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8. Foot and Ankle MCQs

Practice Set 254 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 5061

Topic: 8. Foot and Ankle

A surgeon is performing an Achilles tendon repair and wishes to avoid injury to the sural nerve. The sural nerve typically crosses the lateral border of the Achilles tendon at approximately what distance proximal to the calcaneal insertion?

. 2 cm
. 5 cm
. 10 cm
. 15 cm
. 20 cm

Correct Answer & Explanation

. 10 cm

Explanation

The sural nerve generally crosses from the central posterior aspect of the calf to the lateral border of the Achilles tendon roughly 10 cm (range 9-12 cm) proximal to its calcaneal insertion. Incisions in this region should be carefully planned to avoid iatrogenic injury.

Question 5062

Topic: 8. Foot and Ankle

Within the medial retromalleolar space (tarsal tunnel), the posterior tibial artery and tibial nerve are located between the tendons of which two muscles?

. Tibialis posterior and Flexor digitorum longus
. Flexor digitorum longus and Flexor hallucis longus
. Flexor hallucis longus and Achilles
. Tibialis anterior and Extensor hallucis longus
. Peroneus longus and Peroneus brevis

Correct Answer & Explanation

. Flexor digitorum longus and Flexor hallucis longus

Explanation

The anatomical order of structures in the tarsal tunnel from anterior to posterior is Tibialis posterior, Flexor Digitorum Longus, Posterior tibial Artery, Tibial Nerve, and Flexor Hallucis Longus (Tom, Dick, AND Very Nervous Harry). The neurovascular bundle runs between the FDL and FHL.

Question 5063

Topic: 8. Foot and Ankle

Which component of the deltoid ligament complex is considered the strongest and serves as the primary restraint to external rotation and anterolateral displacement of the talus?

. Superficial tibiocalcaneal ligament
. Tibionavicular ligament
. Deep anterior tibiotalar ligament
. Deep posterior tibiotalar ligament
. Spring ligament

Correct Answer & Explanation

. Deep posterior tibiotalar ligament

Explanation

The deep posterior tibiotalar ligament is the strongest and thickest component of the deltoid ligament. It is the primary restraint preventing outward translation and external rotation of the talus within the mortise.

Question 5064

Topic: 8. Foot and Ankle

In the anatomical layout of the tarsal tunnel at the medial malleolus, which of the following structures is positioned most posteriorly?

. Tibialis posterior tendon
. Flexor digitorum longus tendon
. Posterior tibial artery
. Posterior tibial vein
. Flexor hallucis longus tendon

Correct Answer & Explanation

. Flexor hallucis longus tendon

Explanation

The mnemonic "Tom, Dick, And Very Nervous Harry" dictates the order from anterior to posterior: Tibialis posterior, flexor Digitorum longus, Artery, Vein, Nerve, and flexor Hallucis longus. The FHL is the most posterior structure.

Question 5065

Topic: 8. Foot and Ankle

When utilizing the extensile lateral approach for open reduction internal fixation of a calcaneus fracture, where should the corner of the L-shaped incision be placed to minimize the risk of flap necrosis?

. Directly over the lateral malleolus tip
. Over the peroneal tubercle
. At the junction of the glabrous and non-glabrous skin
. 1 cm proximal to the sural nerve
. Directly over the Achilles tendon insertion

Correct Answer & Explanation

. At the junction of the glabrous and non-glabrous skin

Explanation

The incision should be made at the junction of the glabrous (plantar) and non-glabrous (lateral) skin to preserve the lateral calcaneal artery, which is the primary vascular supply to the full-thickness soft tissue flap.

Question 5066

Topic: Midfoot & Hindfoot

In a patient with acquired adult flatfoot deformity, progressive failure of the posterior tibial tendon often leads to attenuation of the plantar calcaneonavicular (spring) ligament. Which of the following is the primary attachment site of the superomedial bundle of the spring ligament?

. Sustentaculum tali to the navicular tuberosity
. Calcaneal anterior process to the cuboid
. Sustentaculum tali to the medial cuneiform
. Medial malleolus to the navicular
. Calcaneal tuberosity to the navicular tuberosity

Correct Answer & Explanation

. Sustentaculum tali to the navicular tuberosity

Explanation

The superomedial bundle of the spring ligament originates on the sustentaculum tali and inserts on the navicular tuberosity. It is a critical static stabilizer of the medial longitudinal arch, supporting the talar head.

