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 441
Topic: 8. Foot and Ankle
Which of the following is true concerning the repair of acute Achilles tendon ruptures:
Correct Answer & Explanation
. Open treatment has a lower rerupture rate but higher infection rate compared to nonoperative treatment.
A 55-year-old diabetic patient presents with a warm, swollen, erythematous foot without an open wound. Radiographs show fragmentation of the navicular and cuneiforms. Which of the following is the most appropriate initial management?
Correct Answer & Explanation
. Total contact casting (TCC)
Explanation
Acute Charcot arthropathy (Eichenholtz stage 1) is characterized by a warm, swollen foot and radiographic fragmentation. Initial management is immediate offloading with a total contact cast to prevent further mechanical deformity.
Question 443
Topic: 8. Foot and Ankle
A 55-year-old diabetic patient presents with a swollen, erythematous, and warm left foot. There are no open ulcers. Radiographs show soft tissue swelling but no acute fractures. What is the most appropriate initial management?
Correct Answer & Explanation
. Total contact casting
Explanation
This presentation is highly suspicious for acute Charcot neuroarthropathy (Eichenholtz stage 0). Total contact casting is the initial treatment of choice to offload the foot, decrease inflammation, and prevent severe deformity.
Question 444
Topic: 8. Foot and Ankle
A 24-year-old football player sustains a hyperplantarflexion injury to his midfoot. Radiographs show widening of the space between the medial cuneiform and the base of the second metatarsal. What is the primary stabilizing structure injured?
Correct Answer & Explanation
. Lisfranc ligament
Explanation
The Lisfranc ligament uniquely connects the medial cuneiform to the base of the second metatarsal. It is the primary stabilizer of the tarsometatarsal articulation, and its disruption leads to midfoot instability.
Question 445
Topic: Midfoot & Hindfoot
A 55-year-old female presents with medial ankle pain and a progressive flatfoot deformity. Examination reveals an inability to perform a single-leg heel rise, but the hindfoot remains flexible and correctable. Which of the following surgical interventions is most appropriate for this stage of disease?
Correct Answer & Explanation
. Medial displacement calcaneal osteotomy and flexor digitorum longus (FDL) transfer
Explanation
This patient has Stage II posterior tibial tendon dysfunction (PTTD), characterized by a flexible hindfoot and inability to perform a single-leg heel rise. Treatment involves a joint-sparing procedure such as an FDL transfer combined with a medial displacement calcaneal osteotomy.
Question 446
Topic: Ankle Trauma & Sports
During open reduction and internal fixation of a Weber C ankle fracture, the syndesmosis is reduced and clamped. Which of the following radiographic parameters best confirms accurate reduction of the syndesmosis on a standard mortise view?
Correct Answer & Explanation
. Tibiofibular clear space less than 5 mm
Explanation
On the anteroposterior and mortise views, the tibiofibular clear space should be less than 5 mm when measured 1 cm proximal to the joint line. This is the most reliable and consistent two-dimensional radiographic indicator of syndesmotic reduction.
Question 447
Topic: 8. Foot and Ankle
A 45-year-old weekend warrior feels a 'pop' in his posterior ankle while playing tennis. Clinical examination reveals a positive Thompson test. If non-operative management is chosen, which of the following functional rehabilitation protocols yields outcomes most comparable to surgical repair regarding re-rupture rates?
Correct Answer & Explanation
. Early weight-bearing in a functional brace with progressive decrease in equinus
Explanation
Early functional rehabilitation with protected weight-bearing in a brace has been shown to reduce re-rupture rates in non-operatively managed Achilles tendon ruptures. This dynamic protocol makes clinical outcomes highly comparable to surgical repair while avoiding wound complications.
Question 448
Topic: 8. Foot and Ankle
A 52-year-old patient with long-standing peripheral neuropathy presents with an acutely swollen, warm, and erythematous left foot. Radiographs show no fractures or dislocations, and laboratory markers (ESR, CRP) are within normal limits. What is the most appropriate initial management?
Correct Answer & Explanation
. Total contact casting and strict offloading
Explanation
The clinical presentation is classic for acute Eichenholtz stage 0 Charcot arthropathy (warm, swollen foot with normal radiographs and normal inflammatory markers). The standard of care to prevent progressive architectural collapse and fragmentation is immediate strict offloading via total contact casting.
