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8. Foot and Ankle MCQs

Practice Set 239 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 4761

Topic: Midfoot & Hindfoot

A 12-year-old boy complains of recurrent ankle sprains and midfoot pain. Examination reveals a rigid flatfoot with absent subtalar motion. Oblique radiographs demonstrate a "calcaneonavicular" coalition. He has failed 6 months of conservative management with custom orthotics and a short leg cast. What is the most appropriate surgical treatment?

. Subtalar arthrodesis
. Triple arthrodesis
. Coalition resection with interposition of the extensor digitorum brevis
. Calcaneal lengthening osteotomy (Evans procedure)
. Talonavicular arthrodesis

Correct Answer & Explanation

. Coalition resection with interposition of the extensor digitorum brevis

Explanation

Symptomatic calcaneonavicular coalitions that fail extensive conservative management are best treated with surgical resection. Interposition of autologous fat or the extensor digitorum brevis muscle belly is performed to prevent recurrence of the coalition.

Question 4762

Topic: 8. Foot and Ankle

A 12-year-old boy presents with rigid flatfeet and recurrent ankle sprains. Radiographs show a "C sign" on the lateral view of the ankle. What is the most likely diagnosis?

. Calcaneonavicular coalition
. Talocalcaneal coalition
. Posterior tibial tendon insufficiency
. Congenital vertical talus
. Naviculocuneiform coalition

Correct Answer & Explanation

. Talocalcaneal coalition

Explanation

The "C sign" on a lateral radiograph is formed by the continuous outline of the medial talar dome and the sustentaculum tali, strongly suggesting a talocalcaneal coalition. Calcaneonavicular coalitions typically demonstrate the "anteater nose" sign.

Question 4763

Topic: 8. Foot and Ankle

A 12-year-old boy complains of recurrent right ankle sprains and lateral foot pain. Examination reveals a rigid flatfoot with restricted subtalar motion. An oblique radiograph of the foot demonstrates an 'anteater nose' sign. Which type of tarsal coalition does this patient have?

. Talocalcaneal coalition
. Calcaneonavicular coalition
. Talonavicular coalition
. Cubonavicular coalition
. Calcaneocuboid coalition

Correct Answer & Explanation

. Calcaneonavicular coalition

Explanation

The 'anteater nose' sign on an oblique view of the foot is a pathognomonic radiographic finding for a calcaneonavicular coalition. It represents an elongated anterior process of the calcaneus attempting to fuse with the navicular.

Question 4764

Topic: 8. Foot and Ankle

A 2-year-old boy is evaluated for bilateral genu varum. Standing long-leg radiographs demonstrate a metaphyseal-diaphyseal (MD) angle of 9 degrees bilaterally. The medial proximal tibial physes appear normal. What is the most appropriate management?

. Observation and reassurance
. Knee-ankle-foot orthosis (KAFO) bracing
. Proximal tibial valgus producing osteotomy
. Medial plateau elevation osteotomy
. Lateral proximal tibial hemiepiphysiodesis

Correct Answer & Explanation

. Observation and reassurance

Explanation

An MD angle of less than 11 degrees in a 2-year-old child strongly suggests physiologic bowing rather than infantile Blount disease. The appropriate management is observation, as physiologic bowing typically resolves spontaneously by age 3.

Question 4765

Topic: 8. Foot and Ankle

During the normal gait cycle, at what point does maximum ankle dorsiflexion occur?

. Initial contact (Heel strike)
. Midstance
. Terminal stance
. Pre-swing
. Mid-swing

Correct Answer & Explanation

. Terminal stance

Explanation

Maximum ankle dorsiflexion occurs at the end of terminal stance (just prior to pre-swing/toe-off), as the body's center of mass progresses and the tibia advances over the planted foot, reaching approximately 10 degrees of dorsiflexion. During this phase, the triceps surae (gastrocnemius and soleus) contracts eccentrically to control the forward progression of the tibia.

Question 4766

Topic: 8. Foot and Ankle

During a posterolateral approach to the ankle for a posterior malleolus fracture, the sural nerve is at risk. Which of the following correctly describes the typical anatomical course of the sural nerve relative to the Achilles tendon and lateral malleolus?

. It runs medial to the Achilles tendon and posterior to the medial malleolus.
. It runs lateral to the Achilles tendon and posterior to the lateral malleolus.
. It runs anterior to the lateral malleolus along with the superficial peroneal nerve.
. It pierces the Achilles tendon 5 cm proximal to its insertion.
. It runs centrally deep to the Achilles tendon and posterior to the tibia.

Correct Answer & Explanation

. It runs lateral to the Achilles tendon and posterior to the lateral malleolus.

Explanation

The sural nerve provides sensory innervation to the lateral hindfoot. It courses down the posterior leg, running just lateral to the Achilles tendon and then posterior to the lateral malleolus.

Question 4767

Topic: 8. Foot and Ankle

In evaluating a severe midfoot sprain, the integrity of the Lisfranc ligament is crucial. This primary stabilizing ligament connects which two osseous structures?

