Menu

8. Foot and Ankle MCQs

Practice Set 252 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 5021

Topic: Midfoot & Hindfoot
A 35-year-old man falls from a height and sustains a Hawkins type III fracture of the talar neck. What is the approximate reported rate of avascular necrosis (AVN) of the talar body associated with this specific injury pattern?
. 0-10%
. 15-30%
. 40-50%
. 80-100%
. Approximately 5%

Correct Answer & Explanation

. 80-100%

Explanation

A Hawkins type III talar neck fracture involves subluxation or dislocation of both the subtalar and tibiotalar joints. This severe displacement disrupts the major blood supply to the talar body, leading to an AVN rate of 80% to 100%.

Question 5022

Topic: Midfoot & Hindfoot

A 55-year-old woman presents with a flexible flatfoot deformity, lateral hindfoot pain, and an inability to perform a single-leg heel rise. Radiographs show uncovering of the talonavicular joint. What is the most widely accepted initial surgical management for stage IIb posterior tibial tendon dysfunction?

. UCBL orthosis
. Flexor digitorum longus (FDL) transfer, medial displacement calcaneal osteotomy, and lateral column lengthening
. Triple arthrodesis
. Subtalar arthrodesis alone
. Gastrocnemius recession alone

Correct Answer & Explanation

. Flexor digitorum longus (FDL) transfer, medial displacement calcaneal osteotomy, and lateral column lengthening

Explanation

Stage IIb PTTD denotes a flexible flatfoot with forefoot abduction. Surgical reconstruction typically involves an FDL tendon transfer to substitute for the PTT, combined with a medializing calcaneal osteotomy and lateral column lengthening to correct the forefoot abduction.

Question 5023

Topic: Forefoot

A 48-year-old woman has a severe hallux valgus deformity with a hallux valgus angle of 45 degrees and an intermetatarsal angle of 18 degrees. Clinical examination reveals gross hypermobility of the first tarsometatarsal (TMT) joint. Which of the following procedures is most indicated?

. Distal chevron osteotomy
. Proximal crescentic osteotomy
. Lapidus procedure
. Akin osteotomy
. Keller resection arthroplasty

Correct Answer & Explanation

. Lapidus procedure

Explanation

The Lapidus procedure (first TMT joint arthrodesis) is the procedure of choice for severe hallux valgus associated with first ray hypermobility. Distal osteotomies are insufficient for high intermetatarsal angles combined with TMT instability.

Question 5024

Topic: 8. Foot and Ankle

A 60-year-old patient with long-standing poorly controlled diabetes presents with a red, hot, swollen right foot. Radiographs demonstrate fragmentation and periarticular debris at the tarsometatarsal joints. What is the most appropriate initial management?

. Immediate ORIF of the midfoot
. Total contact casting and strict non-weight-bearing
. Intravenous antibiotics for 6 weeks
. Midfoot arthrodesis
. Partial calcanectomy

Correct Answer & Explanation

. Total contact casting and strict non-weight-bearing

Explanation

This presentation is classic for Eichenholtz Stage I (fragmentation phase) Charcot neuroarthropathy. The mainstay of initial treatment is immobilization and offloading, most effectively achieved with a total contact cast until the acute inflammatory phase resolves.

Question 5025

Topic: 8. Foot and Ankle

A 68-year-old man with end-stage post-traumatic tibiotalar arthritis is considering surgical intervention. He has concomitant severe subtalar osteoarthritis but no significant coronal plane deformity. Which of the following is a primary indication for total ankle arthroplasty over an ankle arthrodesis in this patient?

. Severe tibiotalar avascular necrosis
. Active deep infection
. Advanced adjacent joint subtalar arthritis
. Charcot neuroarthropathy
. Significant lower extremity neuropathy

Correct Answer & Explanation

. Advanced adjacent joint subtalar arthritis

Explanation

Advanced adjacent joint arthritis (e.g., subtalar or talonavicular joints) is a major indication for total ankle arthroplasty. Preserving tibiotalar motion prevents accelerated wear and worsening pain in the already arthritic adjacent hindfoot joints.

