Menu

8. Foot and Ankle MCQs

Practice Set 208 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 4141

Topic: 8. Foot and Ankle

A 24-year-old competitive skier presents with lateral ankle pain and a snapping sensation behind the lateral malleolus after catching an edge. On examination, resisted eversion with the ankle in dorsiflexion reproduces the snapping. Which anatomic structure is most likely attenuated or torn?

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

Correct Answer & Explanation

. Anterior talofibular ligament

Explanation

The superior peroneal retinaculum (SPR) is the primary restraint to subluxation of the peroneal tendons. Injury to the SPR allows the tendons to subluxate or dislocate anteriorly over the fibula during active dorsiflexion and eversion.

Question 4142

Topic: Midfoot & Hindfoot

A 58-year-old man with poorly controlled type 2 diabetes presents with an acutely swollen, erythematous, and warm left foot. He denies trauma. Radiographs reveal no fractures or subluxations. Serum inflammatory markers are mildly elevated, but he is afebrile. What is the most appropriate initial management?

. Urgent surgical debridement and intravenous antibiotics
. Total contact casting and strict non-weight-bearing
. Primary subtalar and talonavicular arthrodesis
. Aspirin 81 mg and supportive care for deep vein thrombosis
. Custom accommodative footwear and full weight-bearing

Correct Answer & Explanation

. Urgent surgical debridement and intravenous antibiotics

Explanation

This patient presents with Eichenholtz stage 0 acute Charcot neuroarthropathy. The gold standard treatment to prevent progressive deformity and joint destruction is immediate immobilization with a total contact cast and offloading.

Question 4143

Topic: 8. Foot and Ankle

A 22-year-old man presents with progressive bilateral high arched feet and frequent lateral ankle sprains. A Coleman block test is performed, which completely corrects the hindfoot varus alignment. This finding indicates that the primary driver of his hindfoot deformity is:

. Spasticity of the posterior tibial tendon
. Rigid contracture of the subtalar joint
. A plantarflexed first ray driven by the peroneus longus
. Overactivity of the peroneus brevis
. Achilles tendon contracture

Correct Answer & Explanation

. Spasticity of the posterior tibial tendon

Explanation

The Coleman block test evaluates hindfoot flexibility in a cavovarus foot. If the hindfoot corrects to neutral or valgus when the first ray is offloaded, the deformity is primarily driven by a rigid plantarflexed first ray caused by peroneus longus overpull.

Question 4144

Topic: 8. Foot and Ankle

A 22-year-old collegiate football player complains of midfoot pain after an axial load was applied to his plantarflexed foot. Plain radiographs are normal, but a weight-bearing CT scan demonstrates a 2.5 mm diastasis between the first and second metatarsal bases. What is the most appropriate definitive management?

. Non-weight-bearing cast immobilization for 6 weeks
. Custom rigid shoe insert and immediate weight-bearing
. Open reduction and internal fixation or dorsal bridge plating
. Primary midfoot arthrodesis
. Closed reduction and percutaneous K-wire fixation

Correct Answer & Explanation

. Non-weight-bearing cast immobilization for 6 weeks

Explanation

Subtle Lisfranc injuries in high-level athletes with greater than 2 mm of diastasis are best treated surgically with ORIF or dorsal bridge plating. This restores anatomic alignment and stability, whereas primary arthrodesis is generally reserved for purely ligamentous injuries in older or non-athletic patients, or delayed presentations.

Question 4145

Topic: 8. Foot and Ankle

A 34-year-old man sustains a displaced talar neck fracture with subluxation of the subtalar joint (Hawkins Type II). Which of the following radiographic findings at 8 weeks post-injury indicates a favorable prognosis regarding osteonecrosis of the talus?

. Sclerosis of the talar dome
. Subchondral radiolucency of the talar dome
. Joint space narrowing of the tibiotalar joint
. Cystic changes in the talar body
. Fragmentation of the lateral talar process

Correct Answer & Explanation

. Sclerosis of the talar dome

Explanation

The Hawkins sign, which is subchondral radiolucency of the talar dome seen on the AP or mortise view at 6 to 8 weeks, indicates intact vascularity and active bone resorption. Its presence is a highly reliable predictor that avascular necrosis (AVN) will not occur.

