Menu

8. Foot and Ankle MCQs

Practice Set 243 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 4841

Topic: 8. Foot and Ankle

A 7-year-old boy with spastic diplegic cerebral palsy ambulates with a crouch gait. He has dynamic knee flexion contractures but no fixed bony deformities. Which of the following surgical interventions is contraindicated as an isolated procedure, as it may exacerbate his crouch gait?

. Hamstring lengthening
. Achilles tendon lengthening
. Distal femoral extension osteotomy
. Psoas lengthening
. Patellar advancement

Correct Answer & Explanation

. Achilles tendon lengthening

Explanation

Isolated lengthening of the Achilles tendon in a patient with crouch gait will weaken plantar flexion. This leads to increased forward tibial advancement and severe exacerbation of the crouch deformity.

Question 4842

Topic: 8. Foot and Ankle

A 14-year-old boy with a history of recurrent ankle sprains complains of deep, aching lateral hindfoot pain. On examination, he has rigid subtalar motion and pes planovalgus. Radiographs demonstrate a "C-sign" on the lateral view. Which of the following is the most likely diagnosis?

. Calcaneonavicular coalition
. Talocalcaneal coalition
. Accessory navicular syndrome
. Osteochondritis dissecans of the talus
. Posterior tibial tendon dysfunction

Correct Answer & Explanation

. Talocalcaneal coalition

Explanation

A rigid flatfoot with a "C-sign" on lateral ankle radiographs indicates a talocalcaneal coalition. The C-sign represents the continuous bony outline bridging the medial talar dome and the sustentaculum tali.

Question 4843

Topic: Midfoot & Hindfoot

A 12-year-old boy presents with recurring ankle sprains and rigid flatfeet. CT scan confirms a large, symptomatic talocalcaneal coalition involving the middle facet, comprising 60% of the joint surface. Nonoperative management has failed. What is the most appropriate surgical treatment?

. Resection of the coalition with fat graft interposition
. Subtalar arthrodesis
. Triple arthrodesis
. Calcaneal lengthening osteotomy
. Talonavicular arthrodesis

Correct Answer & Explanation

. Subtalar arthrodesis

Explanation

For a talocalcaneal coalition involving greater than 50% of the posterior facet, isolated resection is associated with poor outcomes and recurrence. Subtalar arthrodesis is the most appropriate procedure to relieve pain and restore stability.

Question 4844

Topic: 8. Foot and Ankle

A 12-year-old boy complains of recurrent left ankle sprains and lateral foot pain. On examination, he has a rigid, flat foot and lacks subtalar motion. Radiographs demonstrate a "C-sign" on the lateral view. A CT scan confirms a talocalcaneal coalition involving 25% of the posterior facet. Non-operative management has failed. What is the most appropriate surgical intervention?

. Subtalar arthrodesis
. Triple arthrodesis
. Resection of the coalition with interposition of fat or extensor digitorum brevis
. Calcaneal lengthening osteotomy (Evans)
. Medial displacement calcaneal osteotomy

Correct Answer & Explanation

. Resection of the coalition with interposition of fat or extensor digitorum brevis

Explanation

For symptomatic talocalcaneal coalitions that fail conservative treatment, resection is indicated if the coalition involves less than 50% of the posterior facet and there is no degenerative arthritis. Interposition of material (fat, wax, EDB muscle) prevents recurrence.

Question 4845

Topic: 8. Foot and Ankle

A 14-year-old boy complains of recurrent ankle sprains and deep lateral hindfoot pain. On examination, he has rigid pes planus and absent subtalar motion. Radiographs demonstrate a continuous bony C-shaped ring on the lateral view. Which of the following is the most likely diagnosis?

. Calcaneonavicular coalition
. Talocalcaneal coalition
. Accessory navicular
. Congenital vertical talus
. Fibular hemimelia

Correct Answer & Explanation

. Talocalcaneal coalition

Explanation

The C-sign on a lateral radiograph is characteristic of a talocalcaneal (subtalar) coalition, representing the bony bridge between the talar dome and the sustentaculum tali. Calcaneonavicular coalitions are better visualized on the oblique view.

