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8. Foot and Ankle MCQs

Practice Set 19 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 361

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.C orrect Answer: A purely ligamentous Lisfranc injury

Correct Answer & Explanation

. A purely ligamentous Lisfranc injury

Explanation

Question 362

Topic: Midfoot & Hindfoot

The joint contact area of the second tarsometatarsal joint after Lisfranc dislocation diminishes the greatest with:

. Dorsolateral subluxation
. Dorsal subluxation
. Lateral subluxation
. Medial subluxation
. Plantar subluxation

Correct Answer & Explanation

. Dorsolateral subluxation

Explanation

Minor degrees of displacement not apparent on plain radiographs lead to significant decrease in the contact area of the second tarsometatarsal joint. Dorsolateral subluxation of the second tarsometatarsal joint suffers a loss of contact area more severely than pure dorsal or lateral subluxation. Just 3 mm of dorsolateral subluxation causes a 38% loss of contact area.

Question 363

Topic: 8. Foot and Ankle
The "fleck sign" in midfoot injuries is a result of avulsion of the:
. Lisfranc ligament that extends from the first metatarsal base to the second metatarsal base
. Lisfranc ligament that extends from the middle cuneiform to the first metatarsal base
. Lisfranc ligament that extends from the medial cuneiform to the first metatarsal base
. Lisfranc ligament that extends from the medial cuneiform to the second metatarsal base
. Lisfranc ligament that extends from the lateral cuneiform to the third metatarsal base

Correct Answer & Explanation

. Lisfranc ligament that extends from the medial cuneiform to the second metatarsal base

Explanation

The fleck sign was described as an avulsion of the ligament that runs from the medial cuneiform to the base of the second metatarsal, the so-called Lisfranc ligament. It is considered pathognomonic for a tarsometatarsal injury.

Question 364

Topic: 8. Foot and Ankle
Following calcaneus fracture, risk factors for later need for subtalar arthrodesis due to painful posttraumatic arthritis include all of the following except:
. Bohler's angle <0°
. Sanders type IV fractures
. Workers' compensation
. Initial nonoperative care
. Female gender

Correct Answer & Explanation

. Female gender

Explanation

Buckley conducted a series of large prospective studies following calcaneus fracture outcomes in Canada. All of the above factors were associated with the need for later subtalar fusion except female gender. In his other studies, it was demonstrated that male gender was a risk factor for not having a significantly better clinical outcome with surgery versus nonsurgical treatment.

Question 365

Topic: 8. Foot and Ankle

During percutaneous repair of an acute Achilles tendon rupture, the sural nerve is at greatest risk of injury in which of the following areas?

. Medial to the tendon, 5 cm proximal to the insertion
. Lateral to the tendon, 10 cm proximal to the insertion
. Directly anterior to the tendon at the myotendinous junction
. Medial to the tendon, 15 cm proximal to the insertion
. Lateral to the tendon, 2 cm proximal to the insertion

Correct Answer & Explanation

. Lateral to the tendon, 10 cm proximal to the insertion

Explanation

The sural nerve crosses from the midline of the calf to the lateral border of the Achilles tendon approximately 10 cm proximal to its insertion on the calcaneus. Percutaneous sutures placed lateral to the tendon at this level carry the highest risk of nerve entrapment.

Question 366

Topic: 8. Foot and Ankle

When performing an open repair of an Achilles tendon rupture using a standard posteromedial approach, which of the following structures is at greatest risk of iatrogenic injury if the incision extends too far laterally or distally?

. Tibial nerve
. Sural nerve
. Posterior tibial artery
. Saphenous nerve
. Deep peroneal nerve

Correct Answer & Explanation

. Sural nerve

Explanation

The sural nerve courses distally along the posterolateral aspect of the calf, crossing the lateral border of the Achilles tendon roughly 10 cm proximal to its insertion. A posteromedial incision is utilized specifically to minimize the risk of injuring this nerve.

Question 367

Topic: 8. Foot and Ankle

Which of the following radiographic findings is considered pathognomonic for a Lisfranc injury?

