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8. Foot and Ankle MCQs

Practice Set 279 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 5561

Topic: 8. Foot and Ankle

A 14-year-old boy complains of a painful, rigid flatfoot and a history of recurrent ankle sprains. Physical examination demonstrates severe restriction of subtalar motion and peroneal spasticity. A 45-degree internal oblique radiograph of the foot reveals an 'anteater nose' sign. Which of the following is the most likely diagnosis?

. Talocalcaneal coalition
. Calcaneonavicular coalition
. Cubonavicular coalition
. Talonavicular coalition
. Accessory navicular syndrome

Correct Answer & Explanation

. Talocalcaneal coalition

Explanation

The 'anteater nose' sign is pathognomonic for a calcaneonavicular coalition. It is best visualized on a 45-degree internal oblique radiograph and represents an elongated anterior process of the calcaneus extending toward the navicular. Talocalcaneal coalitions are more likely to present with a 'C-sign' on a lateral radiograph.

Question 5562

Topic: 8. Foot and Ankle

A 13-year-old male presents with recurrent ankle sprains and a rigid, painful flatfoot. Radiographs show an elongated anterior process of the calcaneus resembling an "anteater's nose" on the lateral view. What is the most likely diagnosis?

. Talocalcaneal coalition
. Calcaneonavicular coalition
. Accessory navicular syndrome
. Posterior tibial tendon insufficiency
. Vertical talus

Correct Answer & Explanation

. Talocalcaneal coalition

Explanation

The "anteater nose" sign on a lateral radiograph is highly indicative of a calcaneonavicular coalition, representing an elongated anterior process of the calcaneus approaching the navicular. Talocalcaneal coalitions are typically associated with the "C-sign."

Question 5563

Topic: 8. Foot and Ankle

A 12-year-old boy presents with a history of recurrent ankle sprains and a rigid, painful flatfoot. Radiographs demonstrate an "anteater nose" sign.

Which radiographic view is most sensitive for confirming the exact location of the most likely coalition?

. Weight-bearing AP of the foot
. Weight-bearing Lateral of the foot
. 45-degree internal oblique view of the foot
. Harris axial view of the calcaneus
. Canale view

Correct Answer & Explanation

. Weight-bearing AP of the foot

Explanation

The "anteater nose" sign on a lateral radiograph is pathognomonic for a calcaneonavicular coalition. The 45-degree internal oblique view of the foot optimally profiles the calcaneonavicular interval to confirm the diagnosis.

Question 5564

Topic: Forefoot

A 45-year-old female presents with a painful bunion. Radiographs demonstrate a hallux valgus angle (HVA) of 35 degrees and an intermetatarsal angle (IMA) of 16 degrees. Clinical examination reveals profound hypermobility at the first tarsometatarsal (TMT) joint. What is the most appropriate surgical treatment?

. Distal chevron osteotomy
. Proximal crescentic osteotomy
. First TMT joint arthrodesis (Lapidus procedure)
. First MTP joint arthrodesis
. Scarf osteotomy

Correct Answer & Explanation

. Distal chevron osteotomy

Explanation

The Lapidus procedure (first TMT joint arthrodesis) is indicated for moderate to severe hallux valgus associated with first TMT joint hypermobility. It stabilizes the medial column and corrects the IMA effectively.

Question 5565

Topic: Forefoot

A 60-year-old male complains of severe pain and stiffness in his right big toe. Examination reveals significantly limited dorsiflexion and pain at the extremes of motion. Radiographs demonstrate large dorsal osteophytes and near-complete joint space narrowing of the first MTP joint, consistent with Grade 3 hallux rigidus. Which of the following is considered the gold standard surgical treatment?

. Cheilectomy
. Moberg osteotomy
. First MTP joint arthrodesis
. Keller arthroplasty
. First MTP joint silicone arthroplasty

Correct Answer & Explanation

. Cheilectomy

Explanation

First MTP joint arthrodesis is the gold standard for severe (Grade 3 or 4) hallux rigidus. It provides excellent, reliable pain relief and maintains functional outcomes for daily activities and moderate exercise.

Question 5566

Topic: 8. Foot and Ankle

When comparing early functional rehabilitation protocols to traditional cast immobilization for acute Achilles tendon ruptures treated nonoperatively, which of the following statements is most accurate?

