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8. Foot and Ankle MCQs

Practice Set 289 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 5761

Topic: 8. Foot and Ankle
A 58-year-old male with long-standing, poorly controlled type II diabetes presents with a red, hot, swollen left foot. He denies trauma. Pulses are bounding, and sensation to monofilament testing is absent. Radiographs demonstrate marked periarticular fragmentation, subchondral debris, and subluxation at the tarsometatarsal joints. According to the Eichenholtz classification, what stage of Charcot neuroarthropathy does this represent?
. Stage 0
. Stage I
. Stage II
. Stage III
. Stage IV

Correct Answer & Explanation

. Stage I

Explanation

Eichenholtz Stage I (Developmental/Fragmentation stage) is characterized by acute inflammation, osseous fragmentation, joint subluxation/dislocation, and debris formation. Stage II involves coalescence and absorption of fine debris, while Stage III shows consolidation and remodeling.

Question 5762

Topic: 8. Foot and Ankle

A 28-year-old female presents with chronic ankle pain following recurrent sprains. MRI reveals an osteochondral lesion of the talus (OCD). Which of the following best describes the characteristics and mechanism of a posteromedial talar dome lesion?

. Deep, cup-shaped, less likely to displace, caused by inversion and plantarflexion
. Shallow, wafer-shaped, more likely to displace, caused by inversion and dorsiflexion
. Deep, cup-shaped, highly likely to displace, caused by eversion and plantarflexion
. Shallow, wafer-shaped, less likely to displace, caused by eversion and dorsiflexion
. Cartilaginous flap tear, non-displaced, caused by pure axial loading

Correct Answer & Explanation

. Deep, cup-shaped, less likely to displace, caused by inversion and plantarflexion

Explanation

Posteromedial talar dome lesions are typically deep, cup-shaped, and less likely to displace. They are classically caused by an inversion injury while the foot is plantarflexed, which compresses the medial talar dome against the tibial plafond.

Question 5763

Topic: 8. Foot and Ankle

A patient with Charcot-Marie-Tooth disease presents with a bilateral cavovarus foot deformity. A Coleman block test is performed on the right foot, and the hindfoot varus corrects completely to a neutral alignment. What does this clinical finding indicate?

. The hindfoot deformity is rigid and requires a triple arthrodesis
. The hindfoot deformity is flexible and primarily driven by a plantarflexed first ray
. The deformity is solely due to severe gastrocnemius contracture
. There is underlying deltoid ligament insufficiency
. A talocalcaneal coalition is present

Correct Answer & Explanation

. The hindfoot deformity is rigid and requires a triple arthrodesis

Explanation

The Coleman block test distinguishes between a flexible and rigid hindfoot varus in cavovarus feet. If placing the lateral foot on a block (allowing the plantarflexed first ray to drop) corrects the hindfoot varus to neutral, the hindfoot is flexible and the deformity is forefoot-driven.

Question 5764

Topic: 8. Foot and Ankle
A 68-year-old male presents with severe pain in his first metatarsophalangeal (MTP) joint, particularly during toe-off. Examination reveals pain throughout the mid-range of motion. Radiographs demonstrate >50% joint space narrowing, a dorsal ring of osteophytes, and subchondral cysts (Coughlin/Shurnas Grade 4 Hallux Rigidus). What is the most reliable definitive surgical treatment?
. Aggressive dorsal cheilectomy
. Keller resection arthroplasty
. First MTP arthrodesis
. Weil osteotomy of the first metatarsal
. Moberg dorsal closing wedge osteotomy

Correct Answer & Explanation

. First MTP arthrodesis

Explanation

For advanced hallux rigidus (Grade 3 with pain at mid-range or Grade 4) with significant joint degeneration, first MTP arthrodesis is the gold standard. It provides predictable pain relief, corrects deformity, and allows for near-normal gait biomechanics.

Question 5765

Topic: Ankle Trauma & Sports

A 30-year-old male presents to the emergency department after a twisting injury to his ankle. Radiographs show a widened medial clear space and an isolated proximal third fibula fracture (Maisonneuve fracture). Given the location of the proximal fibula fracture, which nerve is at greatest risk of associated injury?