Question 449
Topic: 8. Foot and Ankle
A 30-year-old male sustains a severely displaced talar neck fracture following a high-speed motor vehicle collision. Disruption of which of the following blood vessels places the talar body at the highest risk for developing avascular necrosis (AVN)?
Correct Answer & Explanation
. Artery of the tarsal canal
Explanation
The artery of the tarsal canal, a major branch of the posterior tibial artery, provides the dominant blood supply to the talar body. Displaced talar neck fractures routinely disrupt this critical vascular supply, leading to a high incidence of avascular necrosis.
Question 450
Topic: Forefoot
A 40-year-old female presents with painful bunions. Weight-bearing radiographs demonstrate a hallux valgus angle of 35 degrees and an intermetatarsal angle of 15 degrees. Clinical exam reveals gross hypermobility of the first tarsometatarsal (TMT) joint. Which of the following surgical procedures is most indicated?
Correct Answer & Explanation
. Lapidus procedure (first TMT arthrodesis)
Explanation
The Lapidus procedure (arthrodesis of the first tarsometatarsal joint) is specifically indicated for moderate to severe hallux valgus associated with first ray hypermobility. It definitively stabilizes the medial column and reliably corrects the intermetatarsal angle.
Question 451
Topic: 8. Foot and Ankle
A 48-year-old woman complains of burning pain in the plantar forefoot radiating to the third and fourth toes, worsening with tight shoes. A palpable Mulder's click is present. If standard operative treatment is performed following failed conservative measures, what is the most common post-surgical complication?
Correct Answer & Explanation
. Stump neuroma formation
Explanation
The standard surgical treatment for refractory Morton's neuroma is dorsal or plantar excision of the affected interdigital nerve. The most common complication of this neurectomy is the formation of a symptomatic stump neuroma, causing recurrent or worsened pain.
Question 452
Topic: 8. Foot and Ankle
A 35-year-old roofer falls from a height and sustains a severely comminuted intra-articular calcaneal fracture. Which of the following radiographic findings on a lateral foot radiograph best indicates the loss of calcaneal height and collapse of the posterior facet?
Correct Answer & Explanation
. Bohler's angle less than 20 degrees
Explanation
Bohler's angle (normally 20 to 40 degrees) is formed by lines drawn tangentially to the anterior and posterior aspects of the superior calcaneus. A flattened or negative Bohler's angle is the primary radiographic hallmark indicating collapse of the posterior facet and severe loss of calcaneal height.
Question 453
Topic: 8. Foot and Ankle
A 67-year-old woman sustained a cerebrovascular accident 18 months previously, and has problems with ambulation. She notes that the ankle buckles with ground contact. Upon examination, she ambulates with slight circumduction of one limb, and heel varus is present during the swing and heel strike phases of gait. The procedure that would stabilize her foot during ground contact is:
Correct Answer & Explanation
. Split anterior tibial tendon transfer
Explanation
A patient with persistent hindfoot varus during ground contact has an overactive anterior tibialis, which will cause a sense of instability upon heel strike. This can be effectively treated with a split anterior tibial tendon transfer, transferring half of the tendon more laterally to the lateral cuneiform or cuboid.
Question 454
Topic: 8. Foot and Ankle
A 19-year-old man presents for treatment in the emergency department following a motorcycle accident. He sustained an isolated injury to his foot and ankle. The recommended treatment is:
Correct Answer & Explanation
. Open reduction internal fixation
Explanation
The prognosis following fracture dislocation of the navicular is not good regardless of treatment. Although one may be tempted to perform an open reduction and immediate primary talonavicular arthrodesis, this is notnecessary. Following open reduction and internal fixation, arthritis of the talonavicular joint may occur.
Question 455
Topic: 8. Foot and Ankle
A 23-year-old man sustains an injury to his foot when falling off a ladder. The foot is grossly twisted inward, and the talonavicular joint is dislocated with the talar head penetrating through the extensor brevis muscle. The dislocation is reduced. The likelihood of this resulting in avascular necrosis of the talus is:
Correct Answer & Explanation
. Rare
Explanation
Medial peritalar dislocation does not result in avascular necrosis of the talus. The development of subtalar arthritis is more likely.