. Lateral aspect of the medial cuneiform to the medial base of the 2nd metatarsal
. Medial aspect of the lateral cuneiform to the base of the 2nd metatarsal
. Distal navicular to the medial cuneiform
. Cuboid to the lateral base of the 4th metatarsal
. Medial cuneiform to the base of the 1st metatarsal

Correct Answer & Explanation

. Lateral aspect of the medial cuneiform to the medial base of the 2nd metatarsal

Explanation

The Lisfranc ligament is a strong interosseous ligament that runs from the lateral aspect of the medial cuneiform to the medial base of the second metatarsal. Its disruption severely destabilizes the tarsometatarsal joint complex.

Question 4768

Topic: Ankle Trauma & Sports

A 13-year-old sustains a juvenile Tillaux fracture of the ankle. The specific mechanism involves an avulsion of the anterolateral distal tibial epiphysis. Which ligament is responsible for the avulsive force causing this fracture pattern?

. Anterior inferior tibiofibular ligament (AITFL)
. Posterior inferior tibiofibular ligament (PITFL)
. Anterior talofibular ligament (ATFL)
. Calcaneofibular ligament (CFL)
. Interosseous membrane

Correct Answer & Explanation

. Anterior inferior tibiofibular ligament (AITFL)

Explanation

The anterior inferior tibiofibular ligament (AITFL) attaches the distal fibula to the anterolateral distal tibia (Chaput's tubercle). In adolescents whose medial physis has closed but lateral physis remains open, external rotation forces cause the AITFL to avulse the anterolateral epiphysis.

Question 4769

Topic: 8. Foot and Ankle

Following a displaced talar neck fracture, avascular necrosis of the talar body is a major concern. Which of the following vessels provides the predominant blood supply to the body of the talus?

. Artery of the tarsal sinus
. Artery of the tarsal canal
. Dorsalis pedis artery
. Peroneal artery
. Anterior tibial artery

Correct Answer & Explanation

. Artery of the tarsal canal

Explanation

The artery of the tarsal canal, a branch of the posterior tibial artery, supplies the majority of the talar body. Disruption of this vessel in displaced talar neck fractures significantly increases the risk of avascular necrosis.

Question 4770

Topic: 8. Foot and Ankle

The Lisfranc ligament is critical for midfoot stability. Which of the following describes its precise anatomical attachment?

. Lateral cuneiform to the second metatarsal base
. Medial cuneiform to the second metatarsal base
. Medial cuneiform to the first metatarsal base
. Middle cuneiform to the second metatarsal base
. Navicular to the medial cuneiform

Correct Answer & Explanation

. Medial cuneiform to the second metatarsal base

Explanation

The Lisfranc ligament is a strong interosseous ligament that connects the medial cuneiform to the base of the second metatarsal. It is the primary stabilizer of the second tarsometatarsal joint, and its disruption leads to midfoot instability.

Question 4771

Topic: 8. Foot and Ankle

A 35-year-old man sustains a displaced talar neck fracture. Which of the following provides the primary blood supply to the body of the talus, placing it at high risk for avascular necrosis in this injury?

. Artery of the tarsal canal
. Artery of the tarsal sinus
. Deltoid branches of the posterior tibial artery
. Anterior tibial artery branches
. Perforating 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. Displaced talar neck fractures often disrupt this vessel, leading to osteonecrosis.

Question 4772

Topic: 8. Foot and Ankle

During surgical release for tarsal tunnel syndrome, the flexor retinaculum is divided. What is the correct order of structures within the tarsal tunnel from anterior to posterior?

. Tibialis posterior, Flexor digitorum longus, Posterior tibial artery, Tibial nerve, Flexor hallucis longus
. Tibialis anterior, Flexor hallucis longus, Posterior tibial artery, Tibial nerve, Flexor digitorum longus
. Flexor hallucis longus, Tibial nerve, Posterior tibial artery, Flexor digitorum longus, Tibialis posterior
. Flexor digitorum longus, Tibialis posterior, 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 from anterior to posterior are: Tibialis posterior, Flexor digitorum longus, Posterior tibial Artery, tibial Nerve, and Flexor hallucis longus. This is remembered by the mnemonic 'Tom, Dick, And Very Nervous Harry'.

Question 4773

Topic: 8. Foot and Ankle

During a lateral extensile approach for an intra-articular calcaneus fracture, the sural nerve is at risk of injury. Which of the following correctly describes the normal anatomical course of the sural nerve at the level of the ankle?

. Anterior to the lateral malleolus, deep to the peroneal tendons
. Posterior to the lateral malleolus, superficial to the peroneal tendons
. Anterior to the lateral malleolus, superficial to the peroneal tendons
. Posterior to the lateral malleolus, deep to the peroneal tendons
. Medial to the lateral malleolus, posterior to the Achilles tendon

Correct Answer & Explanation

. Posterior to the lateral malleolus, superficial to the peroneal tendons

Explanation

The sural nerve courses posterior to the lateral malleolus, traveling superficially to the peroneal tendon sheath. It must be carefully protected in the full-thickness flap of the lateral extensile approach.

