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8. Foot and Ankle MCQs

Practice Set 193 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 3841

Topic: 8. Foot and Ankle

A 30-year-old male sustains a knee dislocation (KD-III) in a high-velocity accident. After closed reduction, distal pulses are palpable but the ankle-brachial index (ABI) is measured at 0.8. What is the most appropriate next step in management?

. Observation and repeat ABI in 24 hours
. Immediate application of a spanning external fixator
. CT angiography of the lower extremity
. Prophylactic fasciotomies of the calf
. Immediate operative exploration of the popliteal artery

Correct Answer & Explanation

. Observation and repeat ABI in 24 hours

Explanation

In the setting of a knee dislocation, an Ankle-Brachial Index (ABI) less than 0.9 is indicative of a potential vascular injury and mandates advanced vascular imaging, most commonly a CT angiogram, to rule out a popliteal artery intimal tear or occlusion.

Question 3842

Topic: 8. Foot and Ankle

A 24-year-old male presents to the emergency department after a high-speed motorcycle accident. His knee is grossly unstable in multiple planes, and a knee dislocation is suspected. The Ankle-Brachial Index (ABI) is calculated to be 0.85. What is the most appropriate next step in management?

. Immediate surgical exploration of the popliteal artery
. CT angiography (CTA) of the lower extremity
. Duplex ultrasonography
. Serial ABI measurements every 4 hours
. Application of a spanning external fixator followed by discharge

Correct Answer & Explanation

. Immediate surgical exploration of the popliteal artery

Explanation

An ABI < 0.90 is highly sensitive for vascular injury in the setting of a knee dislocation. CT angiography is the gold standard next step to precisely delineate the location and extent of the popliteal artery injury before surgery.

Question 3843

Topic: 8. Foot and Ankle



A 32-year-old male presents with a grossly deformed knee after a motorcycle crash. Following closed reduction of an anterior knee dislocation, his pedal pulses are palpable and symmetric. His Ankle-Brachial Index (ABI) is calculated as 0.85. What is the most appropriate next step in management?

. Discharge with close outpatient follow-up
. Routine observation and serial neurovascular checks
. CT angiography of the lower extremity
. Immediate surgical exploration of the popliteal artery
. Urgent MRI of the knee

Correct Answer & Explanation

. Discharge with close outpatient follow-up

Explanation

An ABI of less than 0.9 in the setting of a knee dislocation is highly suspicious for an occult vascular injury, even if pedal pulses are palpable. CT angiography is immediately indicated to rule out a popliteal artery intimal tear or occlusion.

Question 3844

Topic: 8. Foot and Ankle

A 31-year-old male is brought to the emergency department after sustaining a traumatic knee dislocation during a rugby match. The knee was reduced on the field. On examination, the foot is warm, but the dorsalis pedis and posterior tibial pulses are palpable but asymmetric compared to the uninjured limb. The ankle-brachial index (ABI) is 0.85. What is the most appropriate next step in management?

. Immediate surgical exploration of the popliteal artery
. Application of a knee-spanning external fixator
. CT angiography of the lower extremity
. Discharge with a knee immobilizer and close outpatient follow-up
. Serial neurovascular checks every 4 hours without further imaging

Correct Answer & Explanation

. Immediate surgical exploration of the popliteal artery

Explanation

An ankle-brachial index (ABI) of less than 0.90 or asymmetric pulses following a knee dislocation raises high suspicion for a popliteal artery injury. A CT angiogram is indicated to definitively evaluate the vascular status before proceeding with surgical intervention.

Question 3845

Topic: 8. Foot and Ankle

A 34-year-old male is brought to the emergency department after a motorcycle accident. He has a visibly deformed knee that spontaneously reduces. Examination reveals a gross multiligamentous knee injury. His pedal pulses are palpable, but an ankle-brachial index (ABI) is measured at 0.85. What is the most appropriate next step in management?

. Immediate application of a spanning external fixator
. Discharge with a knee immobilizer and outpatient MRI
. CT angiography of the lower extremity
. Urgent surgical exploration of the popliteal artery
. Doppler ultrasound of the deep venous system

Correct Answer & Explanation

. Immediate application of a spanning external fixator

Explanation

In the setting of a knee dislocation, an ABI less than 0.90 is highly suspicious for a popliteal artery injury, even if pulses are palpable. A CT angiogram is indicated to evaluate for vascular compromise requiring possible surgical intervention.