Question 456
Topic: 8. Foot and Ankle
A 32-year-old woman was treated surgically for ankle instability 2 years ago. She notes that her ankle is stable, but over the past year, she has noted progressive difficulty with the use of her big toe. She finds that her toe no longer touches the ground. This is confirmed upon pedobarograph testing, because there is no contact between the first metatarsal and the ground, which is an abnormal finding compared to her opposite foot. The appearance of the foot is presented. The probable cause for this is:
Correct Answer & Explanation
. Use of the peroneus longus in the ankle reconstruction
Explanation
The primary function of the peroneus longus is to depress or plantarflex the first metatarsal and oppose the effect of the anterior tibialis on the base ofthe first metatarsal. The peroneus longus is no longer functioning, and first metatarsus elevatus is present.
Question 457
Topic: 8. Foot and Ankle
A 26-year-old woman presents for treatment of painful forefoot deformity. Hallux valgus is present, with a 35° angle, and arthritis of the metatarsophalangeal (MP) joint. The second and third lesser toe MP joints are dislocated with juxta-articular erosions of the fourth metatarsal head noted. The ideal surgical treatment is:
Correct Answer & Explanation
. Arthrodesis of the hallux MP joint and resection of the lesser metatarsal heads
Explanation
For the patient with rheumatoid arthritis, stabilization of the hallux metatarsophalangeal joint is necessary, and a combination bunionectomy and metatarsal osteotomy is unlikely to succeed in the long-term when arthritis is present. Although shortening osteotomies of the lesser toe metatarsals may be considered to reduce the joint dislocations, this procedure has not yet been reported with long-term follow-up. Silastic joint replacement is not a procedure with long-term benefit, and is not indicated for the lesser toes.
Question 458
Topic: 8. Foot and Ankle
A 20-year-old collegiate football player sustains an injury to his big toe during a scrimmage game. He was pushing off when another player fell on his foot, resulting in the hallux being hyperextended. Two days later he has pain and swelling in the joint, limited motion, and normal radiographs. The recommended treatment is:
Correct Answer & Explanation
. Rest, compression, toe taping, and gradual rehabilitation
Explanation
This is a typical turf toe injury caused by hyperextension of the hallux, and injury to the plantar plate. This injury may result in marked disability if not correctly treated, and the joint must be rested, although cast and boot immobilization is not necessary. Injection is not indicated, and taping of the toe will alleviate pain and permit ambulation.
Question 459
Topic: Forefoot
A 43-year-old patient presents with pain in the hallux metatarsophalangeal (MP) joint. Motion is limited in dorsiflexion and to some extent in plantarflexion, and mild arthritis is radiographically evident. If a cheilectomy is performed on this patient, what is the primary goal of the procedure in the management of hallux rigidus:
Correct Answer & Explanation
. To decrease pain
Explanation
The goal of cheilectomy is to decrease pain. Although motion may increase, this must not be the goal of surgery because the motion may only be minimally increased. Some patients improve motion markedly after cheilectomy, but this should not be the focus of treatment or promised to the patient.
Question 460
Topic: 8. Foot and Ankle
A 22-year-old collegiate basketball player presents for treatment of a stress fracture of the base of the fifth metatarsal at the junction of the metaphysis and diaphysis. The fracture was treated operatively, and the patient returned to playing basketball. Three months later, it was apparent that a repeat fracture was present. The fracture was treated with screw removal and a repeat screw fixation. Four months later, after a successful basketball season, he sustained a repeat stress fracture of the metatarsal. On examination, he has a mild cavovarus foot configuration with normal ankle range of motion. Inversion is 15° and eversion is 5°. The base of the fifth metatarsal is prominent. The most likely cause for the repeat fracture is:
Correct Answer & Explanation
. A varus heel
Explanation
The most common cause of recurrent injury to the fifth metatarsal is unrecognized varus heel deformity. Surgeons must also check for ankle instability, which may be present in this patient. A varus heel, ankle instability, and injury to the fifth metatarsal are associated with recurrent deformity.
Test Yourself
Switch to an interactive, timed exam simulation to truly master this topic.