Question 5026

Topic: 8. Foot and Ankle

A patient with Charcot-Marie-Tooth disease presents with a significant cavovarus foot deformity. Upon performing a Coleman block test, the hindfoot varus deformity corrects entirely to neutral. This clinical finding indicates that the hindfoot varus is primarily driven by:

. A plantarflexed first ray
. A rigid subtalar joint contracture
. A spastic posterior tibial tendon
. Weakness of the peroneus brevis
. A contracture of the Achilles tendon

Correct Answer & Explanation

. A plantarflexed first ray

Explanation

The Coleman block test nullifies the effect of a plantarflexed first ray by allowing it to drop off the block. If the hindfoot varus corrects to neutral, the deformity is forefoot-driven and the subtalar joint remains flexible.

Question 5027

Topic: 8. Foot and Ankle

A 55-year-old runner is undergoing surgical debridement for severe insertional Achilles tendinopathy with a Haglund's deformity. Intraoperatively, the surgeon notes that more than 50% of the Achilles tendon insertion must be detached to thoroughly resect the diseased tissue. Which of the following transfers is most appropriate for augmentation?

. Flexor hallucis longus (FHL) transfer
. Flexor digitorum longus (FDL) transfer
. Peroneus brevis transfer
. Tibialis anterior transfer
. Plantaris augmentation

Correct Answer & Explanation

. Flexor hallucis longus (FHL) transfer

Explanation

When greater than 50% of the Achilles tendon insertion is compromised during debridement, augmentation is necessary to restore plantarflexion strength and prevent rupture. The FHL tendon is the gold standard transfer due to its strength, proximity, and in-phase firing.

Question 5028

Topic: 8. Foot and Ankle

A 45-year-old factory worker complains of burning pain and tingling in the plantar aspect of his foot that worsens after long shifts. Tinel's sign is positive posterior to the medial malleolus. Compression of which of the following nerves is the most likely cause of his symptoms?

. Superficial peroneal nerve
. Deep peroneal nerve
. Posterior tibial nerve
. Sural nerve
. Saphenous nerve

Correct Answer & Explanation

. Posterior tibial nerve

Explanation

Tarsal tunnel syndrome is caused by the entrapment of the posterior tibial nerve (or its branches) as it passes beneath the flexor retinaculum posterior to the medial malleolus. Symptoms typically include plantar foot numbness and pain.

Question 5029

Topic: 8. Foot and Ankle

A 24-year-old downhill skier sustains a forced dorsiflexion and inversion injury to his ankle. He subsequently reports a painful snapping sensation over his lateral malleolus during ambulation. Incompetence of which of the following structures is the primary cause of his pathology?

. Calcaneofibular ligament
. Anterior talofibular ligament
. Inferior extensor retinaculum
. Superior peroneal retinaculum
. Inferior peroneal retinaculum

Correct Answer & Explanation

. Superior peroneal retinaculum

Explanation

The superior peroneal retinaculum is the primary restraint to peroneal tendon subluxation. Forced dorsiflexion and inversion can strip or tear the retinaculum from the fibula, leading to recurrent peroneal tendon dislocation.

Question 5030

Topic: 8. Foot and Ankle

A 42-year-old woman presents with severe burning pain in her forefoot that radiates into her toes, particularly when wearing narrow dress shoes. Examination reveals a palpable click when compressing the metatarsal heads while applying plantar pressure to the web space. Which web space is most commonly affected by this condition?

. First interdigital space
. Second interdigital space
. Third interdigital space
. Fourth interdigital space
. Fifth interdigital space

Correct Answer & Explanation

. Third interdigital space

Explanation

The clinical presentation describes a Morton's neuroma, with a positive Mulder's click. It most frequently occurs in the third interdigital space, where the medial and lateral plantar nerves anastomose, creating a thicker nerve more prone to tethering.

