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8. Foot and Ankle MCQs

Practice Set 209 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 4161

Topic: 8. Foot and Ankle
A 31-year-old male sustains a Hawkins type III talar neck fracture following a motor vehicle collision. Which of the following vascular supplies is completely disrupted in this injury pattern?
. Artery of the tarsal canal
. Artery of the tarsal sinus
. Deltoid branches of the posterior tibial artery
. Dorsalis pedis branches
. All blood supply to the talar body

Correct Answer & Explanation

. All blood supply to the talar body

Explanation

A Hawkins type III fracture involves subluxation or dislocation of both the subtalar and tibiotalar joints. This typically disrupts all three major sources of blood supply to the talar body, resulting in a nearly 100% risk of avascular necrosis.

Question 4162

Topic: 8. Foot and Ankle

A 19-year-old basketball player presents with chronic lateral foot pain. Radiographs reveal a fracture at the proximal diaphyseal junction of the 5th metatarsal, distal to the 4th-5th intermetatarsal articulation, with cortical thickening and a narrow medullary canal. What is the most appropriate definitive management for optimal return to sport?

. Non-weight bearing in a short leg cast for 6 weeks
. Hard-soled shoe weight bearing as tolerated
. Intramedullary screw fixation
. Excision of the proximal fragment and peroneus brevis advancement
. Plate osteosynthesis

Correct Answer & Explanation

. Non-weight bearing in a short leg cast for 6 weeks

Explanation

This represents a Zone 3 stress fracture of the proximal 5th metatarsal diaphyseal junction. In high-level athletes, intramedullary screw fixation is recommended to minimize nonunion risk and expedite return to play.

Question 4163

Topic: 8. Foot and Ankle

A 55-year-old man presents with dorsal midfoot pain and limited great toe dorsiflexion. Figure 46 demonstrates his standing lateral radiograph.

He has failed orthotics and NSAIDs. He wishes to maintain joint motion. What is the most appropriate surgical intervention?

. Arthrodesis of the 1st MTP joint
. Keller resection arthroplasty
. Cheilectomy of the 1st MTP joint
. Akin osteotomy
. Metatarsocuneiform arthrodesis

Correct Answer & Explanation

. Arthrodesis of the 1st MTP joint

Explanation

For early to moderate hallux rigidus (Coughlin and Shurnas grades 1 or 2) in patients wishing to preserve motion, a dorsal cheilectomy is the procedure of choice. It involves resection of the dorsal osteophyte and up to 30% of the dorsal metatarsal head.

Question 4164

Topic: 8. Foot and Ankle

A 40-year-old woman complains of burning pain in the plantar aspect of her forefoot, radiating into the third and fourth toes. Symptoms worsen with tight shoes. A Mulder's click is present. If nonoperative management fails, excision of the neuroma is planned. Which structure must be transected to adequately expose and resect the neuroma from a dorsal approach?

. Deep transverse metatarsal ligament
. Plantar fascia
. Lumbrical tendon
. Flexor digitorum brevis
. Plantar plate

Correct Answer & Explanation

. Deep transverse metatarsal ligament

Explanation

Morton's neuroma most commonly occurs in the third web space. A dorsal surgical approach requires transection of the deep transverse metatarsal ligament to access the neurovascular bundle, which lies plantar to it.

Question 4165

Topic: 8. Foot and Ankle

A 16-year-old female ballet dancer presents with pain and swelling over the dorsal aspect of her second metatarsophalangeal joint. Radiographs reveal flattening and sclerosis of the second metatarsal head. Which of the following describes the underlying pathophysiology?

. Avascular necrosis of the metatarsal head
. Entrapment of the deep peroneal nerve
. Tearing of the plantar plate
. Stress fracture of the proximal phalanx
. Rheumatoid synovitis

Correct Answer & Explanation

. Avascular necrosis of the metatarsal head

Explanation

Freiberg's infraction is an osteochondrosis or avascular necrosis of the metatarsal head, most commonly affecting the second metatarsal in adolescent females. Repetitive microtrauma is believed to compromise the fragile blood supply to the epiphysis.

Question 4166

Topic: 8. Foot and Ankle

A 52-year-old man presents with burning pain and tingling over the plantar aspect of his foot that worsens at night. Tinel's sign is positive posterior to the medial malleolus. EMG confirms entrapment of the posterior tibial nerve. Which structure forms the roof of the anatomical space where this compression occurs?

. Plantar fascia
. Flexor retinaculum
. Extensor retinaculum
. Abductor hallucis fascia
. Spring ligament

Correct Answer & Explanation

. Plantar fascia

Explanation

Tarsal tunnel syndrome is a compression neuropathy of the posterior tibial nerve. The tarsal tunnel is bordered medially by the flexor retinaculum (lanciniate ligament), laterally by the calcaneus and talus, and anteriorly by the medial malleolus.

Question 4167

Topic: 8. Foot and Ankle

A 65-year-old man with end-stage post-traumatic ankle osteoarthritis desires surgical intervention. Which of the following is considered an absolute contraindication to total ankle arthroplasty?