Question 4846

Topic: 8. Foot and Ankle

A 12-year-old boy presents with a rigid flatfoot and recurrent ankle sprains. CT imaging confirms an isolated calcaneonavicular coalition without arthritic changes. After conservative management fails, what is the most appropriate surgical intervention?

. Excision of the coalition with interposition of the extensor digitorum brevis
. Subtalar arthrodesis
. Triple arthrodesis
. Medial displacement calcaneal osteotomy
. Talonavicular arthrodesis

Correct Answer & Explanation

. Excision of the coalition with interposition of the extensor digitorum brevis

Explanation

For a symptomatic calcaneonavicular coalition without degenerative joint changes, resection of the coalition with interposition of the extensor digitorum brevis muscle or fat graft is the primary surgical treatment of choice.

Question 4847

Topic: 8. Foot and Ankle
An 11-year-old boy with spastic diplegic cerebral palsy presents with an increasingly severe crouch gait. Examination reveals fixed knee flexion contractures of 20 degrees. What is the most appropriate surgical approach to address the crouch gait?
. Isolated Achilles tendon lengthening
. Anterior half of tibialis anterior transfer (SPLATT)
. Isolated adductor longus tenotomies
. Hamstring lengthening and distal femoral extension osteotomy
. Selective dorsal rhizotomy

Correct Answer & Explanation

. Hamstring lengthening and distal femoral extension osteotomy

Explanation

Crouch gait is driven by overactive hamstrings and hip flexors often exacerbated by iatrogenic overly lengthened Achilles tendons. Correcting it requires addressing the knee flexion contractures via hamstring lengthening and a distal femoral extension osteotomy.

Question 4848

Topic: Ankle Trauma & Sports

Intraoperatively, following fixation of a Weber C ankle fracture, the cotton test demonstrates widening of the syndesmosis. Which of the following radiographic parameters best assesses the adequacy of syndesmotic reduction on a standard AP or mortise radiograph?

. Medial clear space
. Tibiofibular overlap
. Talocrural angle
. Talar tilt
. Lateral clear space

Correct Answer & Explanation

. Tibiofibular overlap

Explanation

Tibiofibular overlap is a key radiographic parameter to assess syndesmotic integrity. On a proper AP radiograph, it should be greater than 10 mm, and on a mortise view, greater than 1 mm.

Question 4849

Topic: Midfoot & Hindfoot

In a purely ligamentous Lisfranc injury with instability demonstrated on weight-bearing radiographs, what is the most appropriate surgical treatment to maximize long-term functional outcomes?

. Closed reduction and cast immobilization
. Percutaneous K-wire fixation
. Open reduction and screw fixation
. Primary arthrodesis of the first, second, and third tarsometatarsal joints
. Primary arthrodesis of the fourth and fifth tarsometatarsal joints

Correct Answer & Explanation

. Primary arthrodesis of the first, second, and third tarsometatarsal joints

Explanation

For purely ligamentous Lisfranc injuries, primary arthrodesis of the medial column (1st, 2nd, and 3rd tarsometatarsal joints) has been shown to have better functional outcomes and lower reoperation rates compared to open reduction and internal fixation.

Question 4850

Topic: 8. Foot and Ankle

A 40-year-old roofer falls and sustains a displaced intra-articular calcaneus fracture. He undergoes open reduction and internal fixation via an extensile lateral approach. Which of the following is the most common complication associated with this specific surgical approach?

. Sural nerve injury
. Medial plantar nerve entrapment
. Wound edge necrosis
. Tibialis posterior tendon rupture
. Flexor hallucis longus tethering

Correct Answer & Explanation

. Wound edge necrosis

Explanation

The extensile lateral approach to the calcaneus has a high rate of wound complications, particularly wound edge necrosis, due to the tenuous vascular supply of the L-shaped flap. Sural nerve injury is also possible but less frequent than wound healing issues.

