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8. Foot and Ankle MCQs

Practice Set 253 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 5041

Topic: 8. Foot and Ankle

A 40-year-old female complains of burning pain in the plantar aspect of her forefoot that radiates into her third and fourth toes, worsening with tight shoes. Examination reveals a painful click when the metatarsal heads are compressed laterally while applying plantar pressure to the interspace. The pathology most commonly involves which of the following nerves?

. Medial plantar nerve proper
. Lateral plantar nerve proper
. Sural nerve
. Deep peroneal nerve
. Third common digital nerve

Correct Answer & Explanation

. Third common digital nerve

Explanation

The clinical presentation and positive Mulder's sign are classic for a Morton's neuroma, which most frequently involves the third common digital nerve located in the third web space.

Question 5042

Topic: 8. Foot and Ankle

A 25-year-old male suffers an acute inversion ankle sprain. On clinical examination, he demonstrates a positive anterior drawer test of the ankle, but the talar tilt test is firmly negative. Which ligament is primarily injured?

. Calcaneofibular ligament (CFL)
. Anterior talofibular ligament (ATFL)
. Posterior talofibular ligament (PTFL)
. Deltoid ligament
. Anterior inferior tibiofibular ligament (AITFL)

Correct Answer & Explanation

. Anterior talofibular ligament (ATFL)

Explanation

The ATFL is the primary restraint to anterior translation of the talus, assessed by the anterior drawer test. A negative talar tilt test indicates that the calcaneofibular ligament (CFL) remains intact.

Question 5043

Topic: Midfoot & Hindfoot

Which of the following ligaments is considered the strongest and primary stabilizer of the second tarsometatarsal joint?

. Dorsal Lisfranc ligament
. Plantar Lisfranc ligament
. Interosseous Lisfranc ligament
. Plantar plate of the second MTP
. Spring ligament

Correct Answer & Explanation

. Interosseous Lisfranc ligament

Explanation

The interosseous Lisfranc ligament connects the medial cuneiform to the base of the second metatarsal. It is the strongest and most important stabilizing structure of the Lisfranc complex.

Question 5044

Topic: 8. Foot and Ankle

A 55-year-old patient with poorly controlled diabetes presents with a swollen, erythematous, and warm foot without a wound or fever. Radiographs show fragmentation and periarticular debris around the midfoot. What is the most appropriate initial management?

. Intravenous antibiotics and urgent surgical debridement
. Total contact casting and strictly non-weight bearing
. Immediate midfoot arthrodesis
. Corticosteroid injection into the affected joints
. Custom orthotic shoe wear and weight bearing as tolerated

Correct Answer & Explanation

. Total contact casting and strictly non-weight bearing

Explanation

This presentation describes Eichenholtz stage I (fragmentation phase) Charcot neuroarthropathy. The gold standard initial treatment is immediate offloading with a total contact cast to prevent further destructive deformity.

Question 5045

Topic: Forefoot

A 45-year-old woman presents with painful hallux valgus. Examination and weight-bearing radiographs reveal an intermetatarsal angle (IMA) of 12 degrees and a hallux valgus angle (HVA) of 28 degrees. The first tarsometatarsal joint is stable without hypermobility. What is the most appropriate surgical intervention?

. Lapidus procedure
. Proximal crescentic osteotomy
. Distal chevron osteotomy
. Keller resection arthroplasty
. First metatarsophalangeal joint arthrodesis

Correct Answer & Explanation

. Distal chevron osteotomy

Explanation

A distal chevron osteotomy is indicated for mild to moderate hallux valgus deformities (IMA < 13 degrees, HVA < 30 degrees) without hypermobility. The Lapidus procedure is reserved for more severe deformities or when first TMT hypermobility is present.

Question 5046

Topic: 8. Foot and Ankle

A 48-year-old runner presents with chronic posterior heel pain. MRI shows insertional Achilles tendinosis involving 60% of the tendon footprint. Following failed conservative management, surgical intervention includes excision of the Haglund prominence and extensive tendon debridement. What additional procedure is strongly recommended?

. Gastrocnemius recession
. Flexor hallucis longus (FHL) transfer
. Flexor digitorum longus (FDL) transfer
. Plantaris excision and local flap coverage
. Endoscopic retrocalcaneal bursectomy

Correct Answer & Explanation

. Flexor hallucis longus (FHL) transfer

Explanation

When more than 50% of the Achilles tendon insertion requires debridement for insertional tendinopathy, an FHL transfer is recommended. The FHL augments the repair and provides robust local blood supply to aid in healing.

Question 5047

Topic: 8. Foot and Ankle

A 62-year-old woman presents with medial ankle pain and a progressively flattening arch. She can perform a single-leg heel raise but it is weak and painful. Radiographs show a talonavicular uncoverage of 30%. What is the standard surgical treatment for this condition?

