Menu

8. Foot and Ankle MCQs

Practice Set 196 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 3901

Topic: 8. Foot and Ankle

A 65-year-old diabetic patient presents with a recurrent neuropathic ulcer beneath the first metatarsal head despite compliant use of a total contact cast and custom orthotics. Examination reveals that ankle dorsiflexion is limited to 5 degrees of plantarflexion when the knee is fully extended, and remains limited to 5 degrees of plantarflexion when the knee is flexed to 90 degrees. What is the most appropriate surgical intervention?

. Tibialis anterior tendon transfer
. Isolated gastrocnemius recession
. Achilles tendon lengthening
. First metatarsophalangeal arthrodesis
. First ray amputation

Correct Answer & Explanation

. Tibialis anterior tendon transfer

Explanation

The patient has a positive Silfverskiöld test demonstrating equinus contracture with both the knee extended and flexed, indicating combined gastrocnemius-soleus tightness. An Achilles tendon lengthening (TAL) is indicated to reduce forefoot pressures and aid ulcer healing.

Question 3902

Topic: 8. Foot and Ankle

Operative reconstruction (e.g., corrective arthrodesis) for a patient with midfoot Charcot neuroarthropathy is most commonly indicated and safely performed during which Eichenholtz stage?

. Stage 0 (Prodromal)
. Stage I (Fragmentation)
. Stage II (Coalescence)
. Stage III (Consolidation)
. Prophylactically prior to clinical symptoms

Correct Answer & Explanation

. Stage 0 (Prodromal)

Explanation

Major reconstructive surgery for Charcot foot is ideally delayed until the consolidation phase (Eichenholtz Stage III), when the active inflammatory process has resolved. Operating during the acute fragmentation phase carries a high risk of failure and hardware pullout.

Question 3903

Topic: 8. Foot and Ankle

A 62-year-old patient with poorly controlled type 2 diabetes and profound peripheral neuropathy sustains a displaced bimalleolar ankle fracture. Which of the following modifications to standard internal fixation is most strongly recommended to minimize catastrophic complications?

. Standard fixation with 6 weeks of non-weight-bearing
. Use of bioabsorbable implants to reduce infection risk
. Enhanced rigid fixation with prolonged non-weight-bearing for 10-12 weeks
. Immediate weight-bearing in a total contact cast
. Primary below-knee amputation

Correct Answer & Explanation

. Standard fixation with 6 weeks of non-weight-bearing

Explanation

Diabetic patients with neuropathy are at high risk for Charcot arthropathy, nonunion, and hardware failure following ankle fractures. Enhanced rigid fixation (e.g., multiple syndesmotic screws, supplementary K-wires, or locked plating) combined with prolonged non-weight-bearing is recommended to minimize catastrophic loss of fixation.

Question 3904

Topic: 8. Foot and Ankle

A 55-year-old man with a 15-year history of diabetes presents with a red, swollen, and warm right foot. He denies trauma or fevers. Radiographs show periarticular debris, fragmentation of the tarsometatarsal joints, and subluxation. What is the most appropriate initial management?

. Immediate open reduction and internal fixation
. Intravenous antibiotics and bone biopsy
. Incision and drainage
. Total contact casting and non-weight-bearing
. Midfoot arthrodesis with a rigid plate

Correct Answer & Explanation

. Immediate open reduction and internal fixation

Explanation

This patient presents with acute Eichenholtz Stage I Charcot neuroarthropathy, characterized by fragmentation and debris in the setting of neuropathy. The most appropriate initial management for the acute, active phase is immobilization with a total contact cast and strict non-weight-bearing.

Question 3905

Topic: 8. Foot and Ankle

A 65-year-old poorly controlled diabetic with severe peripheral neuropathy sustains a closed, displaced bimalleolar equivalent ankle fracture. He undergoes stable open reduction and internal fixation. What is the most appropriate postoperative weight-bearing protocol for this specific patient?

. Non-weight bearing for 2 weeks
. Non-weight bearing for 6 weeks
. Non-weight bearing for 10 to 12 weeks
. Immediate weight-bearing as tolerated in a CAM boot
. Immediate weight-bearing as tolerated in a total contact cast

Correct Answer & Explanation

. Non-weight bearing for 2 weeks

Explanation

Diabetic patients with peripheral neuropathy undergoing ankle fracture fixation have a significantly higher risk of hardware failure, infection, and Charcot arthropathy. Extended periods of non-weight bearing, typically 10-12 weeks or double the standard duration, are recommended to prevent catastrophic mechanical failure.