Question 4146

Topic: Forefoot

A 45-year-old woman complains of medial eminence pain. Radiographs demonstrate a hallux valgus angle of 45 degrees and an intermetatarsal angle of 18 degrees.

Clinical examination reveals hypermobility at the first tarsometatarsal (TMT) joint. Which procedure is most appropriate?

. Distal chevron osteotomy
. Akin osteotomy
. First TMT arthrodesis (Lapidus procedure)
. First MTP arthrodesis
. Proximal crescentic osteotomy

Correct Answer & Explanation

. Distal chevron osteotomy

Explanation

A first TMT arthrodesis (Lapidus procedure) is indicated for patients with a severe hallux valgus deformity (IMA > 15 degrees) combined with first ray hypermobility. It definitively corrects the deformity while stabilizing the incompetent medial column.

Question 4147

Topic: 8. Foot and Ankle

A 55-year-old male with poorly controlled diabetes mellitus presents with a red, hot, swollen foot without systemic signs of infection. Radiographs show periarticular debris, fragmentation, and subluxation of the midfoot. MRI is negative for osteomyelitis. What is the most appropriate initial management?

. Intravenous antibiotics and surgical I&D
. Total contact casting and non-weight-bearing
. Primary midfoot arthrodesis
. Below-knee amputation
. Excision of the fragmented bone

Correct Answer & Explanation

. Intravenous antibiotics and surgical I&D

Explanation

This clinical picture represents the acute phase (Eichenholtz Stage I - fragmentation) of Charcot neuroarthropathy. The gold standard for initial management is strict immobilization using a total contact cast to prevent further structural collapse until the acute inflammatory phase resolves.

Question 4148

Topic: 8. Foot and Ankle

A 28-year-old man with a history of frequent ankle sprains presents with bilateral foot deformities. A Coleman block test is performed, and the hindfoot varus corrects to neutral when the first metatarsal drops off the block.

What does this clinical finding dictate regarding surgical correction?

. The deformity is primarily hindfoot-driven, requiring calcaneal osteotomy alone
. The deformity is driven by a rigid plantarflexed first ray, requiring a dorsiflexion osteotomy
. Subtalar arthrodesis is the required primary procedure
. The patient lacks posterior tibial tendon function
. There is a fixed valgus deformity of the hindfoot

Correct Answer & Explanation

. The deformity is primarily hindfoot-driven, requiring calcaneal osteotomy alone

Explanation

The Coleman block test distinguishes a flexible forefoot-driven hindfoot varus from a rigid hindfoot varus. If the varus corrects when the first ray is allowed to drop off the block, the primary deforming force is a plantarflexed first ray, which should be addressed with a first metatarsal dorsiflexion osteotomy.

Question 4149

Topic: Midfoot & Hindfoot

A 48-year-old woman reports medial ankle pain and the inability to perform a single-leg heel rise. Examination reveals a flexible flatfoot with a positive "too many toes" sign. Nonoperative management has failed. What is the most appropriate surgical intervention?

. Flexor digitorum longus (FDL) transfer and medializing calcaneal osteotomy
. Triple arthrodesis
. Subtalar arthrodesis
. Tibiotalocalcaneal arthrodesis
. Spring ligament repair alone

Correct Answer & Explanation

. Flexor digitorum longus (FDL) transfer and medializing calcaneal osteotomy

Explanation

This patient has a Stage II (flexible) adult acquired flatfoot deformity secondary to posterior tibial tendon dysfunction. The standard joint-sparing surgical treatment is an FDL transfer to the navicular combined with a medializing calcaneal osteotomy.

Question 4150

Topic: 8. Foot and Ankle

A 65-year-old active man with severe post-traumatic ankle arthritis desires surgical intervention after failing conservative care.

He has minimal coronal plane deformity. Which of the following is considered an absolute contraindication to total ankle arthroplasty (TAA)?

. Age greater than 60 years
. Body Mass Index (BMI) of 28
. Remote history of ankle fracture
. Active Charcot neuroarthropathy
. Concomitant subtalar arthritis

Correct Answer & Explanation

. Age greater than 60 years

Explanation

Active Charcot neuroarthropathy, active infection, and severe avascular necrosis of the talus with poor bone stock are absolute contraindications for a total ankle arthroplasty. Concomitant subtalar arthritis is actually a relative indication for TAA to preserve the remaining hindfoot motion.