. Functional rehabilitation results in a significantly increased re-rupture rate.
. Functional rehabilitation reduces the re-rupture rate to levels comparable to operative treatment.
. Functional rehabilitation significantly increases the rate of deep vein thrombosis.
. Functional rehabilitation leads to a permanent decrease in calf muscle strength.
. Functional rehabilitation increases the time required to return to work.

Correct Answer & Explanation

. Functional rehabilitation results in a significantly increased re-rupture rate.

Explanation

High-level evidence demonstrates that utilizing early functional rehabilitation protocols for nonoperatively managed Achilles tendon ruptures reduces re-rupture rates to levels equivalent to operative treatment, while avoiding surgical complications.

Question 5567

Topic: Midfoot & Hindfoot
A 55-year-old female presents with a progressive flatfoot deformity. She is unable to perform a single-limb heel rise on the affected side. Radiographs demonstrate talonavicular uncoverage of 40% and a Meary's angle of 15 degrees apex plantar. The hindfoot deformity is correctable passively. Which stage of posterior tibial tendon dysfunction (PTTD) does this represent?
. Stage I
. Stage IIa
. Stage IIb
. Stage III
. Stage IV

Correct Answer & Explanation

. Stage IIb

Explanation

Stage IIb PTTD involves a flexible flatfoot with significant forefoot abduction (talonavicular uncoverage >30%). Stage IIa is flexible without significant forefoot abduction. Stage III indicates a rigid hindfoot deformity, and Stage IV involves ankle valgus tilt or arthritis.

Question 5568

Topic: 8. Foot and Ankle
A patient sustained a Hawkins Type III talar neck fracture following a high-energy motor vehicle accident. What does this classification imply regarding the displacement of the talus?
. Undisplaced fracture of the talar neck
. Displacement of the subtalar joint only
. Displacement of both the subtalar and tibiotalar joints
. Displacement of the subtalar, tibiotalar, and talonavicular joints
. Dislocation of the talar body from the ankle mortise without subtalar involvement

Correct Answer & Explanation

. Displacement of both the subtalar and tibiotalar joints

Explanation

The Hawkins classification describes talar neck fractures. Type I is undisplaced. Type II involves subtalar subluxation or dislocation. Type III involves dislocation of both the subtalar and tibiotalar joints. Type IV involves dislocation of the subtalar, tibiotalar, and talonavicular joints.

Question 5569

Topic: Midfoot & Hindfoot
A 60-year-old diabetic male presents with a warm, swollen, erythematous foot. His pedal pulses are bounding. Radiographs demonstrate periarticular fragmentation, subluxation, and bony debris at the tarsometatarsal joints. Which stage of the Eichenholtz classification does this clinical and radiographic picture represent?
. Stage 0
. Stage I (Developmental/Fragmentation)
. Stage II (Coalescence)
. Stage III (Reconstruction/Consolidation)
. Stage IV

Correct Answer & Explanation

. Stage I (Developmental/Fragmentation)

Explanation

Eichenholtz Stage I is the developmental or fragmentation stage of Charcot arthropathy. It is characterized clinically by a hot, swollen foot and radiographically by active bone resorption, fragmentation, joint subluxation, and debris formation.

Question 5570

Topic: 8. Foot and Ankle

When evaluating a patient with a hindfoot cavovarus deformity, the Coleman block test is performed. If the hindfoot varus corrects to neutral when the first metatarsal is allowed to drop off the block, what is the primary biomechanical driver of the varus deformity?

. Tight Achilles tendon
. Rigid subtalar joint
. Plantarflexed first ray
. Weak tibialis anterior
. Spastic posterior tibial tendon

Correct Answer & Explanation

. Tight Achilles tendon

Explanation

The Coleman block test evaluates hindfoot flexibility in a cavovarus foot. Allowing the first ray to drop off the block removes the forefoot pronation effect. If the hindfoot varus corrects, the deformity is flexible and primarily driven by a rigidly plantarflexed first ray.

Question 5571

Topic: 8. Foot and Ankle

Surgical release of the plantar fascia for recalcitrant plantar fasciitis involves releasing only the medial one-third to one-half of the fascia. Releasing the entire plantar fascia significantly increases the biomechanical risk of developing which of the following complications?