. Age greater than 60 years
. Body mass index of 28
. Previous subtalar fusion
. Active deep ankle infection
. Concomitant hindfoot arthritis

Correct Answer & Explanation

. Age greater than 60 years

Explanation

Active deep infection, active Charcot arthropathy, severe uncorrectable malalignment, and inadequate soft tissue coverage are absolute contraindications to total ankle arthroplasty. Concomitant hindfoot arthritis is actually a relative indication for TAA to preserve remaining joint motion.

Question 4168

Topic: 8. Foot and Ankle

A 14-year-old boy presents with progressive bilateral foot deformities, characterized by high arches, claw toes, and a "peek-a-boo" heel sign. Neurological exam reveals absent ankle reflexes and decreased sensation in a stocking distribution. What is the primary muscle imbalance driving the hindfoot varus in this condition?

. Strong tibialis posterior overcoming a weak peroneus brevis
. Strong tibialis anterior overcoming a weak peroneus longus
. Strong peroneus longus overcoming a weak tibialis anterior
. Strong extensor hallucis longus overcoming a weak flexor hallucis longus
. Strong gastrocnemius overcoming a weak soleus

Correct Answer & Explanation

. Strong tibialis posterior overcoming a weak peroneus brevis

Explanation

In Charcot-Marie-Tooth (CMT) disease, the hindfoot varus is primarily driven by a strong, preserved tibialis posterior overpowering a weak peroneus brevis. The forefoot plantarflexion (cavus) is driven by a strong peroneus longus overpowering a weak tibialis anterior.

Question 4169

Topic: 8. Foot and Ankle

A 28-year-old athlete undergoes ORIF for a Weber C ankle fracture with syndesmotic instability. A syndesmotic screw is placed. What is the most appropriate recommendation regarding the syndesmotic screw?

. It must be removed at 6 weeks prior to weight-bearing
. Routine removal is not required unless it becomes symptomatic
. It should be placed through 4 cortices and removed at 12 weeks
. It should be placed in maximum plantarflexion
. Bioabsorbable screws have a lower rate of osteolysis than metallic screws

Correct Answer & Explanation

. It must be removed at 6 weeks prior to weight-bearing

Explanation

Current evidence suggests routine removal of syndesmotic screws is not necessary, as functional outcomes are similar whether the screw is retained, removed, or breaks.

Question 4170

Topic: 8. Foot and Ankle
A 32-year-old male sustains a Hawkins type III talar neck fracture. Which of the following blood vessels provides the primary blood supply to the talar body, placing it at risk for avascular necrosis?
. Artery of the tarsal canal
. Artery of the tarsal sinus
. Deltoid branches
. Dorsalis pedis artery
. Peroneal artery

Correct Answer & Explanation

. Artery of the tarsal canal

Explanation

The artery of the tarsal canal (a branch of the posterior tibial artery) provides the dominant blood supply to the talar body. Disruption in Hawkins III fractures significantly increases the risk of avascular necrosis.

Question 4171

Topic: 8. Foot and Ankle

During an extensile lateral approach for a displaced intra-articular calcaneus fracture, the sural nerve is at risk. Where is the sural nerve most vulnerable during this exposure?

. At the corner of the L-shaped incision
. Posterior to the fibula
. Distal to the calcaneocuboid joint
. At the plantar aspect of the heel
. Medial to the Achilles tendon

Correct Answer & Explanation

. At the corner of the L-shaped incision

Explanation

The sural nerve is most at risk at the apices of the extensile lateral incision, particularly at the corner of the L-shaped flap, and must be protected by creating a full-thickness subperiosteal flap.

Question 4172

Topic: Midfoot & Hindfoot

A 24-year-old football player suffers a purely ligamentous Lisfranc injury. He undergoes surgery. Which of the following has been shown to provide superior functional outcomes for purely ligamentous Lisfranc injuries compared to internal fixation?

. Primary arthrodesis
. Non-weight bearing cast for 8 weeks
. Closed reduction and percutaneous pinning
. Spanning external fixation
. Bridge plating

Correct Answer & Explanation

. Primary arthrodesis

Explanation

Primary arthrodesis of the first, second, and third tarsometatarsal joints provides superior functional outcomes and lower revision rates compared to ORIF for purely ligamentous Lisfranc injuries.

Question 4173

Topic: 8. Foot and Ankle

A 40-year-old recreational basketball player sustains an acute Achilles tendon rupture. If treated non-operatively with a functional rehabilitation protocol, how does the outcome compare to operative treatment?

. Higher rerupture rate, lower complication rate
. Similar rerupture rate, lower overall complication rate
. Lower rerupture rate, higher complication rate
. Similar rerupture rate, similar complication rate
. Higher rerupture rate, higher complication rate

Correct Answer & Explanation

. Higher rerupture rate, lower complication rate

Explanation

Functional rehabilitation (early weight-bearing and ROM) for non-operative management results in rerupture rates similar to operative treatment, while avoiding surgical complications like infection and nerve injury.

