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8. Foot and Ankle MCQs

Practice Set 245 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 4881

Topic: 8. Foot and Ankle

A 45-year-old man presents with sharp radicular pain radiating down the posterior aspect of his right leg to the lateral border of his foot. On examination, he exhibits an absent Achilles reflex and weakness in plantar flexion. Which nerve root is most likely compressed?

. L3
. L4
. L5
. S1
. S2

Correct Answer & Explanation

. S1

Explanation

S1 radiculopathy typically presents with pain in the posterior leg and lateral foot, weakness in ankle plantar flexion, and a diminished or absent Achilles reflex. This is most commonly caused by a paracentral disc herniation at the L5-S1 level.

Question 4882

Topic: Midfoot & Hindfoot

A 55-year-old woman presents with progressive medial ankle pain and the inability to perform a single-leg heel raise. Examination reveals a flexible hindfoot valgus and severe forefoot abduction. Radiographs show greater than 40% talonavicular uncoverage. What is the most appropriate surgical management for this stage IIb adult-acquired flatfoot deformity?

. Flexor digitorum longus (FDL) transfer to the navicular and medial displacement calcaneal osteotomy (MDCO)
. FDL transfer, MDCO, and lateral column lengthening
. Subtalar arthrodesis and FDL transfer
. Triple arthrodesis
. Gastrocnemius recession and FDL transfer

Correct Answer & Explanation

. FDL transfer, MDCO, and lateral column lengthening

Explanation

Stage IIb posterior tibial tendon dysfunction involves flexible hindfoot valgus with significant forefoot abduction (>40% talonavicular uncoverage). Surgical correction requires an FDL transfer, medial displacement calcaneal osteotomy, and a lateral column lengthening to correct the forefoot abduction.

Question 4883

Topic: 8. Foot and Ankle

A 35-year-old man undergoes acute repair of an Achilles tendon rupture. What is the most significant advantage of early functional rehabilitation compared to prolonged immobilization?

. Decreased re-rupture rate
. Lower risk of deep vein thrombosis
. Improved functional outcome and earlier return to work
. Lower risk of wound complications
. Increased tendon lengthening

Correct Answer & Explanation

. Improved functional outcome and earlier return to work

Explanation

Early functional rehabilitation after Achilles tendon repair allows for improved functional outcomes, earlier return to work, and improved patient satisfaction without significantly increasing the re-rupture rate.

Question 4884

Topic: 8. Foot and Ankle

A 14-year-old boy presents with a painful, rigid flatfoot and a history of recurrent ankle sprains. Radiographs demonstrate a "C-sign". What is the most likely diagnosis?

. Calcaneonavicular coalition
. Talocalcaneal coalition
. Talonavicular coalition
. Cuboid-navicular coalition
. Congenital vertical talus

Correct Answer & Explanation

. Talocalcaneal coalition

Explanation

The C-sign on a lateral radiograph is formed by the medial outline of the talar dome and the posterior outline of the sustentaculum tali, strongly indicating a talocalcaneal (subtalar) coalition.

Question 4885

Topic: 8. Foot and Ankle

A 28-year-old equestrian falls from a horse, catching her foot in the stirrup. She has midfoot pain and plantar ecchymosis. Radiographs show widening of the space between the first and second metatarsal bases. What is the primary stabilizing structure of this joint?

. Plantar fascia
. Dorsal tarsometatarsal ligaments
. Plantar ligament from medial cuneiform to second metatarsal base
. Interosseous ligament between the first and second metatarsals
. Peroneus longus tendon

Correct Answer & Explanation

. Plantar ligament from medial cuneiform to second metatarsal base

Explanation

The Lisfranc ligament is a strong plantar interosseous ligament extending from the medial cuneiform to the base of the second metatarsal, providing critical stability to the midfoot.