. Tibial nerve
. Deep peroneal nerve
. Superficial peroneal nerve
. Common peroneal nerve
. Sural nerve

Correct Answer & Explanation

. Tibial nerve

Explanation

A Maisonneuve fracture involves a pronation-external rotation injury that tears the syndesmosis and fractures the proximal fibula. The common peroneal nerve wraps around the fibular neck and is highly vulnerable to stretching or entrapment from injuries in this proximal region.

Question 5766

Topic: 8. Foot and Ankle

A 12-year-old boy presents with a painful, rigid flatfoot and a history of recurrent ankle sprains. Peroneal spasticity is noted on examination. Oblique radiographs of the foot demonstrate an elongated anterior process of the calcaneus approaching the navicular. What is the classic radiographic name for this finding?

. C-sign
. Talar beak sign
. Anteater nose sign
. Fleck sign
. Double density sign

Correct Answer & Explanation

. C-sign

Explanation

The 'anteater nose sign' on an oblique radiograph of the foot is classic for a calcaneonavicular coalition. It represents the elongated tubular anterior process of the calcaneus extending toward the navicular. The 'C-sign' is typically seen on lateral radiographs in talocalcaneal coalitions.

Question 5767

Topic: 8. Foot and Ankle

A 55-year-old runner has chronic insertional Achilles tendinopathy with a prominent Haglund deformity and extensive intratendinous calcification. Conservative management has failed. During surgery, aggressive debridement of the diseased tendon is necessary. At what threshold of Achilles tendon detachment/debridement is augmentation with a flexor hallucis longus (FHL) transfer generally recommended?

. Greater than 10% detachment
. Greater than 25% detachment
. Greater than 50% detachment
. Greater than 75% detachment
. FHL transfer is mandatory regardless of the detachment amount

Correct Answer & Explanation

. Greater than 10% detachment

Explanation

During debridement of insertional Achilles tendinopathy, if more than 50% of the tendon footprint is compromised or resected to remove calcifications and degenerated tissue, augmentation with an FHL tendon transfer is widely recommended to restore plantarflexion power and prevent catastrophic rupture.

Question 5768

Topic: Midfoot & Hindfoot

A 55-year-old diabetic patient presents with a swollen, warm, and erythematous foot without any open ulcers. Radiographs reveal joint subluxation, debris, and fragmentation. According to the Eichenholtz classification, what is the most appropriate initial management for this patient?

. Total contact casting and non-weight bearing
. Immediate surgical arthrodesis
. Amputation of the affected limb
. Oral antibiotics and weight-bearing as tolerated
. Custom accommodative footwear

Correct Answer & Explanation

. Total contact casting and non-weight bearing

Explanation

The patient is in Eichenholtz Stage I (Developmental/Fragmentation stage of Charcot arthropathy), characterized by erythema, warmth, joint laxity, subluxation, and bony fragmentation. The gold standard of initial management is immobilization with a total contact cast and strict non-weight bearing until the acute phase resolves (transition to Stage II).

Question 5769

Topic: Midfoot & Hindfoot

A 55-year-old patient with poorly controlled diabetes presents with a red, hot, swollen foot without skin ulceration. Radiographs show fragmentation of the navicular and cuneiforms with subluxation of the tarsometatarsal joints. According to the Eichenholtz classification, what is the most appropriate initial management?

. Intravenous antibiotics and immediate surgical debridement
. Total contact casting and strict non-weight-bearing
. Primary arthrodesis of the midfoot
. Prescription of custom orthotic rocker-bottom shoes
. Below-knee amputation

Correct Answer & Explanation

. Intravenous antibiotics and immediate surgical debridement

Explanation

The patient is in Eichenholtz Stage I (Developmental/Fragmentation stage) of Charcot arthropathy, characterized by acute inflammation and bony destruction. The gold standard of initial treatment is immobilization and offloading with a total contact cast to prevent progressive, irreversible deformity.

Question 5770

Topic: 8. Foot and Ankle
A 40-year-old female with no history of trauma presents with progressive radial-sided wrist pain. Imaging reveals sclerosis and fragmentation of the entire scaphoid with a normal scapholunate interval and no fracture line. This condition represents idiopathic avascular necrosis of the scaphoid. What is the eponym for this disease?
. Kienböck's disease
. Preiser's disease
. Freiberg's disease
. Panner's disease
. Köhler's disease

Correct Answer & Explanation

. Preiser's disease

Explanation

Preiser's disease is the eponym for idiopathic avascular necrosis of the scaphoid. It occurs without a preceding fracture, differentiating it from traumatic scaphoid AVN. Kienböck's affects the lunate, Freiberg's affects the metatarsal head, Panner's affects the capitellum, and Köhler's affects the navicular bone in the foot.