Question 4174

Topic: 8. Foot and Ankle
A 22-year-old gymnast has chronic lateral ankle instability despite 6 months of dedicated physical therapy. She undergoes a modified Broström procedure. Which structure is typically mobilized and used to reinforce the repair?
. Peroneus brevis tendon
. Inferior extensor retinaculum
. Plantaris tendon
. Superior peroneal retinaculum
. Sural nerve sheath

Correct Answer & Explanation

. Inferior extensor retinaculum

Explanation

The modified Broström (Gould modification) involves mobilizing and advancing the inferior extensor retinaculum to reinforce the direct repair of the anterior talofibular and calcaneofibular ligaments.

Question 4175

Topic: 8. Foot and Ankle

A 55-year-old diabetic patient presents with a warm, swollen, erythematous right foot and ankle. X-rays show periarticular fragmentation and subluxation of the midfoot. What is the most appropriate initial management?

. Urgent surgical debridement and fusion
. Intravenous antibiotics and MRI
. Total contact casting
. Custom orthotics
. External fixation

Correct Answer & Explanation

. Urgent surgical debridement and fusion

Explanation

The patient is in the acute fragmentation phase (Eichenholtz stage I) of Charcot arthropathy. The mainstay of treatment is strict immobilization and offloading, typically with a total contact cast.

Question 4176

Topic: Midfoot & Hindfoot

A 60-year-old female presents with medial ankle pain and a progressive flatfoot. She is unable to perform a single heel raise. Examination shows a flexible hindfoot valgus and forefoot abduction. What is the most appropriate surgical treatment?

. FDL transfer alone
. FDL transfer and medial displacement calcaneal osteotomy
. Triple arthrodesis
. Subtalar arthrodesis
. Spring ligament repair alone

Correct Answer & Explanation

. FDL transfer alone

Explanation

For Stage II posterior tibial tendon dysfunction (flexible deformity, inability to perform heel raise), a flexor digitorum longus (FDL) transfer combined with a medial displacement calcaneal osteotomy (MDCO) is the standard treatment.

Question 4177

Topic: 8. Foot and Ankle

A 16-year-old boy with Charcot-Marie-Tooth disease presents with bilateral cavovarus feet. A Coleman block test is performed, and the hindfoot corrects to neutral. What does this indicate?

. The hindfoot deformity is rigid
. A triple arthrodesis is required
. The deformity is driven by a plantarflexed first ray
. The subtalar joint is arthritic
. A lateralizing calcaneal osteotomy is contraindicated

Correct Answer & Explanation

. The hindfoot deformity is rigid

Explanation

A flexible hindfoot that corrects to neutral on a Coleman block test indicates that the varus hindfoot is secondary to a rigid plantarflexed first ray, guiding surgical management toward a dorsiflexion osteotomy of the first metatarsal.

Question 4178

Topic: Forefoot

A 45-year-old woman presents with a symptomatic hallux valgus deformity. Radiographs show a hallux valgus angle of 35 degrees and an intermetatarsal angle of 18 degrees. The first tarsometatarsal joint is hypermobile. Which procedure is most appropriate?

. Distal chevron osteotomy
. Proximal crescentic osteotomy
. Lapidus procedure
. Keller arthroplasty
. Akin osteotomy

Correct Answer & Explanation

. Distal chevron osteotomy

Explanation

The Lapidus procedure (first TMT arthrodesis) is indicated for severe hallux valgus with a large intermetatarsal angle (>15 degrees) and clinical first ray hypermobility.

Question 4179

Topic: Forefoot

A 65-year-old male presents with dorsal foot pain and limited hallux dorsiflexion. Radiographs reveal dorsal osteophytes at the first MTP joint with preserved joint space on the plantar aspect. What is the most appropriate initial surgical option after failed conservative care?

. First MTP arthrodesis
. Cheilectomy
. Keller arthroplasty
. Silastic joint replacement
. Weil osteotomy

Correct Answer & Explanation

. First MTP arthrodesis

Explanation

For mild-to-moderate hallux rigidus (Coughlin and Shurnas Grade 1 or 2) with dorsal impingement and preserved plantar joint space, a cheilectomy provides excellent pain relief and restores dorsiflexion.

Question 4180

Topic: 8. Foot and Ankle

A 30-year-old man sustains a medial subtalar dislocation after falling from a height. Closed reduction is attempted but is unsuccessful in the emergency department. What structure is most likely blocking reduction?

. Extensor digitorum brevis
. Peroneus brevis tendon
. Tibialis posterior tendon
. Talonavicular joint capsule
. Flexor hallucis longus

Correct Answer & Explanation

. Extensor digitorum brevis

Explanation

In a medial subtalar dislocation, the head of the talus can become buttonholed through the extensor retinaculum or the talonavicular joint capsule, blocking closed reduction. The extensor digitorum brevis may also block reduction.

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