Question 4151

Topic: 8. Foot and Ankle

A 14-year-old boy presents with a history of frequent ankle sprains and a rigid, painful flatfoot. Oblique radiographs of the foot demonstrate an "anteater nose" sign.

Which of the following is the most likely diagnosis?

. Talocalcaneal coalition
. Calcaneonavicular coalition
. Accessory navicular syndrome
. Congenital vertical talus
. Tarsal tunnel syndrome

Correct Answer & Explanation

. Talocalcaneal coalition

Explanation

The "anteater sign" is an elongated anterior process of the calcaneus seen on a 45-degree oblique radiograph, which is pathognomonic for a calcaneonavicular coalition. Talocalcaneal coalitions are typically identified by a "C-sign" on the lateral view or middle facet irregularity on CT.

Question 4152

Topic: 8. Foot and Ankle

A 52-year-old runner complains of chronic posterior heel pain. Imaging reveals insertional Achilles tendinopathy with a large Haglund deformity and 30% degeneration of the distal tendon. Nonoperative management has failed over the last 8 months. Which surgical approach is most appropriate?

. Percutaneous Achilles tendon lengthening
. Retrocalcaneal exostectomy with Achilles debridement and reattachment
. Flexor hallucis longus (FHL) transfer alone
. Endoscopic gastrocnemius recession
. Extracorporeal shockwave therapy

Correct Answer & Explanation

. Percutaneous Achilles tendon lengthening

Explanation

Insertional Achilles tendinopathy with a prominent Haglund deformity is surgically treated via a central tendon splitting approach, retrocalcaneal exostectomy, and debridement. Direct repair/reattachment is indicated when less than 50% of the tendon is compromised, whereas an FHL transfer is added for defects >50%.

Question 4153

Topic: 8. Foot and Ankle

A 24-year-old wide receiver sustains a severe hyperextension injury to his first MTP joint. MRI reveals a complete rupture of the plantar plate with proximal retraction of the sesamoids. Which of the following best establishes the indication for operative intervention in this scenario?

. Presence of a Grade 1 capsular sprain
. Presence of a Grade 2 sprain with partial tearing
. Complete plantar plate avulsion (Grade 3) with sesamoid retraction
. Associated bone bruising of the metatarsal head
. Pain with passive plantarflexion

Correct Answer & Explanation

. Presence of a Grade 1 capsular sprain

Explanation

Grade 3 turf toe injuries involve complete tearing of the plantar plate-sesamoid complex with proximal migration of the sesamoids. Surgical repair is indicated in high-level athletes to restore push-off strength and prevent chronic instability.

Question 4154

Topic: Forefoot

A 50-year-old man presents with pain and stiffness in the great toe. Radiographs show dorsal joint space narrowing and a prominent dorsal osteophyte (Coughlin and Shurnas Grade 2 hallux rigidus). The plantar joint space is relatively preserved. What is the preferred surgical option after failing conservative care?

. First MTP arthrodesis
. Cheilectomy
. Silastic implant arthroplasty
. Keller resection arthroplasty
. Lapidus procedure

Correct Answer & Explanation

. First MTP arthrodesis

Explanation

Cheilectomy, which entails excision of the dorsal osteophyte and the dorsal 30% of the metatarsal head, is the gold standard surgical treatment for early-to-moderate hallux rigidus (Grades 1 and 2). Arthrodesis is reserved for end-stage diffuse joint space loss (Grades 3 and 4).

Question 4155

Topic: 8. Foot and Ankle

A 42-year-old woman complains of a "pebble in her shoe" sensation and burning pain radiating to the third and fourth toes. Examination reveals a painful, palpable click when the metatarsal heads are squeezed together while applying plantar pressure to the webspace. What is the most appropriate initial management?

. Surgical excision through a dorsal approach
. Shoe modification with a wide toe-box and a metatarsal pad
. Surgical excision through a plantar approach
. Metatarsal shortening osteotomy
. Radiofrequency ablation

Correct Answer & Explanation

. Surgical excision through a dorsal approach

Explanation

The clinical presentation is classic for a Morton's neuroma in the 3rd webspace, complete with a positive Mulder's click. First-line management should always be nonoperative, primarily utilizing shoe wear modifications (wide toe-box) and a metatarsal pad, prior to considering surgical excision.