Question 3846

Topic: 8. Foot and Ankle

A 30-year-old male sustains a posterior knee dislocation. After reduction, his ankle-brachial index (ABI) is measured at 0.85. What is the most appropriate next step in management?

. Discharge with crutches and outpatient follow-up
. Immediate surgical exploration of the popliteal artery
. CT angiography of the lower extremity
. Continuous passive motion machine
. Application of a hinged knee brace

Correct Answer & Explanation

. Discharge with crutches and outpatient follow-up

Explanation

Following a knee dislocation, an ABI < 0.9 is highly suggestive of a vascular injury and mandates further advanced imaging, usually CT angiography, to evaluate the popliteal artery. Immediate surgical exploration is reserved for hard signs of vascular injury like absent pulses or expanding hematoma.

Question 3847

Topic: 8. Foot and Ankle

A 30-year-old male is evaluated in the trauma bay after a high-speed motorcycle accident. He has a grossly deformed knee which is quickly reduced and splinted. His ankle-brachial index (ABI) is 0.85. What is the most appropriate next step in management?

. Immediate popliteal bypass surgery
. CT angiography of the lower extremity
. Discharge with a hinged knee brace
. Observation and repeat ABI in 4 hours
. Duplex ultrasonography of the lower extremity

Correct Answer & Explanation

. Immediate popliteal bypass surgery

Explanation

An ABI less than 0.9 following a knee dislocation is a strong indicator of a potential vascular injury. The most appropriate next step to definitively evaluate the popliteal artery in the absence of hard signs of ischemia is a CT angiogram.

Question 3848

Topic: 8. Foot and Ankle

A 26-year-old male is brought to the emergency department after a high-speed motorcycle accident. Examination reveals a grossly unstable knee with a suspected multi-ligamentous injury (knee dislocation). Distal pulses are palpable, but the ankle-brachial index (ABI) is 0.85. What is the most appropriate next step in management?

. Immediate surgical exploration of the popliteal artery
. Observation and repeat ABI in 4 hours
. CT angiography of the lower extremity
. Magnetic resonance angiography (MRA)
. Application of a spanning external fixator before vascular assessment

Correct Answer & Explanation

. Immediate surgical exploration of the popliteal artery

Explanation

An ABI < 0.90 in the setting of a knee dislocation suggests a high risk of vascular injury and warrants an immediate CT angiogram. Immediate surgical exploration is indicated only if there are hard signs of vascular ischemia, such as absent pulses or an expanding hematoma.

Question 3849

Topic: 8. Foot and Ankle



A 35-year-old man sustains an ultra-low velocity knee dislocation after a misstep. Following closed reduction in the emergency department, his ankle-brachial index (ABI) is measured at 0.7. What is the most appropriate next step in management?

. Immediate MRI of the knee to evaluate multi-ligament injury
. Urgent CT angiography of the lower extremity
. Application of a spanning external fixator and re-evaluation in 24 hours
. Immediate open ligamentous reconstruction
. Discharge with a hinged knee brace and 1-week follow-up

Correct Answer & Explanation

. Immediate MRI of the knee to evaluate multi-ligament injury

Explanation

An ABI less than 0.9 following a knee dislocation is highly suspicious for a popliteal artery injury. Urgent vascular evaluation, typically via CT angiography or formal arteriogram, is mandated to rule out limb-threatening ischemia before any definitive orthopedic intervention.

Question 3850

Topic: 8. Foot and Ankle

A 25-year-old male presents to the trauma bay after a motorcycle accident with a grossly deformed knee. Radiographs confirm an anterior knee dislocation. After prompt closed reduction, the patient has normal, symmetric distal pulses. Ankle-brachial index (ABI) is 0.85. What is the most appropriate next step in management?

. Observation and serial vascular checks
. CT angiography of the lower extremity
. Immediate surgical exploration of the popliteal artery
. Application of a hinged knee brace and discharge
. Venous duplex ultrasound

Correct Answer & Explanation

. Observation and serial vascular checks

Explanation

An ABI less than 0.9 in the setting of a knee dislocation is highly suspicious for a vascular injury, even if palpable pulses are present. CT angiography is urgently required to evaluate for a popliteal artery intimal tear or occlusion.