. Tenodesis of the posterior tibial tendon to the Achilles
. Flexor digitorum longus (FDL) transfer and medial displacement calcaneal osteotomy (MDCO)
. Triple arthrodesis
. Isolated talonavicular arthrodesis
. Subtalar arthroereisis

Correct Answer & Explanation

. Flexor digitorum longus (FDL) transfer and medial displacement calcaneal osteotomy (MDCO)

Explanation

This patient has Stage II adult-acquired flatfoot deformity (flexible flatfoot secondary to posterior tibial tendon dysfunction). The standard surgical approach combines a soft tissue reconstruction (FDL transfer) with a bony corrective procedure (MDCO).

Question 5048

Topic: Midfoot & Hindfoot
According to the Hawkins classification of talar neck fractures, which of the following injury patterns carries a risk of avascular necrosis (AVN) to the talar body approaching 100%?
. Type I: Nondisplaced talar neck fracture
. Type II: Displaced fracture with subluxation of the subtalar joint
. Type III: Displaced fracture with dislocation of the subtalar and tibiotalar joints
. Type IV: Displaced fracture with dislocation of the subtalar, tibiotalar, and talonavicular joints
. Type V: Talar head crush fracture

Correct Answer & Explanation

. Type IV: Displaced fracture with dislocation of the subtalar, tibiotalar, and talonavicular joints

Explanation

Hawkins Type IV fractures involve disruption of the subtalar, tibiotalar, and talonavicular joints. Because all three major sources of retrograde blood supply to the talar body are severed, the AVN risk is practically 100%.

Question 5049

Topic: 8. Foot and Ankle

A 16-year-old female dancer presents with chronic pain and swelling over the dorsal aspect of the second metatarsophalangeal joint. Radiographs show flattening, sclerosis, and fragmentation of the second metatarsal head. What is the most likely diagnosis?

. Sever disease
. Kohler disease
. Freiberg infraction
. Iselin disease
. Morton neuroma

Correct Answer & Explanation

. Freiberg infraction

Explanation

Freiberg infraction is an avascular necrosis of the metatarsal head, most frequently affecting the second metatarsal in adolescent females. It presents with localized dorsal forefoot pain exacerbated by weight-bearing.

Question 5050

Topic: 8. Foot and Ankle

A 26-year-old skier presents with lateral ankle pain and a painful snapping sensation behind the lateral malleolus when actively everting and dorsiflexing the foot. Which structure is most likely injured or attenuated?

. Anterior talofibular ligament (ATFL)
. Calcaneofibular ligament (CFL)
. Superior peroneal retinaculum (SPR)
. Inferior peroneal retinaculum (IPR)
. Peroneus brevis tendon

Correct Answer & Explanation

. Superior peroneal retinaculum (SPR)

Explanation

Peroneal tendon subluxation or dislocation is typically caused by an injury or stripping of the superior peroneal retinaculum (SPR). The classic mechanism is sudden forceful dorsiflexion and inversion.

Question 5051

Topic: 8. Foot and Ankle

A 42-year-old man presents with burning pain and tingling radiating into the plantar aspect of his foot, worse after standing. Tinel's sign is strongly positive posterior to the medial malleolus. Entrapment of which nerve is causing these symptoms?

. Deep peroneal nerve
. Superficial peroneal nerve
. Sural nerve
. Saphenous nerve
. Tibial nerve

Correct Answer & Explanation

. Tibial nerve

Explanation

Tarsal tunnel syndrome is a compressive neuropathy of the tibial nerve (or its medial/lateral plantar branches) as it passes beneath the flexor retinaculum posterior to the medial malleolus.

Question 5052

Topic: 8. Foot and Ankle
A 35-year-old construction worker falls from a ladder and sustains the heel injury seen in the lateral radiograph. Which of the following statements regarding the typical morphologic changes in a displaced intra-articular calcaneus fracture is true?
. Bรถhler's angle is typically increased.
. The crucial angle of Gissane is typically decreased.
. The posterior facet is often displaced superiorly.
. The calcaneus is typically shortened, widened, and decreased in height.
. The calcaneocuboid joint is rarely involved.

Correct Answer & Explanation

. The calcaneus is typically shortened, widened, and decreased in height.

Explanation

In displaced intra-articular calcaneus fractures, the lateral wall blows out, causing the calcaneus to become shortened and widened. Bรถhler's angle is characteristically decreased or flattened, while the angle of Gissane is often increased.

