

The sural nerve courses distally down the posterior calf and crosses from the midline to the lateral aspect of the Achilles tendon approximately 10 cm proximal to the calcaneal insertion.

Question 3749

Topic: 8. Foot and Ankle

Inside the tarsal tunnel, the tibial nerve bifurcates into the medial and lateral plantar nerves. Which of the following statements correctly describes the anatomical relationship of the neurovascular structures beneath the flexor retinaculum from anterior to posterior?

. Tibialis posterior, FDL, posterior tibial artery, tibial nerve, FHL
. FDL, Tibialis posterior, tibial nerve, posterior tibial artery, FHL
. Tibialis posterior, FHL, posterior tibial artery, tibial nerve, FDL
. Posterior tibial artery, tibial nerve, tibialis posterior, FDL, FHL
. FHL, tibial nerve, posterior tibial artery, FDL, tibialis posterior

Correct Answer & Explanation

. Tibialis posterior, FDL, posterior tibial artery, tibial nerve, FHL

Explanation

The contents of the tarsal tunnel from anterior to posterior follow the mnemonic Tom, Dick, And Very Nervous Harry: Tibialis posterior, flexor Digitorum longus, posterior tibial Artery, posterior tibial Vein, tibial Nerve, flexor Hallucis longus.

Question 3750

Topic: 8. Foot and Ankle

During a direct lateral approach to the distal fibula for an ORIF, the superficial peroneal nerve must be protected. Where does this nerve typically penetrate the crural fascia to become subcutaneous?

. 3 cm distal to the fibular head
. 10 to 12 cm proximal to the lateral malleolus
. Directly posterior to the lateral malleolus
. Directly anterior to the medial malleolus
. Within the mid-substance of the peroneus brevis

Correct Answer & Explanation

. 3 cm distal to the fibular head

Explanation

The superficial peroneal nerve typically pierces the deep crural fascia of the lateral compartment approximately 10 to 12 cm proximal to the tip of the lateral malleolus. It then courses subcutaneously to provide sensation to the dorsum of the foot.

Question 3751

Topic: 8. Foot and Ankle

During a medial approach to the foot, the branches of the posterior tibial nerve must be identified. The medial plantar nerve provides motor innervation to which of the following muscles?

. Abductor digiti minimi
. Quadratus plantae
. Adductor hallucis
. Abductor hallucis
. Dorsal interossei

Correct Answer & Explanation

. Abductor digiti minimi

Explanation

The medial plantar nerve innervates the abductor hallucis, flexor digitorum brevis, flexor hallucis brevis, and the first lumbrical. The lateral plantar nerve innervates the remaining intrinsic muscles listed.

Question 3752

Topic: Midfoot & Hindfoot

A 50-year-old runner presents with chronic heel pain refractory to conservative management. Entrapment of the first branch of the lateral plantar nerve (Baxter's nerve) is suspected. Which muscle is predominantly innervated by this specific nerve branch?

. Abductor hallucis
. Flexor digitorum brevis
. Abductor digiti minimi
. Quadratus plantae
. Adductor hallucis

Correct Answer & Explanation

. Abductor hallucis

Explanation

Baxter's nerve, the first branch of the lateral plantar nerve, provides motor innervation to the abductor digiti minimi. Entrapment commonly occurs as the nerve passes between the deep fascia of the abductor hallucis and the quadratus plantae.

Question 3753

Topic: 8. Foot and Ankle

A 32-year-old marathon runner presents with chronic, recalcitrant medial heel pain that radiates into the plantar aspect of the foot. A diagnostic injection relieves the pain, suggesting entrapment of the first branch of the lateral plantar nerve. This nerve normally courses between which two structures?

. Abductor hallucis and quadratus plantae
. Medial and lateral plantar nerves
. Plantar fascia and flexor digitorum brevis
. Flexor hallucis longus and flexor digitorum longus
. Medial calcaneal tuberosity and the plantar aponeurosis

Correct Answer & Explanation

. Abductor hallucis and quadratus plantae

Explanation

Baxter's nerve (the first branch of the lateral plantar nerve) typically becomes entrapped as it passes deep to the abductor hallucis and then between the quadratus plantae and the flexor digitorum brevis muscles.