Question 3851

Topic: 8. Foot and Ankle

A 26-year-old male sustains an acute knee dislocation during a football game. The knee was reduced on the field. In the emergency department, his pedal pulses are palpable, but an ankle-brachial index (ABI) is measured at 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 spanning external fixator
. Duplex ultrasound in 24 hours

Correct Answer & Explanation

. Immediate surgical exploration of the popliteal artery

Explanation

In the setting of a knee dislocation, an ABI less than 0.9 or asymmetric pulses is considered a "soft" sign of vascular injury requiring advanced imaging, typically a CT angiogram. Immediate surgical exploration is reserved for "hard" signs of vascular injury, such as absent pulses or active pulsatile hemorrhage.

Question 3852

Topic: 8. Foot and Ankle

A 25-year-old male sustains a high-energy knee dislocation. Following closed reduction, the patient has absent dorsiflexion of the foot and decreased sensation in the first dorsal web space.

Which nerve is injured, and what is its anatomic course around the knee?

. Tibial nerve; runs medial to the popliteal artery
. Deep peroneal nerve; runs anterior to the fibular head
. Common peroneal nerve; runs posterior to the biceps femoris tendon
. Saphenous nerve; exits through the adductor canal
. Sural nerve; runs posterior to the lateral gastrocnemius

Correct Answer & Explanation

. Tibial nerve; runs medial to the popliteal artery

Explanation

The common peroneal nerve is frequently injured in multi-ligament knee injuries and dislocations. It anatomically courses posterior to the biceps femoris tendon before wrapping around the fibular neck.

Question 3853

Topic: 8. Foot and Ankle

A 35-year-old recreational basketball player sustains an acute Achilles tendon rupture. He opts for non-operative management. To optimize his clinical outcome and minimize the risk of re-rupture, which of the following is the most critical component of his non-operative protocol?

. Immediate immobilization in a short-leg cast in neutral dorsiflexion for 6 weeks
. Strict non-weight-bearing for 8 weeks followed by progressive stretching
. Early functional rehabilitation with weight-bearing in a functional brace with heel wedges
. Prolonged immobilization in an equinus cast for 12 weeks
. Immediate passive range of motion exercises starting in the first week without a brace

Correct Answer & Explanation

. Immediate immobilization in a short-leg cast in neutral dorsiflexion for 6 weeks

Explanation

Recent literature demonstrates that non-operative management of acute Achilles tendon ruptures using an early functional rehabilitation protocol (early weight-bearing in equinus bracing) yields re-rupture rates comparable to surgical repair, while avoiding surgical complications.

Question 3854

Topic: Ankle Trauma & Sports

A 21-year-old wide receiver sustains a forceful external rotation injury to his ankle. Examination reveals tenderness over the anterior inferior tibiofibular ligament (AITFL) and a positive squeeze test. Radiographs show a tibiofibular clear space of 7 mm. What is the most appropriate treatment?

. Immediate return to play with taping
. Functional rehabilitation and return to play in 2-4 weeks
. Short-leg cast immobilization for 6 weeks
. Surgical stabilization of the syndesmosis
. Anterior talofibular ligament (ATFL) repair

Correct Answer & Explanation

. Immediate return to play with taping

Explanation

A tibiofibular clear space >5 mm on AP or mortise radiographs indicates a syndesmotic injury with frank diastasis. Operative stabilization (using screws or suture-button constructs) is required to restore the mortise and prevent post-traumatic arthritis.

Question 3855

Topic: Ankle Trauma & Sports

A 19-year-old collegiate soccer player sustains a high ankle sprain. On evaluation 3 weeks post-injury, he is pain-free with walking but unable to run. Weight-bearing CT is utilized to assess the syndesmosis. Which finding would most strongly indicate the need for surgical stabilization?