Question 4886

Topic: Forefoot

A 55-year-old woman has a painful bunion. Radiographs reveal a hallux valgus angle of 45 degrees and an intermetatarsal angle of 18 degrees. There is clinically evident hypermobility at the first tarsometatarsal joint. Which procedure is most appropriate?

. Distal chevron osteotomy
. Proximal crescentic osteotomy
. Lapidus procedure (First TMT arthrodesis)
. Akin osteotomy
. Keller resection arthroplasty

Correct Answer & Explanation

. Lapidus procedure (First TMT arthrodesis)

Explanation

A Lapidus procedure is indicated for severe hallux valgus combined with first tarsometatarsal joint hypermobility. It corrects the deformity and provides stabilization of the medial column.

Question 4887

Topic: 8. Foot and Ankle

A 60-year-old woman presents with medial ankle pain and a progressive flatfoot. She can perform a single-limb heel rise but it is weak and painful. The deformity is fully correctable passively. Which surgical intervention is most appropriate if conservative measures fail?

. Medial displacement calcaneal osteotomy and flexor digitorum longus (FDL) transfer
. Triple arthrodesis
. Subtalar arthrodesis
. Gastrocnemius recession alone
. Tibiotalocalcaneal arthrodesis

Correct Answer & Explanation

. Medial displacement calcaneal osteotomy and flexor digitorum longus (FDL) transfer

Explanation

Stage II adult-acquired flatfoot deformity is characterized by a flexible deformity. The standard surgical treatment includes a medializing calcaneal osteotomy and FDL transfer to the navicular.

Question 4888

Topic: 8. Foot and Ankle

A 22-year-old man with Charcot-Marie-Tooth disease presents with a symptomatic bilateral cavovarus foot deformity. A Coleman block test normalizes the hindfoot varus. What does this test indicate?

. The hindfoot deformity is rigid and requires a triple arthrodesis.
. The deformity is driven by a plantarflexed first ray, and hindfoot flexibility is preserved.
. The tibialis anterior is overpowering the peroneus longus.
. An Achilles tendon lengthening alone will resolve the deformity.
. The forefoot supinates to compensate for hindfoot varus.

Correct Answer & Explanation

. The deformity is driven by a plantarflexed first ray, and hindfoot flexibility is preserved.

Explanation

The Coleman block test evaluates hindfoot flexibility. If hindfoot varus corrects when the first ray drops off the block, the varus is flexible and driven by a plantarflexed first ray.

Question 4889

Topic: 8. Foot and Ankle
A 30-year-old man sustains a Hawkins Type III talar neck fracture following a motor vehicle accident. What is the approximate rate of avascular necrosis (AVN) of the talar body associated with this injury?
. 0-10%
. 15-30%
. 40-50%
. 75-90%
. 100%

Correct Answer & Explanation

. 75-90%

Explanation

Hawkins Type III talar neck fractures disrupt the three major blood supplies to the talus, carrying an AVN rate of approximately 75-100%.

Question 4890

Topic: 8. Foot and Ankle

A 65-year-old man with a BMI of 25 presents with end-stage post-traumatic ankle osteoarthritis. He has minimal deformity and well-preserved subtalar joint motion. He wishes to maintain mobility for walking and golfing. What is the most appropriate surgical treatment?

. Tibiotalocalcaneal arthrodesis
. Total ankle arthroplasty
. Ankle arthrodesis
. Distal tibial osteotomy
. Ankle distraction arthroplasty

Correct Answer & Explanation

. Total ankle arthroplasty

Explanation

Total ankle arthroplasty is an excellent option for older, non-obese patients with end-stage ankle arthritis, minimal deformity, and a desire to preserve motion for low-impact activities.

Question 4891

Topic: Forefoot

A 40-year-old woman complains of burning pain in the plantar aspect of her forefoot, radiating into the third and fourth toes. Symptoms worsen with tight shoes. A Mulder's click is positive. The affected nerve is typically formed by branches from which two nerves?

