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8. Foot and Ankle MCQs

Practice Set 224 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 4461

Topic: 8. Foot and Ankle

A 28-year-old skier presents with lateral ankle pain and a popping sensation behind the lateral malleolus when circumducting the ankle. Examination reveals subluxation of the peroneal tendons with dorsiflexion and eversion. What is the primary anatomic restraint that is typically injured?

. Inferior peroneal retinaculum
. Superior peroneal retinaculum
. Calcaneofibular ligament
. Anterior talofibular ligament
. Peroneus brevis tendon

Correct Answer & Explanation

. Superior peroneal retinaculum

Explanation

The superior peroneal retinaculum (SPR) is the primary anatomic restraint to peroneal tendon subluxation. Injury or attenuation of the SPR allows the tendons to subluxate anteriorly over the lateral malleolus during active dorsiflexion and eversion.

Question 4462

Topic: 8. Foot and Ankle

Which of the following conditions is considered an absolute contraindication for primary Total Ankle Arthroplasty (TAA)?

. End-stage osteoarthritis of the ankle
. Active or recent deep infection in the ankle joint
. Contralateral ankle arthrodesis
. Subtalar arthritis
. Age over 65 years

Correct Answer & Explanation

. Active or recent deep infection in the ankle joint

Explanation

Active or recent deep infection is an absolute contraindication to Total Ankle Arthroplasty (TAA) due to the high risk of periprosthetic joint infection. Other absolute contraindications include Charcot arthropathy, severe avascular necrosis of the talus, and profound neuropathy.

Question 4463

Topic: 8. Foot and Ankle

A 45-year-old runner with chronic plantar fasciitis has failed 9 months of conservative treatment. Examination reveals ankle dorsiflexion of 0 degrees with the knee extended and 15 degrees with the knee flexed. What surgical intervention addresses the underlying biomechanical issue?

. Isolated release of the plantar fascia
. Medial calcaneal nerve release
. Isolated gastrocnemius recession
. Extracorporeal shockwave therapy
. Tarsal tunnel release

Correct Answer & Explanation

. Isolated gastrocnemius recession

Explanation

The patient exhibits an isolated gastrocnemius contracture (positive Silfverskiold test), which is a common biomechanical driver of recalcitrant plantar fasciitis. A gastrocnemius recession improves ankle dorsiflexion and reduces mechanical stress on the plantar fascia.

Question 4464

Topic: 8. Foot and Ankle

A diabetic patient with peripheral neuropathy has a recurrent neuropathic ulcer under the first metatarsal head despite custom orthotics. Examination reveals a tight Achilles tendon. Which adjunctive procedure significantly reduces the risk of forefoot ulcer recurrence?

. Tendo-Achilles lengthening (TAL)
. First metatarsophalangeal joint arthrodesis
. Flexor to extensor tendon transfer
. Plantar fascia release
. First metatarsal head resection

Correct Answer & Explanation

. Tendo-Achilles lengthening (TAL)

Explanation

A tight Achilles tendon causes increased forefoot plantar pressures during the stance phase of gait. Tendo-Achilles lengthening (TAL) reduces these pressures and has been shown to significantly decrease the recurrence rate of forefoot neuropathic ulcers in diabetic patients.

Question 4465

Topic: Midfoot & Hindfoot

A 34-year-old female runner presents with chronic heel pain and tenderness at the medial calcaneal tuberosity. MRI confirms severe plantar fasciitis. If she develops compression of the first branch of the lateral plantar nerve, the function of which muscle is most directly compromised?

. Abductor hallucis
. Flexor digitorum brevis
. Abductor digiti minimi
. Quadratus plantae
. Adductor hallucis

Correct Answer & Explanation

. Abductor digiti minimi

Explanation

Baxter's nerve (first branch of the lateral plantar nerve) innervates the abductor digiti minimi. It can become entrapped between the deep fascia of the abductor hallucis and the medial head of the quadratus plantae in severe plantar fasciitis.

Question 4466

Topic: 8. Foot and Ankle

A 45-year-old male with Stage II adult acquired flatfoot deformity undergoes a flexor digitorum longus (FDL) transfer to the navicular, medial displacement calcaneal osteotomy, and spring ligament repair. What is the primary biomechanical role of the FDL transfer in this reconstruction?

. Recreate the static arch of the foot
. Replace the dynamic inversion function of the posterior tibial tendon
. Plantarflex the first ray to restore the tripod effect
. Provide dynamic soft-tissue support to the lateral column
. Prevent abduction of the forefoot during the propulsive phase

Correct Answer & Explanation

. Replace the dynamic inversion function of the posterior tibial tendon

Explanation

The FDL transfer provides dynamic soft tissue support and replaces the inversion strength of the dysfunctional posterior tibial tendon. The osteotomies are responsible for correcting the static bony deformity.