. Avulsion fracture of the navicular tuberosity
. Fleck sign at the base of the second metatarsal
. Dorsal displacement of the cuboid
. Widening of the calcaneocuboid joint
. Fracture of the anterior process of the calcaneus

Correct Answer & Explanation

. Fleck sign at the base of the second metatarsal

Explanation

The 'fleck sign' represents an avulsion fracture of the Lisfranc ligament from the base of the second metatarsal. It is considered pathognomonic for a Lisfranc injury and indicates significant midfoot instability requiring operative stabilization.

Question 368

Topic: 8. Foot and Ankle

A patient develops isolated acute compartment syndrome of the anterior compartment of the lower leg. Which of the following clinical findings is most likely expected?

. Decreased sensation over the plantar aspect of the foot
. Weakness in foot inversion and plantar flexion
. Decreased sensation in the first dorsal web space
. Weakness of the flexor hallucis longus
. Loss of the Achilles tendon reflex

Correct Answer & Explanation

. Decreased sensation in the first dorsal web space

Explanation

The anterior compartment contains the deep peroneal nerve, which provides motor innervation to the tibialis anterior, EHL, and EDL, and sensory innervation to the first dorsal web space. Ischemia to this compartment results in decreased sensation in the first web space and weakness in ankle and toe dorsiflexion.

Question 369

Topic: 8. Foot and Ankle

When counseling a patient concerning the treatment of an acute Achilles tendon rupture, which of the following is true:

. The relative risk of rerupture is 10 times greater in patients treated nonoperatively.
. The relative risk of infection is five times greater in patients treated operatively.
. The relative risk of complications in the operative group is twice as high as those treated nonoperatively.
. The relative risk of rerupture is equal between the operative and nonoperative treatment.
. The relative risk of rerupture is two times higher with nonoperative treatment.

Correct Answer & Explanation

. The relative risk of rerupture is 10 times greater in patients treated nonoperatively.

Explanation

This meta-analysis showed: Operative versus nonoperative (pooled rates):

Question 370

Topic: 8. Foot and Ankle

Following open repair of an Achilles tendon rupture, which of the following is true:

. C asting alone has a lower risk or rerupture compared to casting followed by functional bracing.
. C asting alone has a higher rate of rerupture compared to casting followed by functional bracing.
. There is a higher complication rate in the group treated by casting followed by functional bracing compared to casting alone.
. C asting alone has a lower rerupture rate and complication rate compared to casting followed by functional bracing.
. C asting followed by functional bracing has an unacceptable rerupture rate.

Correct Answer & Explanation

. C asting alone has a higher rate of rerupture compared to casting followed by functional bracing.

Explanation

This meta-analysis showed: Postoperative splinting: cast alone compared with cast followed by functional bracing Rerupture Cast alone 5.0% (7/140) (relative risk 2.04) Cast followed by functional bracing 2.3% (3/133) Complications (adhesions, infection, disturbed sensibility): Cast alone 35.7% (50/140) (relative risk 1.88) Cast followed by functional bracing 19.5% (26/133)

Question 371

Topic: 8. Foot and Ankle
Which of the following is the most commonly accepted number of foot compartments?
. Three
. Five
. Eight
. Nine
. Twelve

Correct Answer & Explanation

. Nine

Explanation

The foot can be divided into nine distinct compartments. A. Calcaneal compartment: 1. Quadratus plantae, 2. Posterior tibial nerve, artery, and vein, 3. Lateral plantar nerve, artery, and vein, 4. Medial plantar nerve (variable). *Remember that the calcaneal compartment may communicate with the posterior tibial compartment. B. Interossei (four separate compartments). C. Adductor muscle. D. Medial: 1. Flexor hallucis brevis, 2. Abductor hallucis. E. Lateral: 1. Abductor digiti minimi, 2. Flexor digiti minimi. F. Superficial: 1. Flexor digitorum brevis, 2. Lumbricals (four), 3. Flexor digitorum longus, 4. Medial plantar nerve (variable).