Question 5053

Topic: 8. Foot and Ankle

A 50-year-old man presents with progressive weakness in right foot dorsiflexion following a traumatic knee dislocation. An EMG reveals a lesion localized to the common peroneal nerve. During its course, this nerve is most vulnerable to compression or tethering at which anatomical landmark?

. The popliteal fossa superior to the femoral condyles
. As it passes deep to the soleus bridge
. As it wraps around the fibular neck
. Within the anterior compartment of the leg
. Posterior to the medial malleolus

Correct Answer & Explanation

. As it wraps around the fibular neck

Explanation

The common peroneal nerve is uniquely superficial and relatively tethered as it wraps around the fibular neck. This anatomical feature makes it highly susceptible to traction injuries, knee dislocations, and external compression.

Question 5054

Topic: 8. Foot and Ankle

The majority of the blood supply to the body of the talus is provided by the artery of the tarsal canal. This vessel is primarily a branch of which of the following arteries?

. Anterior tibial artery
. Dorsalis pedis artery
. Posterior tibial artery
. Peroneal artery
. Medial plantar artery

Correct Answer & Explanation

. Posterior tibial artery

Explanation

The artery of the tarsal canal is typically a branch of the posterior tibial artery and provides the dominant blood supply to the talar body. Injury to this vessel, particularly in displaced talar neck fractures, significantly increases the risk of avascular necrosis.

Question 5055

Topic: 8. Foot and Ankle

Which class of antibiotics is strongly associated with an increased risk of Achilles tendon rupture, particularly in elderly patients or those concurrently taking corticosteroids?

. Aminoglycosides
. Macrolides
. Fluoroquinolones
. Cephalosporins
. Tetracyclines

Correct Answer & Explanation

. Fluoroquinolones

Explanation

Fluoroquinolones (such as ciprofloxacin and levofloxacin) are associated with tendinopathy and tendon rupture. They are believed to upregulate matrix metalloproteinases (MMPs) and alter collagen synthesis, weakening the tendon structure.

Question 5056

Topic: 8. Foot and Ankle

What is the primary blood supply to the body of the talus?

. Artery of the tarsal sinus
. Artery of the tarsal canal
. Dorsalis pedis artery
. Deltoid branches of the posterior tibial 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, is the major blood supply to the body of the talus. It forms an essential vascular sling with the artery of the tarsal sinus.

Question 5057

Topic: 8. Foot and Ankle
A 30-year-old man falls from a height and sustains a displaced talar neck fracture (Hawkins Type III). He is at high risk for osteonecrosis. The major blood supply to the body of the talus is provided by the artery of the tarsal canal, which is a branch of which artery?
. Dorsalis pedis artery
. Anterior tibial artery
. Posterior tibial artery
. Peroneal artery
. Medial plantar artery

Correct Answer & Explanation

. Posterior tibial artery

Explanation

The artery of the tarsal canal, a branch of the posterior tibial artery, is the dominant blood supply to the talar body. It forms an anastomotic sling with the artery of the sinus tarsi.

Question 5058

Topic: 8. Foot and Ankle

A 55-year-old diabetic woman presents with burning pain and tingling in the plantar aspect of her foot, which worsens at night. Tinel's sign is positive posterior to the medial malleolus. The structure responsible for compressing the nerve in this syndrome is the:

. Superior extensor retinaculum
. Inferior extensor retinaculum
. Flexor retinaculum
. Peroneal retinaculum
. Plantar fascia

Correct Answer & Explanation

. Flexor retinaculum

Explanation

Tarsal tunnel syndrome is caused by entrapment of the tibial nerve under the flexor retinaculum (laciniate ligament) posterior to the medial malleolus. It results in neuropathic pain in the plantar foot.

Question 5059

Topic: Midfoot & Hindfoot

A 60-year-old woman presents with a progressive flatfoot deformity. Examination reveals a loss of the medial longitudinal arch and a positive too-many-toes sign. Which ligament is considered the primary static stabilizer of the talonavicular joint and medial longitudinal arch?

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

Correct Answer & Explanation

. Plantar calcaneonavicular ligament

Explanation

The plantar calcaneonavicular (spring) ligament originates on the sustentaculum tali and inserts on the navicular. It supports the talar head and is a critical static stabilizer of the medial longitudinal arch.

Question 5060

Topic: 8. Foot and Ankle

In percutaneous or minimally invasive repairs of the Achilles tendon, sutures passed through the proximal-lateral aspect of the tendon are most likely to injure which nerve?

. Superficial peroneal
. Deep peroneal
. Sural
. Saphenous
. Tibial

Correct Answer & Explanation

. Sural

Explanation

The sural nerve courses distally on the posterolateral aspect of the calf, crossing in close proximity to the lateral border of the Achilles tendon in its proximal and mid-substance regions, making it highly vulnerable during percutaneous repair.

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