Question 3754

Topic: 8. Foot and Ankle

During an extensile lateral approach for a comminuted calcaneus fracture, the surgeon must carefully identify and protect a nerve that provides sensation to the lateral border of the foot. What is the normal anatomical course of this nerve at the level of the ankle?

. It courses anterior to the lateral malleolus
. It courses posterior to the medial malleolus
. It courses posterior to the lateral malleolus alongside the short saphenous vein
. It courses posterior to the lateral malleolus alongside the great saphenous vein
. It lies deep to the superior peroneal retinaculum

Correct Answer & Explanation

. It courses anterior to the lateral malleolus

Explanation

The sural nerve provides sensation to the lateral aspect of the foot. It descends posterior to the lateral malleolus in close proximity to the short (small) saphenous vein.

Question 3755

Topic: 8. Foot and Ankle

During a plantar approach to the foot for a compartment release, the surgeon encounters the "Master Knot of Henry." Which two tendons cross at this anatomical landmark?

. Flexor hallucis longus and flexor digitorum longus
. Tibialis posterior and flexor digitorum longus
. Tibialis anterior and tibialis posterior
. Peroneus longus and flexor hallucis longus
. Flexor hallucis brevis and flexor digitorum longus

Correct Answer & Explanation

. Flexor hallucis longus and flexor digitorum longus

Explanation

The Master Knot of Henry is located in the medial plantar midfoot where the flexor hallucis longus tendon crosses dorsal to the flexor digitorum longus tendon.

Question 3756

Topic: 8. Foot and Ankle

A 22-year-old football player sustains a midfoot injury. The Lisfranc ligament is crucial for midfoot stability. What are the true bony attachments of the Lisfranc ligament?

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

Correct Answer & Explanation

. Medial cuneiform to the first metatarsal base

Explanation

The Lisfranc ligament connects the lateral aspect of the medial cuneiform to the medial base of the second metatarsal, providing critical stability to the tarsometatarsal joint complex.

Question 3757

Topic: 8. Foot and Ankle

A patient complains of lateral leg pain and numbness over the dorsum of the foot following a fibular fracture. The superficial peroneal nerve typically pierces the deep fascia to become subcutaneous at what location?

. Proximal third of the lateral leg
. Middle and distal third junction of the lateral leg
. Posterior to the lateral malleolus
. Anterior to the medial malleolus
. Directly over the fibular head

Correct Answer & Explanation

. Proximal third of the lateral leg

Explanation

The superficial peroneal nerve pierces the deep crural fascia at the junction of the middle and distal thirds of the lateral leg to provide sensory innervation to the dorsum of the foot.

Question 3758

Topic: 8. Foot and Ankle

During a surgical release for tarsal tunnel syndrome, the flexor retinaculum is divided. What is the normal anatomic order of structures passing behind the medial malleolus, from anterior to posterior?

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

Correct Answer & Explanation

. Tibialis posterior, Flexor digitorum longus, Posterior tibial artery, Posterior tibial nerve, Flexor hallucis longus

Explanation

The order of structures from anterior to posterior is Tom, Dick, AND Very Nervous Harry: Tibialis posterior, Flexor Digitorum Longus, Artery (Posterior tibial), Vein, Nerve (Posterior tibial), and Flexor Hallucis Longus.

Question 3759

Topic: 8. Foot and Ankle

In evaluating a patient with a midfoot injury, the Lisfranc ligament is identified on MRI. This ligament securely connects which two osseous structures?

. Medial cuneiform to the base of the first metacarpal
. 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 first metacarpal

Explanation

The Lisfranc ligament is a strong interosseous ligament that connects the lateral aspect of the medial cuneiform to the medial base of the second metatarsal. It is the primary stabilizer of the second tarsometatarsal joint.

Question 3760

Topic: 8. Foot and Ankle
In a severe talar neck fracture (Hawkins Type III), the body of the talus is at high risk for avascular necrosis. The primary blood supply to the talar body enters via the artery of the tarsal canal, which is a direct branch of the:
. Anterior tibial artery
. Posterior tibial artery
. Peroneal artery
. Dorsalis pedis artery
. Medial plantar artery

Correct Answer & Explanation

. Posterior tibial artery

Explanation

The artery of the tarsal canal is a branch of the posterior tibial artery and provides the dominant blood supply to the body of the talus.

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