Question 5031

Topic: Ankle Trauma & Sports

A 30-year-old man undergoes ORIF for a Weber C ankle fracture. After fibular fixation, the surgeon suspects a concomitant syndesmotic injury. Which of the following intraoperative tests is most reliable for dynamically assessing the integrity of the distal tibiofibular syndesmosis?

. Coleman block test
. Silfverskiold test
. Cotton test
. Jack test
. Mulder's test

Correct Answer & Explanation

. Cotton test

Explanation

The Cotton test is performed intraoperatively by placing a bone hook around the fibula and applying a lateral traction force. Widening of the syndesmosis under fluoroscopy confirms syndesmotic instability requiring fixation.

Question 5032

Topic: Midfoot & Hindfoot

A 55-year-old woman presents with a painful, flexible acquired flatfoot deformity. She is unable to perform a single-leg heel rise. Radiographs demonstrate uncovering of the talonavicular joint of 45% and significant forefoot abduction. Which of the following surgical interventions is most appropriate if conservative management fails?

. Flexor digitorum longus (FDL) transfer to the navicular alone
. FDL transfer with a medial displacement calcaneal osteotomy
. FDL transfer with a lateral column lengthening (Evans osteotomy)
. Triple arthrodesis
. Isolated talonavicular arthrodesis

Correct Answer & Explanation

. FDL transfer with a lateral column lengthening (Evans osteotomy)

Explanation

This represents a Stage IIb posterior tibial tendon dysfunction (PTTD), characterized by >30% talonavicular uncovering and forefoot abduction. Appropriate treatment requires FDL transfer combined with lateral column lengthening to correct the abduction deformity.

Question 5033

Topic: 8. Foot and Ankle

A 35-year-old man is 8 weeks post-operative from open reduction and internal fixation of a Hawkins Type II talar neck fracture. Radiographs obtained at this visit demonstrate a subchondral radiolucent band in the dome of the talus. This radiographic finding indicates which of the following?

. Impending avascular necrosis (AVN) of the talar body
. Intact vascularity to the talar body
. Early onset of post-traumatic subtalar arthritis
. Deep space infection
. Delayed union of the talar neck

Correct Answer & Explanation

. Intact vascularity to the talar body

Explanation

The presence of a subchondral radiolucent band in the talar dome at 6 to 8 weeks is known as the Hawkins sign. It represents subchondral osteopenia secondary to bone resorption, which confirms intact vascularity and a low risk of avascular necrosis.

Question 5034

Topic: 8. Foot and Ankle

A 28-year-old male sustains a hyperplantarflexion injury to his foot. Non-weight-bearing radiographs appear normal. On clinical exam, he has midfoot swelling, pain with midfoot pronation/abduction, and ecchymosis on the plantar aspect of the midfoot. What is the next best step in management?

. Reassurance and return to activity in a supportive shoe
. Immediate MRI of the midfoot
. Weight-bearing radiographs of the foot
. CT scan of the foot to rule out subtle fractures
. Immobilization in a rigid walking boot for 6 weeks

Correct Answer & Explanation

. Weight-bearing radiographs of the foot

Explanation

Plantar ecchymosis is highly suspicious for a Lisfranc injury. When non-weight-bearing radiographs are normal, weight-bearing radiographs are the essential next step to evaluate for dynamic instability of the tarsometatarsal joints.

Question 5035

Topic: 8. Foot and Ankle

A 58-year-old male with long-standing, poorly controlled diabetes presents with a swollen, erythematous, warm, and relatively painless foot. Pulses are palpable. Radiographs reveal early fragmentation and subluxation of the tarsometatarsal joints. What is the most appropriate initial management?

. Intravenous antibiotics and bone biopsy
. Total contact casting and strict non-weight-bearing
. Open reduction and internal fixation of the midfoot
. Primary midfoot arthrodesis
. Below-knee amputation

Correct Answer & Explanation

. Total contact casting and strict non-weight-bearing

Explanation

This presentation is classic for acute Eichenholtz stage I Charcot neuroarthropathy. The mainstay of initial management is offloading the foot with total contact casting until the acute inflammatory phase (warmth and erythema) resolves.