Question 4156

Topic: 8. Foot and Ankle

A 45-year-old male presents with acute posterior ankle pain after playing tennis. Clinical exam reveals a positive Thompson test. An MRI is obtained as seen in Figure 17.

Which of the following physical examination findings is most specific for this condition?

. Posterior heel tenderness
. Inability to perform a single heel raise
. Increased resting ankle dorsiflexion compared to the contralateral side
. Weakness with active plantarflexion
. Plantar ecchymosis

Correct Answer & Explanation

. Posterior heel tenderness

Explanation

A positive Matles test (increased resting ankle dorsiflexion when prone with knees flexed 90 degrees) and positive Thompson test are highly specific for Achilles tendon ruptures. Active plantarflexion may remain intact due to the recruitment of accessory flexors like the tibialis posterior.

Question 4157

Topic: Midfoot & Hindfoot

A 56-year-old diabetic patient presents with a red, hot, swollen foot without systemic signs of infection. Radiographs show fragmentation of the navicular and cuneiforms with subluxation of the midfoot. Which Eichenholtz stage does this represent, and what is the best initial management?

. Stage 0; Total contact cast
. Stage 1; Total contact cast
. Stage 2; Surgical arthrodesis
. Stage 3; Custom orthotic shoe
. Stage 1; Surgical arthrodesis

Correct Answer & Explanation

. Stage 0; Total contact cast

Explanation

Eichenholtz Stage 1 (development/fragmentation) is characterized by acute inflammation, osteopenia, fragmentation, and subluxation. The gold standard initial treatment for acute Charcot arthropathy is offloading with a total contact cast.

Question 4158

Topic: 8. Foot and Ankle

A 30-year-old equestrian presents after falling from her horse with her foot caught in the stirrup. She has severe midfoot pain and plantar ecchymosis. Radiographs are shown in Figure 43.

The primary deforming force causing lateral displacement of the lesser metatarsals is mediated by which structure?

. Tibialis anterior
. Peroneus brevis
. Tibialis posterior
. Extensor hallucis longus
. Plantar fascia

Correct Answer & Explanation

. Tibialis anterior

Explanation

In a Lisfranc injury, lateral displacement of the lesser metatarsal bases is primarily driven by the unopposed pull of the peroneus brevis. It inserts on the base of the 5th metatarsal and acts as the main deforming force when the midfoot ligaments are disrupted.

Question 4159

Topic: Midfoot & Hindfoot

A 62-year-old woman complains of progressive medial foot pain and flattening of her arch. On examination, she has a "too many toes" sign and cannot perform a single-limb heel rise. Radiographs demonstrate a flexible pes planus deformity without degenerative changes in the subtalar or talonavicular joints. What is the most appropriate surgical treatment?

. Flexor digitorum longus transfer and medial displacement calcaneal osteotomy
. Subtalar arthrodesis
. Triple arthrodesis
. Talonavicular arthrodesis
. Gastrocnemius recession alone

Correct Answer & Explanation

. Flexor digitorum longus transfer and medial displacement calcaneal osteotomy

Explanation

Stage II adult-acquired flatfoot deformity involves a flexible hindfoot without arthritis. Appropriate surgical management includes a flexor digitorum longus (FDL) transfer to replace the diseased posterior tibial tendon, combined with a medial displacement calcaneal osteotomy to correct the valgus.

Question 4160

Topic: 8. Foot and Ankle

A 24-year-old hockey player sustains an external rotation injury to his right ankle. Figure 45 demonstrates his intraoperative stress radiograph after fibular fixation.

Which ligament provides the greatest resistance to lateral displacement of the fibula in the distal tibiofibular syndesmosis?

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

Correct Answer & Explanation

. Anterior inferior tibiofibular ligament (AITFL)

Explanation

The posterior inferior tibiofibular ligament (PITFL) is the strongest component of the syndesmotic complex. Biomechanical studies show it contributes approximately 42% of the resistance to lateral fibular displacement.

Test Yourself

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

On this Page