Question 3906

Topic: Midfoot & Hindfoot

A 58-year-old male with long-standing diabetes presents with a red, hot, swollen unilateral foot without open wounds. Radiographs show periarticular fragmentation and subluxation at the tarsometatarsal joints. What is the most appropriate initial management?

. Intravenous antibiotics
. Total contact casting and strict non-weight bearing
. Open reduction and internal fixation of the midfoot
. Primary midfoot arthrodesis
. Immediate MRI to rule out osteomyelitis

Correct Answer & Explanation

. Intravenous antibiotics

Explanation

The patient is in Eichenholtz Stage I (fragmentation) of acute Charcot arthropathy. The gold standard for initial management of acute Charcot without deep ulceration is immobilization via total contact casting and strict non-weight bearing to halt deformity progression.

Question 3907

Topic: 8. Foot and Ankle

A 32-year-old male sustains a pronation-external rotation (PER) ankle fracture. Intraoperatively, after medial and lateral malleolar fixation, the Cotton test is positive indicating syndesmotic instability. When placing a syndesmotic screw, what is the optimal ankle position and screw technique?

. Neutral dorsiflexion, lag technique
. Maximum plantarflexion, position screw technique
. Maximum plantarflexion, lag technique
. Maximum dorsiflexion, lag technique
. Neutral to maximal dorsiflexion, position screw technique

Correct Answer & Explanation

. Neutral dorsiflexion, lag technique

Explanation

Syndesmotic screws should be placed as position screws (not lagged) to maintain the relationship of the fibula in the incisura without over-compression. The ankle should be held in neutral or maximum dorsiflexion during placement to accommodate the wider anterior aspect of the talar dome.

Question 3908

Topic: 8. Foot and Ankle

A 28-year-old male presents with a severe ankle injury following a fall. Closed reduction in the emergency department is unsuccessful. Radiographs show a distinct fracture-dislocation of the ankle.

Which of the following pathoanatomic features most likely prevents closed reduction in this specific injury pattern?

. Interposition of the posterior tibial tendon
. Entrapment of the proximal fibular fragment behind the posterior lateral tubercle of the tibia
. Interposition of the deltoid ligament in the medial gutter
. Impaction of the talus into the central tibial plafond
. Spasm of the peroneus brevis tendon

Correct Answer & Explanation

. Interposition of the posterior tibial tendon

Explanation

A Bosworth fracture-dislocation is characterized by the proximal fragment of the fibula becoming entrapped behind the posterior lateral tubercle of the tibia. This osseous entrapment creates an anatomic block that makes closed reduction impossible, necessitating emergent open reduction.

Question 3909

Topic: 8. Foot and Ankle

A 55-year-old diabetic man presents with a plantar midfoot ulceration measuring 2 cm in diameter. Which of the following is an absolute contraindication to the use of a total contact cast for offloading this patient's ulcer?

. Mild peripheral sensorimotor neuropathy
. Palpable dorsalis pedis and posterior tibial pulses
. Wagner Grade 1 classification of the ulceration
. Active purulent drainage and a deep suspected abscess
. Previous history of a healed contralateral ulcer

Correct Answer & Explanation

. Mild peripheral sensorimotor neuropathy

Explanation

Total contact casting (TCC) strictly relies on offloading the foot to heal neuropathic ulcers. The presence of active deep infection, purulence, or severe ischemia is an absolute contraindication, as the enclosed cast environment can lead to rapid soft tissue destruction and systemic sepsis.

Question 3910

Topic: Ankle Trauma & Sports

A 40-year-old male sustains an ankle fracture. Radiographs reveal a transverse fracture of the medial malleolus and a high spiral fracture of the fibula above the syndesmosis (Weber C).

According to the Lauge-Hansen classification, what was the mechanism of injury?

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

Correct Answer & Explanation

. Supination-External Rotation

Explanation

A transverse medial malleolus fracture combined with a high or short oblique fibular fracture (Weber C) is the classic hallmark of a Pronation-External Rotation (PER) injury. The mechanism initiates medially with a tension failure (deltoid tear or transverse medial malleolus fracture) and progresses laterally through the syndesmosis.