Question 4467

Topic: 8. Foot and Ankle

A 25-year-old athlete sustains a purely ligamentous Lisfranc injury involving the medial cuneiform and second metatarsal base. According to recent prospective literature, how do outcomes of primary arthrodesis compare to open reduction and internal fixation (ORIF) for this specific injury pattern?

. Lower rate of hardware removal in ORIF
. Higher rate of secondary subsequent surgery in primary arthrodesis
. Better functional outcomes and a lower reoperation rate with primary arthrodesis
. Equal clinical outcomes but significantly lower healthcare costs for ORIF
. Faster return to competitive sports with arthrodesis

Correct Answer & Explanation

. Better functional outcomes and a lower reoperation rate with primary arthrodesis

Explanation

Studies have demonstrated that primary arthrodesis for purely ligamentous Lisfranc injuries results in better functional outcomes and a lower rate of secondary surgeries (due to hardware removal or post-traumatic arthritis) compared to ORIF.

Question 4468

Topic: Forefoot

A 55-year-old woman presents with severe hallux valgus (HVA 45 degrees, IMA 18 degrees) and clinical hypermobility of the first tarsometatarsal (TMT) joint. Which of the following surgical interventions is most appropriate?

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

Correct Answer & Explanation

. Lapidus procedure

Explanation

The Lapidus procedure (first TMT arthrodesis) is indicated for severe hallux valgus (IMA > 15 degrees) accompanied by first TMT hypermobility, as it permanently stabilizes the medial column.

Question 4469

Topic: Forefoot

A 42-year-old man presents with chronic pain at the first MTP joint. Examination reveals dorsal osteophytes and pain limited to maximum forced dorsiflexion. Radiographs confirm Grade 2 Hallux Rigidus. Initial conservative management has failed. What is the most appropriate surgical treatment?

. Cheilectomy
. First MTP arthrodesis
. Keller arthroplasty
. Total joint arthroplasty
. First TMT arthrodesis

Correct Answer & Explanation

. Cheilectomy

Explanation

Cheilectomy, which involves excision of dorsal osteophytes and the dorsal one-third of the metatarsal head, is the treatment of choice for symptomatic mild-to-moderate hallux rigidus that fails nonoperative care.

Question 4470

Topic: Midfoot & Hindfoot
According to the Hawkins classification of talar neck fractures, a Type III fracture is defined by displacement of the talar neck with subluxation or dislocation of which specific joints?
. Subtalar joint only
. Subtalar and tibiotalar joints
. Subtalar, tibiotalar, and talonavicular joints
. Tibiotalar joint only
. Talonavicular joint only

Correct Answer & Explanation

. Subtalar and tibiotalar joints

Explanation

Hawkins Type III describes a talar neck fracture with dislocation of both the subtalar and tibiotalar joints. Type IV involves the additional dislocation of the talonavicular joint.

Question 4471

Topic: 8. Foot and Ankle

A 19-year-old soccer player experiences persistent lateral ankle pain and a palpable snapping sensation behind the lateral malleolus during active eversion. A diagnosis of peroneal tendon subluxation is made. Which anatomical structure is primarily deficient?

. Anterior talofibular ligament
. Calcaneofibular ligament
. Superior peroneal retinaculum
. Inferior peroneal retinaculum
. Lateral root of the extensor retinaculum

Correct Answer & Explanation

. Superior peroneal retinaculum

Explanation

Peroneal tendon subluxation is primarily caused by incompetence, stripping, or rupture of the superior peroneal retinaculum (SPR), which normally secures the tendons in the retromalleolar groove.

Question 4472

Topic: Midfoot & Hindfoot
A 60-year-old diabetic patient presents with a red, swollen, and warm foot without skin ulceration. Radiographs show bone fragmentation, periarticular debris, and subluxation at the tarsometatarsal joints. According to the Eichenholtz classification, what stage of Charcot arthropathy does this represent?
. Stage 0 (High risk)
. Stage I (Development/Fragmentation)
. Stage II (Coalescence)
. Stage III (Reconstruction/Consolidation)
. Stage IV (Degenerative)

Correct Answer & Explanation

. Stage I (Development/Fragmentation)

Explanation

Eichenholtz Stage I is the active development phase characterized by a hot, swollen foot and radiographs demonstrating bone fragmentation, joint subluxation, and bony debris.

Question 4473

Topic: 8. Foot and Ankle

During the establishment of portals for anterior ankle arthroscopy, which nerve is at greatest risk of iatrogenic injury when creating the anterolateral portal?

. Deep peroneal nerve
. Superficial peroneal nerve
. Sural nerve
. Saphenous nerve
. Tibial nerve

Correct Answer & Explanation

. Superficial peroneal nerve

Explanation

The superficial peroneal nerve runs adjacent to the anterolateral portal site. It can often be visualized or palpated by plantarflexing and inverting the foot to avoid transection during portal placement.