Question 5067

Topic: 8. Foot and Ankle

Resection of a large soft tissue sarcoma in the popliteal fossa requires sacrifice of the tibial nerve. What specific post-operative functional deficit will this patient most likely demonstrate?

. Inability to dorsiflex the foot and extend the toes
. Inability to plantarflex the foot and loss of plantar sensation
. Inability to evert the foot and loss of dorsal sensation
. Inability to extend the knee
. Weakness in hip extension and knee flexion

Correct Answer & Explanation

. Inability to plantarflex the foot and loss of plantar sensation

Explanation

The tibial nerve innervates the posterior compartment of the leg (gastrocnemius, soleus, posterior tibialis) and provides sensation to the plantar surface of the foot. Sacrifice results in a loss of active plantarflexion and an insensate sole.

Question 5068

Topic: 8. Foot and Ankle

A 35-year-old male sustains a displaced talar neck fracture following a motor vehicle accident. Which of the following arteries provides the primary blood supply to the body of the talus, placing it at high risk for avascular necrosis if disrupted?

. Artery of the tarsal canal
. Artery of the tarsal sinus
. Dorsalis pedis artery
. Deltoid 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 body of the talus. It forms an essential anastomosis with the artery of the tarsal sinus.

Question 5069

Topic: 8. Foot and Ankle
A 32-year-old man sustains a displaced talar neck fracture (Hawkins type III). Which of the following vessels provides the predominant blood supply to the talar body and is at highest risk of disruption in this injury?
. Artery of the tarsal sinus
. Dorsalis pedis artery
. Artery of the tarsal canal
. Deltoid branch of the posterior tibial artery
. 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 body of the talus. It forms an anastomotic sling with the artery of the tarsal sinus beneath the talar neck.

Question 5070

Topic: 8. Foot and Ankle

A patient presents with midfoot pain and instability following a fall from a horse. Radiographs show a widened space between the first and second metatarsals. The primary ligament injured in this scenario originates from which bone?

. Lateral cuneiform
. Medial cuneiform
. Navicular
. Cuboid
. First metatarsal base

Correct Answer & Explanation

. Medial cuneiform

Explanation

The Lisfranc ligament connects the lateral aspect of the medial cuneiform to the medial base of the second metatarsal. It is the strongest and most critical ligament for maintaining the stability of the tarsometatarsal articulation.

Question 5071

Topic: 8. Foot and Ankle

A fracture of the talar neck places the blood supply to the talar body at significant risk. Which artery provides the predominant blood supply to 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 major branch of the posterior tibial artery, forms a sling around the talar neck and supplies the majority of the talar body. Disruption of this supply frequently leads to avascular necrosis.

Question 5072

Topic: 8. Foot and Ankle

When performing an extensile lateral approach to the calcaneus, the sural nerve is at risk of iatrogenic injury. The sural nerve typically courses parallel and adjacent to which vascular structure in the posterolateral hindfoot?

. Anterior tibial artery
. Small saphenous vein
. Great saphenous vein
. Peroneal artery
. Posterior tibial artery

Correct Answer & Explanation

. Small saphenous vein

Explanation

The sural nerve travels down the posterior calf and curves posterior to the lateral malleolus, maintaining close proximity to the small saphenous vein. Care must be taken to elevate the full-thickness flap without dissecting out the nerve to preserve its blood supply.

Question 5073

Topic: Ankle Trauma & Sports

Which ligament is anatomically the strongest component of the distal tibiofibular syndesmotic complex?

. Anterior inferior tibiofibular ligament (AITFL)
. Posterior inferior tibiofibular ligament (PITFL)
. Interosseous ligament
. Transverse tibiofibular ligament
. Anterior talofibular ligament

Correct Answer & Explanation

. Posterior inferior tibiofibular ligament (PITFL)

Explanation

The posterior inferior tibiofibular ligament (PITFL) is the strongest ligament of the syndesmosis, contributing over 40% of the complex's resistance to lateral fibular displacement. The AITFL is the most commonly injured component but is structurally weaker.