. Subchondral sclerosis of the tibial plafond
. Asymmetry of the syndesmotic area compared to the contralateral side > 2 mm
. Thickening of the AITFL
. Anterior talofibular ligament (ATFL) discontinuity
. Calcification of the interosseous membrane

Correct Answer & Explanation

. Subchondral sclerosis of the tibial plafond

Explanation

Weight-bearing CT is highly sensitive for detecting subtle syndesmotic instability. Asymmetry in the syndesmotic clear space, volume, or area (e.g., >2 mm side-to-side difference) under weight-bearing loads indicates a dynamic instability that warrants surgical fixation.

Question 3856

Topic: 8. Foot and Ankle

A 35-year-old male "weekend warrior" suffers an acute Achilles tendon rupture. When discussing operative repair versus non-operative management with an early functional rehabilitation protocol, what should the patient be counseled regarding outcomes?

. Operative treatment has a significantly higher re-rupture rate.
. Non-operative treatment has a higher rate of deep infection.
. Re-rupture rates are similar, but operative treatment has a higher risk of wound complications.
. Operative treatment results in significantly less plantarflexion strength.
. Non-operative treatment requires 12 weeks of strict cast immobilization.

Correct Answer & Explanation

. Operative treatment has a significantly higher re-rupture rate.

Explanation

Recent high-level evidence shows that when early functional rehabilitation is utilized, re-rupture rates are similar between operative and non-operative groups. However, operative management carries a higher risk of wound complications and sural nerve injury.

Question 3857

Topic: 8. Foot and Ankle

A 23-year-old alpine skier presents with lateral ankle pain and a snapping sensation behind the lateral malleolus when dorsiflexing and everting the foot against resistance. What is the primary structure injured in this clinical presentation?

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

Correct Answer & Explanation

. Inferior extensor retinaculum

Explanation

The clinical presentation is classic for peroneal tendon subluxation. The primary restraint to peroneal tendon subluxation is the superior peroneal retinaculum (SPR), which is typically avulsed from the lateral malleolus.

Question 3858

Topic: Ankle Trauma & Sports

A 19-year-old female gymnast with chronic lateral ankle instability fails non-operative management and is indicated for a modified Broström procedure. The Gould modification of this procedure involves advancing which structure to reinforce the repair?

. Peroneus brevis tendon
. Inferior extensor retinaculum
. Superior peroneal retinaculum
. Plantaris tendon
. Calcaneofibular ligament

Correct Answer & Explanation

. Peroneus brevis tendon

Explanation

The standard Broström procedure involves anatomic repair of the ATFL and CFL. The Gould modification reinforces this repair by advancing the extensor retinaculum (specifically the inferior portion) over the repaired ligaments.

Question 3859

Topic: 8. Foot and Ankle

A 22-year-old hockey player presents with severe lateral ankle pain after an eversion twisting injury. The squeeze test is positive, and radiographs reveal a widened tibiofibular clear space. Which ligament is the primary restraint to anterior translation of the distal fibula?

. Anterior inferior tibiofibular ligament (AITFL)
. Posterior inferior tibiofibular ligament (PITFL)
. Interosseous ligament
. Calcaneofibular ligament
. Anterior talofibular ligament

Correct Answer & Explanation

. Anterior inferior tibiofibular ligament (AITFL)

Explanation

The AITFL is the primary restraint to anterior translation of the distal fibula relative to the tibia. It is the most commonly disrupted structure in syndesmotic (high ankle) sprains, which are typically caused by an external rotation force.

Question 3860

Topic: 8. Foot and Ankle

A 35-year-old male weekend warrior sustains an acute Achilles tendon rupture while playing basketball. He elects to pursue non-operative management. What rehabilitation protocol has been shown in Level I studies to optimize functional outcomes and minimize re-rupture rates?

. 8 weeks of strict cast immobilization in maximal equinus
. Early functional rehabilitation with weight-bearing in a functional brace
. 6 weeks of strict non-weight-bearing in a neutral walking boot
. Serial casting initiated in dorsiflexion to stretch the gastrocnemius
. Initial 4 weeks of strict bed rest followed by aggressive physical therapy

Correct Answer & Explanation

. 8 weeks of strict cast immobilization in maximal equinus

Explanation

Recent Level I evidence demonstrates that dynamic functional rehabilitation with early weight-bearing provides equivalent functional outcomes and re-rupture rates to operative repair for acute Achilles tendon ruptures. This approach significantly reduces the risk of surgical wound complications.

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