Question 4774

Topic: Midfoot & Hindfoot

The superomedial calcaneonavicular (spring) ligament is a critical static stabilizer of the longitudinal arch. Which of the following tendons provides dynamic support by coursing directly plantar to this ligament?

. Flexor hallucis longus
. Flexor digitorum longus
. Tibialis posterior
. Peroneus longus
. Tibialis anterior

Correct Answer & Explanation

. Tibialis posterior

Explanation

The tibialis posterior tendon courses directly plantar and medial to the spring ligament, providing critical dynamic support to the talonavicular joint and medial longitudinal arch. Dysfunction of this tendon places excessive stress on the spring ligament, often precipitating acquired adult flatfoot deformity.

Question 4775

Topic: Ankle Trauma & Sports

The distal tibiofibular syndesmosis is stabilized by a complex of multiple ligaments. Based on biomechanical sectioning studies, which structure provides the greatest resistance to lateral displacement of the fibula?

. Anterior inferior tibiofibular ligament (AITFL)
. Posterior inferior tibiofibular ligament (PITFL)
. Interosseous ligament (IOL)
. Inferior transverse ligament (ITL)
. Deltoid ligament

Correct Answer & Explanation

. Posterior inferior tibiofibular ligament (PITFL)

Explanation

Biomechanical studies have demonstrated that the posterior inferior tibiofibular ligament (PITFL) is the strongest component of the syndesmosis, contributing approximately 42% of the resistance to lateral fibular displacement. The AITFL contributes roughly 35% of the total resistance.

Question 4776

Topic: 8. Foot and Ankle

The Lisfranc ligament is vital for the stability of the tarsometatarsal articulation. What are the specific bony attachments of this key ligament?

. Medial cuneiform to the base of the first metatarsal
. Intermediate cuneiform to the base of the second metatarsal
. Medial cuneiform to the base of the second metatarsal
. Lateral cuneiform to the base of the third metatarsal
. Cuboid to the base of the fourth metatarsal

Correct Answer & Explanation

. Medial cuneiform to the base of the second metatarsal

Explanation

The Lisfranc ligament is a robust interosseous ligament that spans obliquely from the lateral aspect of the medial cuneiform to the medial aspect of the base of the second metatarsal. Because there is no direct intermetatarsal ligament between the first and second metatarsal bases, this structure is crucial for midfoot stability.

Question 4777

Topic: 8. Foot and Ankle

A 45-year-old patient sustains a displaced talar neck fracture. Which of the following arteries provides the primary blood supply to the body of the talus and is at greatest risk of disruption in this injury?

. Dorsalis pedis artery
. Artery of the sinus tarsi
. Artery of the tarsal canal
. Perforating peroneal artery
. Medial plantar 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 body of the talus. It forms an anastomotic sling with the artery of the sinus tarsi beneath the talar neck.

Question 4778

Topic: 8. Foot and Ankle

A patient sustains a midfoot sprain. Radiographs are suspicious for a subtle Lisfranc injury. The primary stabilizing ligament of this joint complex connects which of the following osseous structures?

. Medial cuneiform to the base of the first metatarsal
. Medial cuneiform to the base of the second metatarsal
. Middle cuneiform to the base of the second metatarsal
. Lateral cuneiform to the base of the third metatarsal
. Cuboid to the base of the fourth metatarsal

Correct Answer & Explanation

. Medial cuneiform to the base of the second metatarsal

Explanation

The Lisfranc ligament is an interosseous ligament that connects the lateral aspect of the medial cuneiform to the medial aspect of the base of the second metatarsal. It is critical for the primary stability of the tarsometatarsal joint complex.

Question 4779

Topic: 8. Foot and Ankle

A 28-year-old man sustains a displaced talar neck fracture. Disruption of which of the following vessels puts him at highest risk for avascular necrosis of the talar body?

. Artery of the tarsal sinus
. Dorsalis pedis artery
. Artery of the tarsal canal
. Peroneal artery
. Anterior tibial 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 of this vessel in talar neck fractures significantly increases the risk of avascular necrosis.

Question 4780

Topic: 8. Foot and Ankle

A 45-year-old marathon runner presents with burning pain and tingling in the plantar aspect of her foot. Tinel's sign is positive posterior to the medial malleolus. In the tarsal tunnel, what is the anatomical relationship of the structures from anterior to posterior?

. Tibialis posterior, Flexor digitorum longus, Posterior tibial artery, Tibial nerve, Flexor hallucis longus
. 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
. Tibialis anterior, Flexor digitorum longus, Anterior tibial artery, Deep peroneal nerve, Flexor hallucis longus
. Flexor hallucis longus, Tibialis posterior, Posterior tibial artery, Tibial nerve, Flexor digitorum longus

Correct Answer & Explanation

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

Explanation

The structures in the tarsal tunnel from anterior to posterior follow the mnemonic "Tom, Dick, AND Very Nervous Harry": Tibialis posterior, flexor Digitorum longus, posterior tibial Artery, Tibial Nerve, and flexor Hallucis longus.

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