Question 4851

Topic: 8. Foot and Ankle

A 22-year-old football player sustains a hyperplantarflexion injury to his foot. On an anteroposterior radiograph of the foot, a small bony avulsion is seen in the first intermetatarsal space. This 'fleck sign' represents an avulsion of the Lisfranc ligament from which of the following structures?

. Medial cuneiform
. Base of the second metatarsal
. Intermediate cuneiform
. Base of the first metatarsal
. Cuboid

Correct Answer & Explanation

. Base of the second metatarsal

Explanation

The Lisfranc ligament connects the medial cuneiform to the base of the second metatarsal. The 'fleck sign' represents a bony avulsion of this ligament, most commonly from the base of the second metatarsal.

Question 4852

Topic: 8. Foot and Ankle

A 28-year-old presents after a high-energy knee dislocation, which is immediately reduced in the emergency department. The patient has palpable pedal pulses. The Ankle-Brachial Index (ABI) is measured at 0.8. What is the most appropriate next step in management?

. Discharge with a hinged knee brace
. Immediate CT angiography
. Formal open arteriogram in the OR
. Serial neurovascular checks on the floor
. Immediate surgical exploration of the popliteal fossa

Correct Answer & Explanation

. Immediate CT angiography

Explanation

An Ankle-Brachial Index (ABI) of less than 0.9 after a knee dislocation is highly suspicious for a popliteal artery injury and warrants immediate further imaging, typically with a CT angiogram.

Question 4853

Topic: Midfoot & Hindfoot

A 35-year-old male sustains a purely ligamentous Lisfranc injury with dynamic instability. Based on recent literature, which surgical intervention yields the best long-term functional outcomes and lowest revision rates?

. Closed reduction and percutaneous pinning
. Open reduction and internal fixation (ORIF) with transarticular screws
. Open reduction and internal fixation (ORIF) with dorsal spanning plates
. Primary arthrodesis of the first three tarsometatarsal joints
. Application of a bridging external fixator

Correct Answer & Explanation

. Primary arthrodesis of the first three tarsometatarsal joints

Explanation

Current evidence demonstrates that purely ligamentous Lisfranc injuries treated with primary arthrodesis of the first three TMT joints have superior functional outcomes and lower revision rates compared to ORIF.

Question 4854

Topic: 8. Foot and Ankle
A 29-year-old sustains a Hawkins Type III talar neck fracture. Disruption of which of the following arteries is the primary cause of the high rate of avascular necrosis seen in this injury?
. Artery of the tarsal sinus
. Artery of the tarsal canal
. Dorsalis pedis artery
. Anterior 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 predominant blood supply to the talar body. Its disruption in displaced talar neck fractures is the primary driver of avascular necrosis.

Question 4855

Topic: Midfoot & Hindfoot

A 34-year-old man presents with a purely ligamentous Lisfranc injury of the midfoot following a fall from a horse. The injury involves the 1st, 2nd, and 3rd tarsometatarsal joints. Comparing primary arthrodesis to open reduction and internal fixation (ORIF), primary arthrodesis in this specific injury pattern is associated with:

. Decreased rates of hardware removal
. Higher rates of deep postoperative infection
. Decreased rate of return to pre-injury activity levels
. Increased incidence of complex regional pain syndrome
. Inferior short-term functional outcome scores

Correct Answer & Explanation

. Decreased rates of hardware removal

Explanation

Studies comparing ORIF to primary arthrodesis for purely ligamentous Lisfranc injuries demonstrate that primary arthrodesis yields similar or slightly superior functional outcomes. Arthrodesis significantly lowers the rates of subsequent surgeries, specifically hardware removal and secondary salvage fusions.

Question 4856

Topic: Midfoot & Hindfoot

A 35-year-old male sustains a purely ligamentous Lisfranc injury. There are no associated fractures, but weight-bearing radiographs show 3 mm of widening between the medial and middle cuneiforms. What is the recommended definitive treatment to optimize long-term functional outcomes?