. Deep peroneal and superficial peroneal nerves
. Medial plantar and lateral plantar nerves
. Medial plantar and saphenous nerves
. Lateral plantar and sural nerves
. Sural and deep peroneal nerves

Correct Answer & Explanation

. Medial plantar and lateral plantar nerves

Explanation

Morton's neuroma most commonly affects the third web space. The third common digital nerve is typically formed by communicating branches from both the medial and lateral plantar nerves.

Question 4892

Topic: 8. Foot and Ankle

A 50-year-old runner has chronic posterior heel pain exacerbated by running. Examination reveals a prominent posterosuperior calcaneal tuberosity and pain at the Achilles insertion. MRI shows tendinosis involving 60% of the tendon width. Operative intervention is planned. What must be included in the procedure?

. Gastrocnemius recession alone
. Debridement, ostectomy, and detachment/reattachment of the Achilles tendon
. Endoscopic retrocalcaneal bursectomy without ostectomy
. Flexor hallucis longus transfer alone
. Percutaneous tenotomy

Correct Answer & Explanation

. Debridement, ostectomy, and detachment/reattachment of the Achilles tendon

Explanation

For severe insertional Achilles tendinosis with a Haglund's deformity, treatment requires excision of the prominent bone (ostectomy), debridement of the diseased tendon, and reattachment if >50% of the tendon is detached.

Question 4893

Topic: Forefoot

A 58-year-old man presents with pain and stiffness in his right great toe. Examination shows restricted dorsiflexion with a palpable dorsal exostosis. Radiographs show joint space narrowing primarily in the dorsal half and a large dorsal osteophyte (Grade 2). He wants to preserve joint motion. What is the most appropriate surgery?

. First MTP arthrodesis
. Cheilectomy
. Keller resection arthroplasty
. Total first MTP joint replacement
. Lapidus procedure

Correct Answer & Explanation

. Cheilectomy

Explanation

A cheilectomy (removal of the dorsal osteophyte and the dorsal third of the metatarsal head) is indicated for mild to moderate hallux rigidus (Grades 1 and 2) in patients who wish to preserve motion.

Question 4894

Topic: Midfoot & Hindfoot

A 55-year-old patient with poorly controlled diabetes presents with a red, hot, swollen foot. Radiographs show fragmentation, periarticular debris, and subluxation at the tarsometatarsal joints. There are no ulcers. What is the most appropriate initial management?

. Intravenous antibiotics and urgent debridement
. Total contact casting and non-weight-bearing
. Midfoot arthrodesis with robust hardware
. Calcaneal osteotomy
. Below-knee amputation

Correct Answer & Explanation

. Total contact casting and non-weight-bearing

Explanation

This patient is in the acute fragmentation phase (Eichenholtz stage I) of Charcot arthropathy. The mainstay of initial treatment is total contact casting and offloading to prevent further deformity.

Question 4895

Topic: Midfoot & Hindfoot

A 48-year-old overweight man has classic plantar fasciitis symptoms for 12 months that have failed nonoperative management. He elects to proceed with surgery. Which specific structure must be protected during a plantar fascia release?

. Medial calcaneal nerve
. First branch of the lateral plantar nerve (nerve to the abductor digiti minimi)
. Deep peroneal nerve
. Sural nerve
. Saphenous nerve

Correct Answer & Explanation

. First branch of the lateral plantar nerve (nerve to the abductor digiti minimi)

Explanation

The first branch of the lateral plantar nerve (Baxter's nerve) courses deep to the abductor hallucis and is at risk during plantar fascial release. Entrapment of this nerve can also be a concurrent cause of heel pain.