Question 5036

Topic: Forefoot

A 45-year-old female presents with a painful bunion. Clinical examination reveals hypermobility of the first tarsometatarsal (TMT) joint with primarily sagittal plane instability. Radiographs show a hallux valgus angle of 38 degrees and an intermetatarsal angle of 18 degrees. Which of the following surgical procedures is most appropriate?

. Distal chevron osteotomy
. Proximal crescentic osteotomy
. First TMT joint arthrodesis (Lapidus procedure)
. First metatarsophalangeal joint arthrodesis
. Akin osteotomy alone

Correct Answer & Explanation

. First TMT joint arthrodesis (Lapidus procedure)

Explanation

A Lapidus procedure (first TMT arthrodesis) is indicated for patients with moderate-to-severe hallux valgus associated with first ray hypermobility. It stabilizes the medial column and corrects the intermetatarsal angle at its apex.

Question 5037

Topic: 8. Foot and Ankle

When evaluating a patient with end-stage ankle osteoarthritis, which of the following is considered an absolute contraindication to a total ankle arthroplasty (TAA)?

. Patient age over 65 years
. Inflammatory arthritis (e.g., Rheumatoid arthritis)
. Active or recent deep ankle joint infection
. Prior lateral ligament reconstruction
. Bilateral ankle osteoarthritis

Correct Answer & Explanation

. Active or recent deep ankle joint infection

Explanation

Active infection, Charcot neuroarthropathy, and severe avascular necrosis of the talus with collapse are absolute contraindications for total ankle arthroplasty. Advanced age and inflammatory arthritis are typical indications for TAA.

Question 5038

Topic: 8. Foot and Ankle

A 32-year-old runner complains of chronic retromalleolar lateral ankle pain. MRI reveals a longitudinal split tear of the peroneus brevis tendon, with an intact peroneus longus. Intraoperatively, the tear involves 30% of the cross-sectional area of the tendon. What is the best surgical management?

. Excision of the torn portion and tubularization of the remaining tendon
. Tenodesis of the peroneus brevis to the peroneus longus
. Allograft tendon reconstruction
. Lateralizing calcaneal osteotomy
. Subtalar arthrodesis

Correct Answer & Explanation

. Excision of the torn portion and tubularization of the remaining tendon

Explanation

For isolated peroneus brevis tears involving less than 50% of the tendon cross-section, the standard of care is debridement of the torn segment followed by tubularization. Tears >50% often necessitate tenodesis to the peroneus longus.

Question 5039

Topic: 8. Foot and Ankle

A 45-year-old male presents with chronic posterior heel pain. Radiographs show a prominent posterosuperior calcaneal tuberosity and an enthesophyte. MRI shows insertional Achilles tendinosis involving 60% of the tendon insertion. Which surgical approach is most appropriate?

. Endoscopic retrocalcaneal bursectomy
. Percutaneous Achilles tendon lengthening
. Debridement, calcaneal ostectomy, and FHL transfer
. Isolated gastrocnemius recession
. Platelet-rich plasma (PRP) injection

Correct Answer & Explanation

. Debridement, calcaneal ostectomy, and FHL transfer

Explanation

For insertional Achilles tendinopathy requiring detachment and debridement of >50% of the tendon footprint, augmentation with a Flexor Hallucis Longus (FHL) transfer is recommended to maintain plantarflexion strength and protect the repair.

Question 5040

Topic: 8. Foot and Ankle

What is the most common long-term complication following open reduction and internal fixation of a displaced intra-articular calcaneus fracture?

. Avascular necrosis of the calcaneus
. Sural nerve entrapment
. Subtalar post-traumatic arthritis
. Tarsal tunnel syndrome
. Fracture nonunion

Correct Answer & Explanation

. Subtalar post-traumatic arthritis

Explanation

Subtalar post-traumatic arthritis is the most frequent long-term complication following intra-articular calcaneal fractures, regardless of whether they are treated operatively or non-operatively, often eventually requiring a subtalar arthrodesis.

Test Yourself

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

On this Page