Question 372

Topic: 8. Foot and Ankle
Which of the following structures is in the calcaneal compartment of the foot?
. Flexor hallucis
. Abductor digiti minimi
. Flexor digitorum longus
. Quadratus plantae
. Flexor digiti minimi

Correct Answer & Explanation

. Quadratus plantae

Explanation

The foot can be divided into nine distinct compartments. A. Calcaneal compartment: 1. Quadratus plantae, 2. Posterior tibial nerve, artery, and vein, 3. Lateral plantar nerve, artery, and vein, 4. Medial plantar nerve (variable). *Remember that the calcaneal compartment may communicate with the posterior tibial compartment. B. Interossei (four separate compartments). C. Adductor muscle. D. Medial: 1. Flexor hallucis, 2. Abductor hallucis. E. Lateral: 1. Abductor digiti minimi, 2. Flexor digiti minimi. F. Superficial: 1. Flexor digitorum brevis, 2. Lumbricals (four), 3. Flexor digitorum longus, 4. Medial plantar nerve (variable).

Question 373

Topic: 8. Foot and Ankle

Which of the following structures is in the medial compartment of the foot:

. Abductor digiti minimi
. Flexor digiti minimi
. Abductor hallucis
. Flexor digitorum brevis
. Flexor digitorum longus

Correct Answer & Explanation

. Flexor digitorum brevis

Explanation

The foot can be divided into nine distinct compartments. A. C alcaneal compartment 1. Quadratus plantae 2. Posterior tibial nerve, artery, and vein 3. Lateral plantar nerve, artery, and vein 4. Medial plantar nerve (variable) *Remember that the calcaneal compartment may communicate with the posterior tibial compartment. B. Interossei (four separate compartments) C . Adductor muscle D. Medial 1. Flexor hallucis 2. Abductor hallucis E. Lateral 1. Abductor digiti minimi 2. Flexor digiti minimi F. Superficial 1. Flexor digitorum brevis 2. Lumbricals (four) 3. Flexor digitorum longus 4. Medial plantar nerve (variable)

Question 374

Topic: 8. Foot and Ankle
Which of the following foot compartments communicates with the deep posterior tibial compartment?
. Medial
. Lateral
. Adductor
. Calcaneal
. Superficial

Correct Answer & Explanation

. Calcaneal

Explanation

The foot can be divided into nine distinct compartments. A. Calcaneal compartment: 1. Quadratus plantae, 2. Posterior tibial nerve, artery, and vein, 3. Lateral plantar nerve, artery, and vein, 4. Medial plantar nerve (variable). *Remember that the calcaneal compartment may communicate with the posterior tibial compartment. B. Interossei (four separate compartments). C. Adductor muscle. D. Medial: 1. Flexor hallucis, 2. Abductor hallucis. E. Lateral: 1. Abductor digiti minimi, 2. Flexor digiti minimi. F. Superficial: 1. Flexor digitorum brevis, 2. Lumbricals (four), 3. Flexor digitorum longus, 4. Medial plantar nerve (variable).

Question 375

Topic: 8. Foot and Ankle

Which of the following groups of muscles are located in the first layer of the foot muscles:

. Abductor hallucis, flexor digitorum brevis, quadratus plantae
. Flexor hallucis brevis, adductor hallucis, flexor digiti, minimi
. Abductor, hallucis, flexor digitorum brevis, abductor digiti minimi
. Quadratus plantae, lumbricals
. Abductor hallucis, quadratus plantae, lumbricals

Correct Answer & Explanation

. Abductor hallucis, flexor digitorum brevis, quadratus plantae

Explanation

The muscles of the foot and their innervations are as follows: Abbreviations: MPN=medial plantar nerve, LPN=lateral plantar nerve, MTPJ=metatarsophalangeal joint, PIP=proximal interphalangeal joint, and DIP=distal interphalangeal joint.

Question 376

Topic: 8. Foot and Ankle

Which of the following muscles are in the second layer of the foot:

. Abductor hallucis, flexor digitorum brevis, abductor digiti minimi
. Abductor hallucis, quadratus plantae
. Flexor hallucis brevis, abductor hallucis, flexor digiti minimi
. Quadratus plantae, lumbricals
. Plantar interossei, dorsal interossei

Correct Answer & Explanation

. Abductor hallucis, flexor digitorum brevis, abductor digiti minimi

Explanation

The muscles of the foot and their innervations are as follows: Abbreviations: MPN=medial plantar nerve, LPN=lateral plantar nerve, MTPJ=metatarsophalangeal joint, PIP=proximal interphalangeal joint, and DIP=distal interphalangeal joint.