Question 3911

Topic: Midfoot & Hindfoot

A 45-year-old female sustains a purely ligamentous Lisfranc injury with 3 mm of displacement between the medial and middle cuneiforms. She has no significant past medical history. Which surgical treatment has been shown in prospective studies to yield superior functional outcomes and a lower rate of revision compared to traditional open reduction and internal fixation (ORIF)?

. Closed reduction and percutaneous pinning
. Primary arthrodesis of the affected tarsometatarsal joints
. Non-weight-bearing cast immobilization for 8 weeks
. Dorsal bridge plating without joint decortication
. Suture button fixation across the Lisfranc interval

Correct Answer & Explanation

. Closed reduction and percutaneous pinning

Explanation

Prospective randomized trials have demonstrated that primary arthrodesis for purely ligamentous Lisfranc injuries results in superior functional outcomes and lower revision rates compared to traditional ORIF.

Question 3912

Topic: 8. Foot and Ankle

A 35-year-old male presents with persistent lateral foot pain 18 months after nonoperative management of a displaced intra-articular calcaneus fracture. Examination reveals localized tenderness inferior to the lateral malleolus, swelling, and pain exacerbated by passive foot inversion and active eversion. What is the most likely etiology of his current symptoms?

. Subtalar post-traumatic osteoarthritis
. Sural nerve entrapment neuritis
. Peroneal tendon impingement
. Tibiotalar post-traumatic osteoarthritis
. Anterior process nonunion

Correct Answer & Explanation

. Subtalar post-traumatic osteoarthritis

Explanation

Lateral wall blowout from a conservatively managed calcaneus fracture can cause subfibular impingement of the peroneal tendons, presenting with lateral pain and mechanical symptoms during active eversion.

Question 3913

Topic: Midfoot & Hindfoot

A 55-year-old patient with long-standing, poorly controlled type 2 diabetes presents with a unilaterally red, hot, and swollen right midfoot. There are no open ulcerations. Radiographs reveal acute bone fragmentation, periarticular debris, and joint subluxation at the midfoot. What is the most appropriate initial management?

. Intravenous antibiotics and bone biopsy
. Immediate open reduction and internal fixation of the midfoot
. Total contact casting and strict offloading
. Below-knee amputation
. Surgical debridement and application of a spanning external fixator

Correct Answer & Explanation

. Intravenous antibiotics and bone biopsy

Explanation

This presentation is classic for Eichenholtz Stage I (Acute/Fragmentation) Charcot neuroarthropathy. The gold standard for initial management in the absence of an open wound or deep infection is immediate offloading with a total contact cast.

Question 3914

Topic: Midfoot & Hindfoot

A 62-year-old woman presents with progressive flattening of her left medial longitudinal arch and medial hindfoot pain. On examination, she is unable to perform a single-leg heel raise, and her hindfoot valgus is passively correctable to neutral. Weight-bearing radiographs show no subtalar or talonavicular osteoarthritis. If conservative measures fail, what is the most appropriate surgical intervention?

. Isolated subtalar arthrodesis
. Triple arthrodesis
. Flexor digitorum longus (FDL) transfer with medial displacement calcaneal osteotomy (MDCO)
. Primary spring ligament repair and gastrocnemius recession
. Anterior tibial tendon transfer (STATT)

Correct Answer & Explanation

. Isolated subtalar arthrodesis

Explanation

The patient has Stage II posterior tibial tendon dysfunction (flexible flatfoot without arthritis). Treatment typically requires reconstruction using an FDL tendon transfer to replace the diseased tendon, combined with an MDCO to correct the mechanical hindfoot valgus.

Question 3915

Topic: Forefoot

A 45-year-old male construction worker complains of dorsal big toe pain with push-off. Radiographs show moderate dorsal osteophytes at the first metatarsophalangeal (MTP) joint, but the plantar joint space remains well preserved. He has failed shoe modifications and NSAIDs. What is the most appropriate surgical option?

. First MTP arthrodesis
. First MTP total joint arthroplasty
. Cheilectomy
. Proximal phalanx osteotomy (Akin)
. First tarsometatarsal arthrodesis (Lapidus)

Correct Answer & Explanation

. First MTP arthrodesis

Explanation

For early to moderate hallux rigidus (Coughlin and Shurnas Grade 1 or 2) with preserved plantar cartilage and pain primarily with dorsiflexion, a cheilectomy (removal of the dorsal osteophyte and dorsal third of the metatarsal head) is the procedure of choice.