Question 4474

Topic: 8. Foot and Ankle

A 28-year-old man undergoes primary surgical repair for an acute Achilles tendon rupture. Compared to nonoperative management with early functional rehabilitation, operative repair is statistically associated with which of the following?

. Lower rate of soft tissue wound complications
. Higher rate of deep vein thrombosis
. Lower rate of tendon rerupture
. Decreased maximum plantarflexion strength
. Longer time interval for return to work

Correct Answer & Explanation

. Lower rate of tendon rerupture

Explanation

Operative repair of acute Achilles tendon ruptures significantly decreases the rerupture rate compared to traditional nonoperative management, though it does carry a higher risk of soft-tissue and wound complications.

Question 4475

Topic: 8. Foot and Ankle

A 50-year-old woman with advanced rheumatoid arthritis presents with severe forefoot deformities, including severe hallux valgus and rigid dorsal subluxation of all lesser MTP joints. What is the most reliable surgical reconstruction for long-term pain relief?

. First MTP arthroplasty and lesser MTP arthroplasties
. First MTP arthrodesis and lesser metatarsal head resections
. Proximal crescentic osteotomy and lesser toe PIP fusions
. Keller arthroplasty and Weil osteotomies
. Lapidus procedure and lesser toe amputations

Correct Answer & Explanation

. First MTP arthrodesis and lesser metatarsal head resections

Explanation

First MTP arthrodesis combined with lesser metatarsal head resections (the Hoffman procedure) is the gold standard for severe rheumatoid forefoot reconstruction, providing excellent deformity correction and pain relief.

Question 4476

Topic: Ankle Trauma & Sports

A 45-year-old woman with chronic lateral ankle instability is scheduled for a Brostrom-Gould procedure. This procedure involves direct repair of the anterior talofibular and calcaneofibular ligaments, augmented by mobilization and advancement of which structure?

. Plantaris tendon
. Extensor digitorum brevis muscle belly
. Inferior extensor retinaculum
. Superior peroneal retinaculum
. Peroneus brevis tendon

Correct Answer & Explanation

. Inferior extensor retinaculum

Explanation

The Gould modification of the Brostrom procedure involves mobilization and advancement of the inferior extensor retinaculum over the repaired lateral ligaments to reinforce the repair and limit inversion.

Question 4477

Topic: 8. Foot and Ankle

During a total ankle arthroplasty for a patient with a varus deformity, the ankle remains tight medially despite release of the superficial deltoid ligament. To properly balance the ankle, what is the next most appropriate step?

. Medial sliding calcaneal osteotomy
. Release of the deep deltoid ligament
. Lateralizing the tibial component
. Release of the spring ligament
. Peroneus brevis to longus tendon transfer

Correct Answer & Explanation

. Release of the deep deltoid ligament

Explanation

In a varus ankle undergoing total ankle arthroplasty, progressive medial release is necessary to balance the joint. If superficial deltoid release is insufficient, the deep deltoid ligament must be released.

Question 4478

Topic: Midfoot & Hindfoot

A 28-year-old female presents with medial midfoot pain and flatfoot deformity. Exam shows a prominent navicular tuberosity. Radiographs demonstrate a Type II accessory navicular. Which tendon inserts onto this accessory bone, potentially leading to its dysfunction?

. Anterior tibial tendon
. Posterior tibial tendon
. Flexor hallucis longus
. Flexor digitorum longus
. Peroneus longus

Correct Answer & Explanation

. Posterior tibial tendon

Explanation

The posterior tibial tendon frequently inserts into a Type II accessory navicular. This abnormal insertion alters the tendon's mechanical advantage, predisposing it to tendinopathy and adult acquired flatfoot deformity.

Question 4479

Topic: Midfoot & Hindfoot

What is the most common complication following an isolated talonavicular arthrodesis for midfoot arthritis?

. Avascular necrosis of the navicular
. Nonunion
. Sural nerve injury
. Dorsal midfoot impingement
. Subtalar arthritis

Correct Answer & Explanation

. Nonunion

Explanation

Isolated talonavicular arthrodesis has a historically high nonunion rate, often cited between 10-30%. This is due to complex biomechanical shear forces and the watershed blood supply of the navicular.

Question 4480

Topic: 8. Foot and Ankle

In the nonoperative management of acute Achilles tendon ruptures using a functional rehabilitation protocol, what is the most significant factor that reduces the re-rupture rate to levels comparable to surgical intervention?

. Prolonged immobilization in plantarflexion for 12 weeks
. Strict non-weight-bearing for the first 6 weeks
. Early weight-bearing and functional mobilization in a brace
. Routine use of therapeutic ultrasound and NSAIDs
. Immobilization in a rigid cast in neutral position

Correct Answer & Explanation

. Early weight-bearing and functional mobilization in a brace

Explanation

Functional rehabilitation featuring early weight-bearing in a functional brace has been shown in high-level studies to reduce re-rupture rates to match those of surgical repair while significantly lowering the risk of wound complications.

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