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8. Foot and Ankle MCQs

Practice Set 236 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 4701

Topic: Ankle Trauma & Sports

While operatively stabilizing a syndesmotic injury of the ankle, the surgeon places a syndesmotic screw from the fibula to the tibia. Anatomically, the distal tibiofibular syndesmosis relies on multiple ligamentous structures for stability. Which of the following is considered the strongest and thickest primary stabilizer of this complex?

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

Correct Answer & Explanation

. Posterior inferior tibiofibular ligament (PITFL)

Explanation

The distal tibiofibular syndesmosis is stabilized by the AITFL, PITFL, and the interosseous ligament/membrane. Biomechanical studies have demonstrated that the posterior inferior tibiofibular ligament (PITFL) is the thickest and strongest component, providing approximately 42% of the strength of the syndesmosis and offering the greatest resistance to lateral displacement of the distal fibula.

Question 4702

Topic: 8. Foot and Ankle
A 28-year-old male sustains a displaced talar neck fracture (Hawkins Type III). He is at high risk for avascular necrosis. Which of the following arteries provides the majority of the blood supply to the talar body and is most likely injured in this fracture pattern?
. Artery of the tarsal sinus
. Deltoid branch of the posterior tibial artery
. Artery of the tarsal canal
. Anterior tibial artery
. Dorsalis pedis artery

Correct Answer & Explanation

. Artery of the tarsal canal

Explanation

The main blood supply to the talar body is derived from the artery of the tarsal canal, which is a branch of the posterior tibial artery. The artery of the tarsal sinus (formed by branches of the perforating peroneal and dorsalis pedis arteries) and the deltoid branch provide supplementary blood supply. Displaced talar neck fractures often disrupt the artery of the tarsal canal, leading to a high rate of avascular necrosis of the talar body.

Question 4703

Topic: 8. Foot and Ankle

The 'Master Knot of Henry' is a recognized surgical landmark in the plantar aspect of the midfoot. Which of the following correctly describes the anatomical intersection that defines this structure?

. Flexor hallucis longus crossing superficial (plantar) to the flexor digitorum longus.
. Flexor digitorum longus crossing superficial (plantar) to the flexor hallucis longus.
. Tibialis posterior crossing superficial to the flexor hallucis longus.
. The medial plantar nerve crossing the lateral plantar nerve.
. Flexor digitorum brevis crossing the quadratus plantae.

Correct Answer & Explanation

. Flexor digitorum longus crossing superficial (plantar) to the flexor hallucis longus.

Explanation

The Master Knot of Henry is located in the medial plantar aspect of the foot at the level of the navicular bone. It is defined by the flexor digitorum longus (FDL) tendon crossing superficial (plantar) to the flexor hallucis longus (FHL) tendon. It is a critical landmark during tendon transfers and when dissecting near the medial and lateral plantar nerves.

Question 4704

Topic: 8. Foot and Ankle

An orthopedic surgeon is performing an extensile lateral approach to the calcaneus for a displaced intra-articular calcaneus fracture. The sural nerve is at significant risk of injury during the creation of the full-thickness soft tissue flap. Which of the following best describes the typical anatomic course of the sural nerve at the level of the lateral malleolus?

. 1.0 cm anterior to the lateral malleolus
. 1.5 cm posterior and inferior to the tip of the lateral malleolus
. 3.0 cm posterior and superior to the tip of the lateral malleolus
. Directly superficial to the peroneal tubercle
. Deep to the superior peroneal retinaculum

Correct Answer & Explanation

. 1.5 cm posterior and inferior to the tip of the lateral malleolus

Explanation

The sural nerve typically crosses approximately 10 to 15 mm (1.0 to 1.5 cm) posterior and inferior to the tip of the lateral malleolus. It is highly susceptible to injury during the extensile lateral approach to the calcaneus if the horizontal arm of the incision is misplaced or if the full-thickness subperiosteal flap is not properly maintained.

Question 4705

Topic: 8. Foot and Ankle

A 35-year-old sustains an intra-articular calcaneus fracture. The surgeon plans a lateral extensile approach. To prevent flap necrosis, a full-thickness subperiosteal flap must be created. What is the primary arterial supply to the apex (corner) of this lateral flap?