. Cast immobilization and non-weight bearing for 6 weeks
. Open reduction and internal fixation with cortical screws
. Primary arthrodesis of the first, second, and third tarsometatarsal joints
. Closed reduction and percutaneous pinning
. Dorsal bridge plating

Correct Answer & Explanation

. Primary arthrodesis of the first, second, and third tarsometatarsal joints

Explanation

Evidence demonstrates that primary arthrodesis yields superior functional outcomes and lower reoperation rates compared to open reduction and internal fixation for purely ligamentous Lisfranc injuries. ORIF is associated with higher rates of hardware failure and post-traumatic arthritis in purely ligamentous variants.

Question 4857

Topic: 8. Foot and Ankle

A 55-year-old male undergoes an extensile lateral approach for open reduction and internal fixation of a joint-depression calcaneus fracture. During the development of the full-thickness subperiosteal flap, which neurological structure is at highest risk of iatrogenic injury?

. Deep peroneal nerve
. Superficial peroneal nerve
. Sural nerve
. Posterior tibial nerve
. Medial plantar nerve

Correct Answer & Explanation

. Sural nerve

Explanation

The sural nerve courses along the lateral aspect of the hindfoot and is at significant risk of injury during the incision, flap elevation, and retraction required for the extensile lateral approach to the calcaneus.

Question 4858

Topic: 8. Foot and Ankle

A 22-year-old athlete sustains a midfoot sprain. Weight-bearing radiographs demonstrate a 3 mm diastasis between the base of the first and second metatarsals. What is the recommended treatment approach?

. Non-weight-bearing cast for 6 weeks
. Rigid carbon-fiber shoe insert and immediate weight-bearing
. Operative intervention (ORIF or primary arthrodesis)
. Midfoot corticosteroid injection
. Closed reduction and percutaneous pinning

Correct Answer & Explanation

. Operative intervention (ORIF or primary arthrodesis)

Explanation

A diastasis greater than 2 mm between the first and second metatarsals on weight-bearing films indicates instability of the Lisfranc ligament complex. Operative stabilization via ORIF or primary arthrodesis is indicated to prevent midfoot collapse and post-traumatic arthritis.

Question 4859

Topic: 8. Foot and Ankle

During open reduction and internal fixation of a bimalleolar equivalent ankle fracture, the intraoperative Cotton test reveals syndesmotic instability. Which of the following is an accepted biomechanical principle regarding syndesmotic screw fixation?

. Screws must be routinely removed in all patients prior to any weight-bearing
. Screws should engage only three cortices strictly in all patients
. Screws should be directed 20-30 degrees anteriorly in the axial plane to parallel the native syndesmosis
. The ankle must be held in maximum plantarflexion during screw insertion
. Rigid fixation yields significantly superior clinical outcomes compared to dynamic suture button constructs

Correct Answer & Explanation

. Screws should be directed 20-30 degrees anteriorly in the axial plane to parallel the native syndesmosis

Explanation

Because the fibula sits posterior to the tibia at the level of the syndesmosis, syndesmotic screws must be angled 20-30 degrees anteriorly from lateral to medial to accurately capture the tibia. Maximum dorsiflexion during insertion is traditionally taught, though modern evidence shows ankle position does not affect syndesmotic width.

Question 4860

Topic: 8. Foot and Ankle

A 45-year-old construction worker falls from scaffolding, sustaining a joint-depressed intra-articular calcaneus fracture. Bohler's angle is measured at 5 degrees. What is the primary anatomic goal of open reduction and internal fixation (ORIF) in this patient?

. Restoration of the medial longitudinal arch
. Restoration of the calcaneocuboid joint congruity
. Restoration of the posterior facet articular surface and calcaneal height
. Arthrodesis of the subtalar joint
. Excision of the comminuted lateral wall fragments

Correct Answer & Explanation

. Restoration of the posterior facet articular surface and calcaneal height

Explanation

The primary goals of operative treatment for intra-articular calcaneus fractures are the anatomic reduction of the posterior facet (to minimize post-traumatic arthritis) and the restoration of calcaneal height, width, and alignment.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page