Question 3916

Topic: 8. Foot and Ankle

A 14-year-old boy presents with a history of recurrent ankle sprains and a rigid, painful flatfoot. A computed tomography (CT) scan confirms an osseous bridge between the calcaneus and the navicular. What is the initial recommended treatment for this condition?

. Surgical resection of the coalition with interposition of the extensor digitorum brevis
. Subtalar arthrodesis
. Triple arthrodesis
. Immobilization in a short leg walking cast or CAM boot for 4 to 6 weeks
. Medial displacement calcaneal osteotomy

Correct Answer & Explanation

. Surgical resection of the coalition with interposition of the extensor digitorum brevis

Explanation

Symptomatic tarsal coalitions initially warrant a trial of conservative management, such as a short leg walking cast or orthotics, to relieve secondary peroneal spasm and inflammation before considering surgical resection.

Question 3917

Topic: 8. Foot and Ankle

A 25-year-old man sustains a foot injury in a motor vehicle collision. He has severe midfoot swelling and plantar ecchymosis. Radiographs reveal widening between the first and second metatarsal bases. The primary stabilizing ligament disrupted in this injury connects which of the following structures?

. Medial cuneiform to the base of the second metatarsal
. Medial cuneiform to the base of the first metatarsal
. Intermediate cuneiform to the base of the second metatarsal
. Navicular to the base of the first metatarsal
. Cuboid to the base of the fifth metatarsal

Correct Answer & Explanation

. Medial cuneiform to the base of the second metatarsal

Explanation

The Lisfranc ligament is the critical primary stabilizer of the midfoot. It originates on the lateral aspect of the medial cuneiform and inserts on the medial aspect of the base of the second metatarsal.

Question 3918

Topic: Midfoot & Hindfoot

A 32-year-old man sustains a Hawkins Type III talar neck fracture after a high-energy motorcycle crash. The fracture exhibits displacement of the talar body with dislocation from both the subtalar and tibiotalar joints. What is the approximate rate of avascular necrosis (AVN) of the talar body associated with this specific injury pattern?

. 0 to 10%
. 20 to 30%
. 40 to 50%
. 80 to 100%
. 100% in all cases regardless of treatment

Correct Answer & Explanation

. 0 to 10%

Explanation

Hawkins Type III talar neck fractures involve dislocation of the talar body from both the subtalar and tibiotalar joints, disrupting the major blood supplies. The risk of AVN is historically reported to be between 80% and 100%.

Question 3919

Topic: 8. Foot and Ankle

A 24-year-old female runner presents with chronic, deep-seated ankle pain following an inversion sprain 8 months ago. MRI reveals a posteromedial osteochondral lesion of the talus (OCLT). Which of the following best describes the typical characteristics of a posteromedial talar dome lesion compared to an anterolateral lesion?

. Deep, cup-shaped, and usually insidious or atraumatic in nature
. Shallow, wafer-shaped, and invariably caused by acute trauma
. Associated primarily with syndesmotic tears rather than lateral ligament tears
. Highly responsive to conservative treatment with NSAIDs alone
. Best approached surgically via an anterior arthrotomy

Correct Answer & Explanation

. Deep, cup-shaped, and usually insidious or atraumatic in nature

Explanation

Posteromedial OCLTs are characteristically deeper, cup-shaped, and often present insidiously without a clear history of a single traumatic event. In contrast, anterolateral lesions are typically shallow, wafer-like, and associated with acute trauma.

Question 3920

Topic: Midfoot & Hindfoot

A 55-year-old woman presents with a progressive flatfoot deformity. Examination shows a "too many toes" sign, and she is unable to perform a single-leg heel rise on the affected side. The hindfoot remains flexible and passively correctable to neutral. If conservative management fails, which surgical procedure is most appropriate?

. Isolated primary repair of the posterior tibial tendon
. Subtalar arthrodesis
. Triple arthrodesis
. Flexor digitorum longus (FDL) transfer to the navicular and medial displacement calcaneal osteotomy
. Ankle arthrodesis

Correct Answer & Explanation

. Isolated primary repair of the posterior tibial tendon

Explanation

This patient has Stage II adult acquired flatfoot deformity (posterior tibial tendon dysfunction) characterized by a flexible deformity. The standard surgical treatment involves an FDL transfer combined with a joint-sparing medial displacement calcaneal osteotomy.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page