. Lateral calcaneal artery
. Medial plantar artery
. Lateral tarsal artery
. Dorsalis pedis artery
. Peroneal artery perforating branches

Correct Answer & Explanation

. Lateral calcaneal artery

Explanation

The lateral calcaneal artery, a terminal branch primarily derived from the peroneal artery, provides the primary blood supply to the lateral heel skin and the apex of the flap in a lateral extensile approach to the calcaneus. The incision should be full-thickness straight to the bone to protect this delicate vascular supply.

Question 4706

Topic: 8. Foot and Ankle

A 52-year-old patient undergoes surgical release for recalcitrant tarsal tunnel syndrome. The flexor retinaculum is carefully incised. Which of the following describes the correct anatomical order of structures within the tarsal tunnel from anterior-medial to posterior-lateral?

. Tibialis posterior, Flexor hallucis longus, Posterior tibial artery, Tibial nerve, Flexor digitorum longus
. Flexor digitorum longus, Tibialis posterior, Posterior tibial artery, Tibial nerve, Flexor hallucis longus
. Tibial nerve, Posterior tibial artery, Tibialis posterior, Flexor digitorum longus, Flexor hallucis longus
. Tibialis posterior, Flexor digitorum longus, Posterior tibial artery, Tibial nerve, Flexor hallucis longus
. Tibialis posterior, Posterior tibial artery, Tibial nerve, Flexor digitorum longus, Flexor hallucis longus

Correct Answer & Explanation

. Tibialis posterior, Flexor digitorum longus, Posterior tibial artery, Tibial nerve, Flexor hallucis longus

Explanation

The structures passing through the tarsal tunnel from anterior to posterior behind the medial malleolus can be recalled with the mnemonic 'Tom, Dick, And Very Nervous Harry': Tibialis posterior tendon, flexor Digitorum longus tendon, posterior tibial Artery, posterior tibial Vein, tibial Nerve, and flexor Hallucis longus tendon.

Question 4707

Topic: 8. Foot and Ankle
A 32-year-old male sustains a high-energy trauma resulting in a Hawkins Type III talar neck fracture. The talar body is completely extruded and at a high risk of avascular necrosis. The majority of the blood supply to the talar body normally enters via the anastomotic sling in the tarsal canal. Which major artery is the primary contributor to the artery of the tarsal canal?
. Anterior tibial artery
. Posterior tibial artery
. Peroneal artery
. Dorsalis pedis artery
. Medial plantar artery

Correct Answer & Explanation

. Posterior tibial artery

Explanation

The talus lacks muscle attachments and relies heavily on an extraosseous vascular ring. The artery of the tarsal canal, which supplies the majority of the talar body, is formed primarily by a branch of the posterior tibial artery (arising proximal to the bifurcation of the medial and lateral plantar arteries). The artery of the sinus tarsi is formed by an anastomosis between the peroneal and anterior tibial/dorsalis pedis arteries.

Question 4708

Topic: 8. Foot and Ankle

A 42-year-old distance runner presents with chronic, recalcitrant midfoot pain and paresthesias radiating into the plantar aspect of the medial toes. You suspect entrapment of the medial plantar nerve at the Master Knot of Henry. Anatomically, which two tendons cross at this specific location?

. Flexor hallucis longus and flexor digitorum longus
. Tibialis posterior and flexor digitorum longus
. Flexor hallucis longus and tibialis posterior
. Peroneus longus and tibialis anterior
. Flexor digitorum brevis and flexor hallucis longus

Correct Answer & Explanation

. Flexor hallucis longus and flexor digitorum longus

Explanation

The Master Knot of Henry is a key anatomical landmark in the plantar midfoot where the flexor hallucis longus (FHL) tendon crosses dorsal to the flexor digitorum longus (FDL) tendon. The medial plantar nerve runs in close proximity to this intersection, and hypertrophy of the muscles/tendons or scar tissue can cause focal nerve entrapment known as medial plantar nerve entrapment (Jogger's foot).