. Lateral column overload and cuboid syndrome
. Medial arch collapse and rigid flatfoot
. Tarsal tunnel syndrome
. Stress fracture of the 1st metatarsal
. Hallux valgus deformity

Correct Answer & Explanation

. Lateral column overload and cuboid syndrome

Explanation

Complete release of the plantar fascia disrupts the windlass mechanism, decreasing arch height. Biomechanically, this transfers significant stress to the lateral column of the foot, frequently leading to iatrogenic lateral column overload, lateral foot pain, and cuboid syndrome.

Question 5572

Topic: 8. Foot and Ankle

A patient is diagnosed with a Morton's neuroma based on a positive Mulder's click and burning forefoot pain. Anatomically, which intermetatarsal web space is most commonly affected by this condition?

. First web space
. Second web space
. Third web space
. Fourth web space
. Medial to the first metatarsal

Correct Answer & Explanation

. First web space

Explanation

Morton's neuroma is a compressive perineural fibrosis of the common plantar digital nerve. It most frequently occurs in the third intermetatarsal web space, followed by the second web space.

Question 5573

Topic: Midfoot & Hindfoot

In the context of Tarsal Tunnel Syndrome, compression of the tibial nerve occurs deep to the flexor retinaculum. The first branch of the lateral plantar nerve, which can become entrapped and cause symptoms mimicking severe chronic heel pain, is anatomically known as:

. Medial calcaneal nerve
. Sural nerve
. Baxter's nerve
. Deep peroneal nerve
. Saphenous nerve

Correct Answer & Explanation

. Medial calcaneal nerve

Explanation

The first branch of the lateral plantar nerve is commonly referred to as Baxter's nerve. It courses anterior to the medial calcaneal tuberosity and deep to the abductor hallucis. Entrapment here can cause chronic heel pain that mimics or coexists with plantar fasciitis.

Question 5574

Topic: 8. Foot and Ankle

A 45-year-old male presents with posterior heel pain. MRI confirms severe insertional Achilles tendinosis with a Haglund's deformity. Surgical debridement is planned. If the debridement requires detachment of greater than 50% of the Achilles tendon insertion, what is the most appropriate adjunct procedure?

. Flexor Hallucis Longus (FHL) transfer
. Flexor Digitorum Longus (FDL) transfer
. Peroneus brevis transfer
. Plantaris augmentation
. Gastrocnemius recession

Correct Answer & Explanation

. Flexor Hallucis Longus (FHL) transfer

Explanation

When surgical debridement for insertional Achilles tendinopathy requires detachment of >50% of the tendon insertion to remove the diseased tissue and bone spur, an FHL tendon transfer is indicated to augment plantarflexion power and provide a well-vascularized tissue bed for healing.

Question 5575

Topic: 8. Foot and Ankle

During the operative fixation of a pronation-external rotation ankle fracture, the syndesmosis is evaluated fluoroscopically. Which radiographic parameter on a standard AP or mortise view is the most reliable indicator of syndesmotic widening?

. Tibiofibular clear space > 5mm
. Tibiofibular overlap > 10mm
. Medial clear space > 2mm
. Talar tilt > 5 degrees
. Decreased superior clear space

Correct Answer & Explanation

. Tibiofibular clear space > 5mm

Explanation

A tibiofibular clear space of greater than 5mm, measured 1cm proximal to the joint line on either an AP or mortise view, is the most reliable and rotationally independent radiographic indicator of syndesmotic injury.

Question 5576

Topic: 8. Foot and Ankle

A 20-year-old collegiate dancer presents with localized, recalcitrant pain directly plantar to the first metatarsal head. Imaging demonstrates a fragmented and nonunited tibial sesamoid. After 6 months of failed conservative management, what is the surgical treatment of choice?

. Excision of both the tibial and fibular sesamoids
. Excision of the tibial sesamoid with repair of the intrinsic muscles
. Dorsiflexion osteotomy of the first metatarsal
. Excision of the fibular sesamoid
. First MTP joint arthroplasty

Correct Answer & Explanation

. Excision of both the tibial and fibular sesamoids

Explanation

For a painful, nonunited tibial sesamoid that has failed conservative treatment, isolated excision of the tibial sesamoid is indicated. It is critical to meticulously repair the plantar plate and the abductor hallucis tendon defect to prevent a postoperative iatrogenic hallux valgus deformity.