Question 377

Topic: 8. Foot and Ankle

Which of the following groups of muscles are in the third layer of the foot:

. Abductor hallucis, flexor digitorum brevis, abductor digiti minimi
. Quadratus plantae, lumbricals
. Flexor hallucis brevis, adductor hallucis, flexor digiti minimi
. Flexor hallucis brevis, quadratus plantae, abductor digiti minimi
. Dorsal interossei, plantar interossei

Correct Answer & Explanation

. Abductor hallucis, flexor digitorum brevis, abductor digiti minimi

Explanation

The muscles of the foot and their innervations are as follows: Abbreviations: MPN=medial plantar nerve, LPN=lateral plantar nerve, MTPJ=metatarsophalangeal joint, PIP=proximal interphalangeal joint, and DIP=distal interphalangeal joint.

Question 378

Topic: 8. Foot and Ankle

Which of the following muscles are innervated by the medial plantar nerve:

. Abductor digiti minimi
. Adductor hallucis, flexor digitorum brevis
. Abductor hallucis, flexor digitorum brevis, flexor hallucis brevis, medial lumbrical
. Adductor hallucis, flexor digiti minimi, plantar interossei
. Plantar interossei, dorsal interossei

Correct Answer & Explanation

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

Explanation

The muscles of the foot and their innervations are as follows: Abbreviations: MPN=medial plantar nerve, LPN=lateral plantar nerve, MTPJ=metatarsophalangeal joint, PIP=proximal interphalangeal joint, and DIP=distal interphalangeal joint.

Question 379

Topic: 8. Foot and Ankle

Which of the following structures can cause chronic impingement-type posterior ankle pain athletes:

. Flexor digitorum longus
. Posterior tibialis
. Gastrocnemius soleus complex
. Peroneus longus
. Peroneus quartus

Correct Answer & Explanation

. Peroneus quartus

Explanation

Discussion Posterior impingent can be caused by anomalous muscles. The most common is the peroneus quartus. Here are some important points. Posterior ankle impingement-compression of the talus and surrounding soft tissues between the tibia and calcaneus A. C ause-forced or repetitive plantar flexion of the foot B. Occurs in dancers and athletes C . Presentation-pain in the medial or lateral aspect of the ankle posteriorly with activities, especially plantar flexion D. Physical examination-tenderness medial or lateral to the Achilles tendon E. Diagnosis is difficult to make and often missed because of the following: 1. Symptoms are reproduced by plantar flexion of the ankle 2. Injections can be performed to see if the injection relieves the symptoms Anomalous muscles about the ankle A. Most common is the peroneus quartus (prevalence of the muscle between 7% and 22%) 1. Arises from peroneus brevis and inserts into retrotrochlear eminence of the calcaneus B. Peroneocalcaneus internus (1%) 1. Arises from the fibula and inserts into under surface of sustentaculum tali C . Long accessory to the long flexors or quadratus plantae (1%-8%) D. Tibiocalcaneus internus E. Accessory soleus

Question 380

Topic: 8. Foot and Ankle
Which of the following may cause impingement-type posterior ankle pain in dancers?
. Gastrocnemius-soleus complex
. Posterior tibialis
. Peroneus longus
. Peroneus brevis
. Flexor hallucis longus

Correct Answer & Explanation

. Flexor hallucis longus

Explanation

Posterior ankle impingement is caused by compression of the talus and surrounding soft tissues between the tibia and calcaneus. In dancers, symptoms may be caused by a low-lying or enlarged flexor hallucis longus muscle. A. Causes: forced or repetitive plantar flexion of the foot. B. Occurs in dancers and athletes. C. Presentation: pain in the medial or lateral aspect of the ankle posteriorly with activities, especially plantar flexion. D. Physical examination: tenderness medial or lateral to the Achilles tendon. E. Diagnosis is difficult to make and often missed: 1. Symptoms are reproduced by plantar flexion of the ankle, 2. Injections can be performed to see if the injection relieves the symptoms. Causes of posterior impingement: Os trigonum, enlarged lateral process of the talus, enlarged posterior process of the calcaneus, posterior intermalleolar ligament, soft tissue impingement, loose bodies, ganglia, low-lying flexor hallucis longus muscle body, anomalous muscle bodies.

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