Question 4709

Topic: Midfoot & Hindfoot

A 45-year-old female marathon runner with recalcitrant heel pain that is worst with the first steps in the morning has failed 9 months of conservative management. Tenderness is distinctly maximal at the medial aspect of the calcaneal tuberosity, and she describes radiating burning pain. A release of the first branch of the lateral plantar nerve (Baxter's nerve) is planned. Between which two muscular structures does this nerve typically become entrapped?

. Abductor hallucis and flexor digitorum brevis
. Quadratus plantae and flexor digitorum brevis
. Abductor digiti minimi and quadratus plantae
. Deep fascia of the abductor hallucis and the medial aspect of the quadratus plantae
. Tibialis posterior and flexor digitorum longus

Correct Answer & Explanation

. Deep fascia of the abductor hallucis and the medial aspect of the quadratus plantae

Explanation

The first branch of the lateral plantar nerve, also known as Baxter's nerve, provides motor innervation to the abductor digiti minimi. It most commonly becomes entrapped as it travels vertically between the deep fascia of the abductor hallucis and the medial margin of the quadratus plantae muscle. Release of this fascial band is the basis of surgical decompression.

Question 4710

Topic: 8. Foot and Ankle
A 30-year-old man sustains a severe hyperdorsiflexion injury of the ankle resulting in a displaced talar neck fracture (Hawkins Type III). Which of the following arterial vessels is the predominant blood supply to the body of the talus, placing it at the highest risk for avascular necrosis if disrupted?
. Artery of the tarsal sinus
. Artery of the tarsal canal
. Dorsalis pedis artery
. Deltoid branch
. Medial plantar artery

Correct Answer & Explanation

. Artery of the tarsal canal

Explanation

The primary blood supply to the body of the talus is the artery of the tarsal canal, which is a branch of the posterior tibial artery. It enters the talar body from the inferior surface. Disruption of this vessel, along with the dorsal network from the anterior tibial artery and the artery of the tarsal sinus, significantly increases the risk of avascular necrosis in displaced talar neck fractures.

Question 4711

Topic: 8. Foot and Ankle

A 28-year-old male sustains a displaced talar neck fracture with subluxation of the subtalar joint (Hawkins type II). Which of the following arteries provides the predominant blood supply to the talar body, and is at greatest risk of disruption in this injury pattern?

. Artery of the tarsal canal
. Artery of the tarsal sinus
. Dorsalis pedis artery
. Deltoid branch of the posterior tibial 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. In displaced talar neck fractures (Hawkins II-IV), this major vascular supply is invariably disrupted or compromised, leading to a high rate of avascular necrosis. The artery of the tarsal sinus (formed by branches from the dorsalis pedis and peroneal arteries) chiefly supplies the head and neck, while the deltoid branch supplies the medial aspect of the talar body.

Question 4712

Topic: 8. Foot and Ankle

A 50-year-old female presents with stage II adult-acquired flatfoot deformity secondary to posterior tibial tendon dysfunction. Which of the following ligamentous structures, critically important for supporting the talar head, is most commonly attenuated alongside the posterior tibial tendon in this condition?

. Plantar fascia
. Bifurcate ligament
. Plantar calcaneonavicular ligament
. Long plantar ligament
. Deltoid ligament

Correct Answer & Explanation

. Plantar calcaneonavicular ligament

Explanation

The plantar calcaneonavicular ligament, commonly known as the spring ligament, extends from the sustentaculum tali of the calcaneus to the navicular. It plays a crucial role in forming a 'sling' supporting the head of the talus and maintaining the medial longitudinal arch. In adult-acquired flatfoot deformity (AAFD), failure of the posterior tibial tendon shifts excessive load to the spring ligament, which frequently becomes stretched, attenuated, or torn.

Question 4713

Topic: 8. Foot and Ankle

A 25-year-old athlete is undergoing anterior ankle arthroscopy for an osteochondral lesion of the talus. The anteromedial portal is established first, followed by the anterolateral portal. Which structure is at greatest risk of iatrogenic injury during the establishment of the anterolateral portal?