Question 5577

Topic: Midfoot & Hindfoot
A 60-year-old female presents with progressive flattening of her left foot. Examination reveals a flexible hindfoot valgus and inability to perform a single-limb heel rise. Radiographs show >40% talonavicular uncoverage on the AP view. What procedure is indicated in addition to flexor digitorum longus (FDL) transfer and medializing calcaneal osteotomy to address the specific deformity seen on the AP radiograph?
. Cotton osteotomy
. Lateral column lengthening (Evans osteotomy)
. Spring ligament reconstruction
. Subtalar arthrodesis
. Tarsometatarsal arthrodesis

Correct Answer & Explanation

. Lateral column lengthening (Evans osteotomy)

Explanation

The patient has Stage IIb adult-acquired flatfoot deformity, characterized by significant forefoot abduction, which corresponds to >30-40% talonavicular uncoverage on the AP radiograph. This requires a lateral column lengthening (e.g., Evans osteotomy) in addition to an FDL transfer and medializing calcaneal osteotomy to structurally correct the abduction. A Cotton osteotomy is used to correct residual forefoot supination.

Question 5578

Topic: 8. Foot and Ankle

A 22-year-old man presents with a right cavovarus foot deformity. On the Coleman block test, the hindfoot varus corrects to neutral when the lateral border of the foot is placed on the block while the first metatarsal is allowed to drop off. What is the primary driver of this patient's hindfoot deformity?

. Plantarflexed first ray
. Weakness of the peroneus brevis
. Spasticity of the posterior tibial tendon
. Contracture of the Achilles tendon
. Tarsal coalition

Correct Answer & Explanation

. Plantarflexed first ray

Explanation

The Coleman block test differentiates between a flexible and rigid hindfoot varus in the setting of a cavovarus foot. By allowing the first ray to drop off the block, the test eliminates the effect of the forefoot on the hindfoot. If the hindfoot corrects to neutral, the deformity is flexible and primarily driven by a rigidly plantarflexed first ray (forefoot-driven hindfoot varus).

Question 5579

Topic: Forefoot

A 45-year-old female presents with a painful bunion. Weight-bearing radiographs show a hallux valgus angle (HVA) of 45 degrees, an intermetatarsal angle (IMA) of 18 degrees, and hypermobility at the first tarsometatarsal (TMT) joint. What is the most appropriate surgical intervention?

. Distal chevron osteotomy
. Proximal crescentic osteotomy with distal soft tissue procedure
. First TMT joint arthrodesis (Lapidus procedure)
. First MTP joint arthrodesis
. Keller resection arthroplasty

Correct Answer & Explanation

. Distal chevron osteotomy

Explanation

The patient has a severe hallux valgus deformity (HVA >40, IMA >13) combined with hypermobility of the first TMT joint. The Lapidus procedure (first TMT arthrodesis) is specifically indicated for hallux valgus associated with first ray hypermobility or first TMT arthritis. It stabilizes the medial column while effectively allowing for correction of large intermetatarsal angles.

Question 5580

Topic: 8. Foot and Ankle

A 58-year-old man complains of dorsal forefoot pain with push-off during walking. Examination reveals restricted first MTP joint dorsiflexion, with pain at the extremes of motion. Radiographs demonstrate a dorsal osteophyte, joint space narrowing, but preservation of the plantar joint space (Coughlin and Shurnas Grade 2). What is the initial surgical procedure of choice if conservative care fails?

. First MTP arthrodesis
. Cheilectomy
. Synthetic cartilage implant
. First MTP total joint arthroplasty
. Metatarsal head resection

Correct Answer & Explanation

. First MTP arthrodesis

Explanation

Coughlin and Shurnas Grade 2 hallux rigidus involves moderate joint space narrowing, dorsal osteophytes, and pain mainly at the extremes of dorsiflexion. Cheilectomy (removal of the dorsal osteophyte and the dorsal 25-30% of the metatarsal head) is the surgical treatment of choice for early to moderate (Grade 1 and 2) hallux rigidus when conservative measures fail. Arthrodesis is definitively preferred for Grade 3 and 4.

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