Question 5074

Topic: 8. Foot and Ankle
A 30-year-old man sustains a Hawkins Type III talar neck fracture. Which of the following arteries represents the major source of blood supply to the body of the talus?
. Artery of the tarsal canal
. Dorsalis pedis artery
. Fibular (peroneal) artery
. Anterior tibial artery
. Artery of the sinus tarsi

Correct Answer & Explanation

. Artery of the tarsal canal

Explanation

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

Question 5075

Topic: 8. Foot and Ankle

A 35-year-old runner sustains an inversion ankle injury resulting in an avulsion fracture of the base of the fifth metatarsal. The tendon responsible for this avulsion fragment belongs to which muscle?

. Peroneus longus
. Peroneus brevis
. Peroneus tertius
. Tibialis posterior
. Extensor digitorum brevis

Correct Answer & Explanation

. Peroneus brevis

Explanation

The peroneus brevis tendon inserts onto the tuberosity at the base of the fifth metatarsal. Forced inversion of the foot can cause the tendon to avulse the tuberosity, resulting in a 'pseudo-Jones' fracture.

Question 5076

Topic: 8. Foot and Ankle

A 45-year-old woman with stage IIb posterior tibial tendon dysfunction is undergoing flatfoot reconstruction. The surgeon plans a spring ligament reconstruction. Which of the following components of the spring ligament complex is the thickest and most critical for supporting the head of the talus?

. Superomedial calcaneonavicular ligament
. Inferior calcaneonavicular ligament
. Plantar fascia
. Bifurcate ligament
. Long plantar ligament

Correct Answer & Explanation

. Superomedial calcaneonavicular ligament

Explanation

The spring ligament complex connects the calcaneus and navicular to cradle the talar head. The superomedial calcaneonavicular ligament is its thickest, most mechanically vital component and is frequently attenuated in adult-acquired flatfoot deformity.

Question 5077

Topic: Midfoot & Hindfoot

A 30-year-old runner develops chronic medial heel pain. Entrapment of the first branch of the lateral plantar nerve (Baxter's nerve) is suspected. This nerve is most commonly compressed between the deep fascia of the abductor hallucis and which other muscle?

. Flexor digitorum brevis
. Tibialis posterior
. Flexor hallucis brevis
. Quadratus plantae
. Adductor hallucis

Correct Answer & Explanation

. Quadratus plantae

Explanation

Baxter's nerve (first branch of the lateral plantar nerve) courses between the deep fascia of the abductor hallucis and the medial aspect of the quadratus plantae, where it is frequently entrapped.

Question 5078

Topic: 8. Foot and Ankle
A 45-year-old man sustains a displaced talar neck fracture (Hawkins type III). The artery of the tarsal canal, which provides the dominant blood supply to the talar body, is a branch of which vessel?
. Anterior tibial artery
. Peroneal artery
. Dorsalis pedis artery
. Posterior tibial artery
. Medial plantar artery

Correct Answer & Explanation

. Posterior tibial artery

Explanation

The artery of the tarsal canal arises from the posterior tibial artery and provides the dominant blood supply to the body of the talus. It enters the talus inferiorly and forms an anastomotic sling with the artery of the sinus tarsi.

Question 5079

Topic: 8. Foot and Ankle

A patient with acquired adult flatfoot deformity has attenuation of the spring ligament. What are the specific bony attachments of the spring ligament?

. Sustentaculum tali to the navicular tuberosity
. Medial malleolus to the navicular tuberosity
. Anterior process of the calcaneus to the cuboid
. Navicular to the medial cuneiform
. Plantar aspect of the cuboid to the base of the first metatarsal

Correct Answer & Explanation

. Sustentaculum tali to the navicular tuberosity

Explanation

The spring ligament (plantar calcaneonavicular ligament) attaches from the sustentaculum tali of the calcaneus to the plantar surface of the navicular. It is a key static stabilizer of the medial longitudinal arch, supporting the talar head.

Question 5080

Topic: 8. Foot and Ankle

During an extensile lateral approach to the calcaneus, the sural nerve is at risk. What is the typical sensory distribution of the sural nerve?

. First web space of the foot
. Medial aspect of the hindfoot
. Lateral aspect of the hindfoot and midfoot
. Plantar aspect of the heel
. Dorsal aspect of the medial three toes

Correct Answer & Explanation

. Lateral aspect of the hindfoot and midfoot

Explanation

The sural nerve provides sensory innervation to the lateral and posterolateral aspect of the hindfoot and midfoot. It is closely associated with the small saphenous vein and must be protected during the lateral extensile approach to the calcaneus.

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