. Sural nerve
. Saphenous nerve
. Superficial peroneal nerve
. Deep peroneal nerve
. Anterior tibial artery

Correct Answer & Explanation

. Superficial peroneal nerve

Explanation

The anterolateral portal in ankle arthroscopy is typically placed just lateral to the peroneus tertius tendon. The superficial peroneal nerve is at significant risk during the creation of this portal. The intermediate dorsal cutaneous branch of the superficial peroneal nerve often crosses the ankle joint in this area. The anteromedial portal risks the saphenous nerve and vein. The deep peroneal nerve and anterior tibial artery are at risk if a central portal is used.

Question 4714

Topic: 8. Foot and Ankle
A 32-year-old man sustains a displaced Hawkins type III talar neck fracture. Which of the following best describes the primary blood supply to the body of the talus, which is at the highest risk of disruption leading to avascular necrosis (AVN)?
. Artery of the tarsal canal, a branch of the posterior tibial artery
. Artery of the tarsal sinus, a branch of the anterior tibial artery
. Deltoid artery, a branch of the dorsalis pedis artery
. Peroneal artery perforators
. Medial plantar artery branches

Correct Answer & Explanation

. Artery of the tarsal canal, a branch of the posterior tibial artery

Explanation

The primary blood supply to the talar body is the artery of the tarsal canal, which arises from the posterior tibial artery approximately 1 cm proximal to the bifurcation. A Hawkins III fracture involves a talar neck fracture with subtalar and tibiotalar dislocations, disrupting the artery of the tarsal canal, the artery of the tarsal sinus, and often the deltoid branch, leading to an extremely high risk of AVN.

Question 4715

Topic: 8. Foot and Ankle

A surgeon is performing a minimally invasive percutaneous repair of an acute Achilles tendon rupture. To minimize the risk of iatrogenic injury to the sural nerve, the surgeon must be aware of its anatomical course. At what approximate level does the sural nerve typically cross the lateral border of the Achilles tendon?

. 2 cm proximal to the calcaneal insertion
. 5 cm proximal to the calcaneal insertion
. 10 cm proximal to the calcaneal insertion
. 15 cm proximal to the calcaneal insertion
. It does not cross the lateral border of the Achilles tendon

Correct Answer & Explanation

. 10 cm proximal to the calcaneal insertion

Explanation

The sural nerve typically crosses the lateral border of the Achilles tendon approximately 10 to 12 cm proximal to its calcaneal insertion. It runs distally and laterally, eventually passing posterior to the lateral malleolus. In percutaneous or minimally invasive Achilles tendon repairs, the sural nerve is at the highest risk of entrapment or laceration when placing sutures in the proximal tendon stump on the lateral side.

Question 4716

Topic: 8. Foot and Ankle

A foot and ankle surgeon is performing a plantar approach for the excision of a deep midfoot mass. During dissection, the surgeon encounters an anatomical landmark where the flexor digitorum longus (FDL) tendon crosses dorsal to the flexor hallucis longus (FHL) tendon. This intersection is known as the Master Knot of Henry. Where is this structure precisely located?

. Plantar to the navicular
. Dorsal to the medial cuneiform
. Posterior to the medial malleolus
. Plantar to the base of the first metatarsal
. Distal to the spring ligament

Correct Answer & Explanation

. Plantar to the navicular

Explanation

The Master Knot of Henry is an important surgical landmark in the medial plantar aspect of the midfoot, situated directly plantar to the navicular bone. At this location, the tendon of the flexor digitorum longus (FDL) crosses over (dorsal/superior to) the tendon of the flexor hallucis longus (FHL). It is a critical site for tendon transfers, such as using the FDL for posterior tibial tendon dysfunction.

Question 4717

Topic: 8. Foot and Ankle
A 28-year-old male is involved in a high-speed motor vehicle collision and sustains a displaced Hawkins type III fracture of the talar neck. Which of the following arteries provides the dominant blood supply to the talar body and is most compromised in this injury?
. Artery of the tarsal sinus
. Artery of the tarsal canal
. Dorsalis pedis artery
. Deltoid branch of the posterior tibial artery
. Peroneal artery

Correct Answer & Explanation

. Artery of the tarsal canal

Explanation

The talar body receives its dominant blood supply from the artery of the tarsal canal, a branch of the posterior tibial artery. It enters the talar body from the plantar surface. A displaced talar neck fracture disrupts this intraosseous blood supply, strongly predisposing the talar body to avascular necrosis (AVN). The artery of the tarsal sinus, formed by the dorsalis pedis and peroneal arteries, supplies the head and neck.