Question 4896

Topic: Midfoot & Hindfoot
A 55-year-old woman with a progressive flatfoot deformity complains of medial ankle pain and an inability to perform a single-limb heel rise. Weight-bearing radiographs show >30% uncovering of the talonavicular joint. What is the most appropriate surgical management?
. Medial displacement calcaneal osteotomy (MDCO) and FDL transfer
. Lateral column lengthening, MDCO, and FDL transfer
. Triple arthrodesis
. First TMT arthrodesis
. Isolated subtalar arthrodesis

Correct Answer & Explanation

. Lateral column lengthening, MDCO, and FDL transfer

Explanation

Stage IIb adult acquired flatfoot deformity is characterized by >30% forefoot abduction (talonavicular uncovering). Management requires a lateral column lengthening in addition to MDCO and FDL transfer to correct the abduction.

Question 4897

Topic: 8. Foot and Ankle

A 25-year-old man presents with midfoot pain after a twisting injury. Weight-bearing radiographs reveal a 3 mm diastasis between the base of the first and second metatarsals without any fractures. What is the most appropriate management?

. Non-weight-bearing cast for 6 weeks
. Closed reduction and percutaneous pinning
. Primary arthrodesis of the medial column
. Open reduction and internal fixation of the lateral column
. Immediate weight-bearing in a stiff-soled shoe

Correct Answer & Explanation

. Primary arthrodesis of the medial column

Explanation

Purely ligamentous Lisfranc injuries have poor healing potential and high rates of post-traumatic arthritis. Primary arthrodesis of the medial column (1st, 2nd, and 3rd TMT joints) is associated with better functional outcomes than ORIF in purely ligamentous injuries.

Question 4898

Topic: Forefoot

A 45-year-old female presents with a painful bunion. Clinical exam reveals severe hallux valgus and first ray hypermobility. Radiographs show a hallux valgus angle of 45 degrees and an intermetatarsal angle of 18 degrees. What is the most appropriate surgical management?

. Chevron osteotomy
. Scarf osteotomy
. First tarsometatarsal (Lapidus) arthrodesis
. First metatarsophalangeal arthrodesis
. Akin osteotomy

Correct Answer & Explanation

. First tarsometatarsal (Lapidus) arthrodesis

Explanation

The Lapidus procedure (first TMT arthrodesis) is indicated for severe hallux valgus with first ray hypermobility. It provides powerful correction and stabilizes the medial column to prevent recurrence.

Question 4899

Topic: Midfoot & Hindfoot

A 55-year-old male with poorly controlled diabetes presents with a red, hot, swollen right foot for 3 weeks. There is no history of ulceration or open wounds. Radiographs show periarticular debris, fragmentation, and subluxation at the tarsometatarsal joints. What is the most appropriate initial management?

. Intravenous antibiotics and urgent debridement
. Total contact casting and non-weight-bearing
. Open reduction and internal fixation of the midfoot
. Midfoot arthrodesis with autogenous bone graft
. Below-knee amputation

Correct Answer & Explanation

. Total contact casting and non-weight-bearing

Explanation

This patient has Eichenholtz stage I (fragmentation) Charcot arthropathy. The mainstay of initial treatment is offloading with total contact casting to prevent further deformity until the active inflammatory phase resolves.

Question 4900

Topic: 8. Foot and Ankle

A 22-year-old male with Charcot-Marie-Tooth disease presents with a progressive bilateral cavovarus foot deformity. The Coleman block test demonstrates that the hindfoot varus corrects to neutral when the first metatarsal is allowed to plantarflex off the block. What does this finding indicate regarding surgical planning?

. A triple arthrodesis is required to stabilize the hindfoot.
. The hindfoot deformity is fixed and requires a calcaneal osteotomy.
. The deformity is driven by the forefoot and requires a first metatarsal dorsiflexion osteotomy.
. The tibialis posterior tendon must be transferred to the dorsum of the foot.
. The plantar fascia should be left intact to maintain arch stability.

Correct Answer & Explanation

. The deformity is driven by the forefoot and requires a first metatarsal dorsiflexion osteotomy.

Explanation

A flexible hindfoot varus that corrects on a Coleman block test indicates the deformity is driven by a rigidly plantarflexed first ray. Treatment should focus on correcting the forefoot with a first metatarsal dorsiflexion osteotomy.

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