Question 4718

Topic: 8. Foot and Ankle

A 22-year-old football player sustains a hyperplantarflexion injury to his midfoot. Radiographs show a widening of the space between the first and second metatarsals. An MRI confirms a complete rupture of the Lisfranc ligament. Between which two specific osseous structures does the Lisfranc ligament course?

. Medial cuneiform and the base of the first metatarsal
. Medial cuneiform and the base of the second metatarsal
. Intermediate cuneiform and the base of the second metatarsal
. Lateral cuneiform and the cuboid
. Cuboid and the base of the fourth metatarsal

Correct Answer & Explanation

. Medial cuneiform and the base of the second metatarsal

Explanation

The Lisfranc ligament is an oblique, interosseous ligament that runs from the lateral aspect of the medial cuneiform to the medial aspect of the base of the second metatarsal. It is the strongest and most important stabilizing structure of the tarsometatarsal joint complex, compensating for the lack of a transverse intermetatarsal ligament between the first and second metatarsal bases.

Question 4719

Topic: 8. Foot and Ankle

A patient presents with recalcitrant tarsal tunnel syndrome. Surgical release of the flexor retinaculum is planned. From anteromedial to posterolateral, what is the anatomical arrangement of the contents within the tarsal tunnel posterior to the medial malleolus?

. Tibialis posterior tendon, flexor digitorum longus tendon, posterior tibial artery, posterior tibial vein, tibial nerve, flexor hallucis longus tendon
. Tibialis posterior tendon, flexor hallucis longus tendon, posterior tibial artery, posterior tibial vein, tibial nerve, flexor digitorum longus tendon
. Flexor digitorum longus tendon, tibialis posterior tendon, posterior tibial artery, tibial nerve, posterior tibial vein, flexor hallucis longus tendon
. Tibialis posterior tendon, flexor digitorum longus tendon, tibial nerve, posterior tibial artery, posterior tibial vein, flexor hallucis longus tendon
. Flexor hallucis longus tendon, tibialis posterior tendon, flexor digitorum longus tendon, posterior tibial artery, posterior tibial vein, tibial nerve

Correct Answer & Explanation

. Tibialis posterior tendon, flexor digitorum longus tendon, posterior tibial artery, posterior tibial vein, tibial nerve, flexor hallucis longus tendon

Explanation

The contents of the tarsal tunnel, arranged from anteromedial to posterolateral, can be recalled using the classic mnemonic 'Tom, Dick, And Very Nervous Harry': Tibialis posterior tendon, flexor digitorum longus (FDL) tendon, posterior tibial Artery, posterior tibial Vein, tibial Nerve, and flexor hallucis longus (FHL) tendon. Recognizing this exact anatomical sequence is essential for safe surgical decompression.

Question 4720

Topic: 8. Foot and Ankle

A 32-year-old male suffers an acute Achilles tendon rupture while playing basketball. He elects to pursue nonoperative management. Compared to traditional prolonged cast immobilization, what is the primary advantage of employing an early functional rehabilitation protocol (early weight-bearing in an orthosis with functional ROM)?

. Significantly lower re-rupture rate compared to operative repair
. Decreased risk of deep vein thrombosis with superior functional scores
. Decreased time to complete tendon healing on MRI
. Lower risk of sural nerve injury
. Equivalent re-rupture rate to operative repair with improved early functional outcomes

Correct Answer & Explanation

. Equivalent re-rupture rate to operative repair with improved early functional outcomes

Explanation

Recent high-quality literature demonstrates that nonoperative management of acute Achilles tendon ruptures utilizing an early functional rehabilitation protocol has an equivalent re-rupture rate to operative management. It avoids surgical complications (infection, nerve injury) and provides better early functional outcomes and less muscle atrophy compared to traditional rigid cast immobilization.

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