Question 5771

Topic: Midfoot & Hindfoot

A 13-year-old male presents with recurrent ankle sprains and chronic vague midfoot pain. Physical examination demonstrates a rigid flatfoot with absent subtalar motion. Radiographs reveal a 'C-sign' on the lateral view. A CT scan confirms a talocalcaneal coalition. Which of the following specific anatomical sites is most commonly involved in this type of coalition?

. Anterior facet of the subtalar joint
. Middle facet of the subtalar joint
. Posterior facet of the subtalar joint
. Calcaneocuboid joint
. Talonavicular joint

Correct Answer & Explanation

. Anterior facet of the subtalar joint

Explanation

Talocalcaneal coalitions most commonly involve the middle facet of the subtalar joint. Radiographically, the 'C-sign' (formed by the medial outline of the talar dome and the inferior outline of the sustentaculum tali) is highly indicative of a middle facet talocalcaneal coalition. Resection of the coalition is typically considered if the coalition involves less than 50% of the posterior facet surface area and there are no significant degenerative changes; otherwise, subtalar fusion may be required.

Question 5772

Topic: 8. Foot and Ankle

A 14-year-old boy presents with a history of recurrent ankle sprains and rigid, painful flatfeet. Examination shows markedly decreased subtalar motion bilaterally and spasm of the peroneal tendons upon passive inversion. Lateral radiographs of the foot demonstrate a continuous bony bridge between the talus and calcaneus, forming a 'C-sign'. Which of the following is the most likely diagnosis?

. Calcanonavicular coalition
. Talocalcaneal coalition
. Accessory navicular
. Congenital vertical talus
. Posterior tibial tendon dysfunction

Correct Answer & Explanation

. Calcanonavicular coalition

Explanation

The clinical presentation is classic for a tarsal coalition, characterized by rigid flatfoot and peroneal spasticity. 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 coalition. Calcanonavicular coalitions are best seen on a 45-degree internal oblique radiograph ('anteater nose' sign).

Question 5773

Topic: 8. Foot and Ankle

A newborn presents with a rigid flatfoot deformity characterized by a convex plantar surface (rocker-bottom foot). Radiographs show the talus in a severe plantarflexed position. On a maximum plantarflexion lateral radiograph, the navicular remains dorsally dislocated on the talar neck. What is the most appropriate initial management for this condition?

. Immediate surgical release of the dorsal structures and talonavicular pinning
. Serial manipulation and casting (Dobbs method)
. Observation until 6 months of age
. Triple arthrodesis
. Denis Browne splinting

Correct Answer & Explanation

. Immediate surgical release of the dorsal structures and talonavicular pinning

Explanation

Congenital vertical talus (CVT) is characterized by a fixed dorsal dislocation of the navicular on the talus. The most appropriate initial management is the Dobbs method, which involves serial manipulation and casting (stretching the forefoot into plantarflexion and inversion to align it with the plantarflexed talus), followed by minimally invasive pinning of the talonavicular joint and percutaneous Achilles tenotomy.

Question 5774

Topic: 8. Foot and Ankle

A 12-year-old boy presents with a painful, rigid flatfoot. Radiographs demonstrate a 'C-sign' on the lateral view of the foot. Which of the following is the most likely diagnosis?

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

Correct Answer & Explanation

. Calcaneonavicular coalition

Explanation

The 'C-sign' on a lateral foot radiograph is classic for a talocalcaneal (subtalar) coalition, representing a continuous bony outline from the talar dome to the sustentaculum tali. Calcaneonavicular coalitions typically display the 'anteater nose' sign.

Question 5775

Topic: 8. Foot and Ankle

A newborn is diagnosed with congenital vertical talus. What is the classic radiographic relationship between the talus and the navicular in this condition?

. Navicular is dorsally dislocated on the talus.
. Navicular is plantarflexed and medially dislocated on the talus.
. Talus and navicular are fused.
. Navicular is laterally subluxated on the cuboid.
. Talus is parallel to the calcaneus in the lateral view.

Correct Answer & Explanation

. Navicular is dorsally dislocated on the talus.

Explanation

Congenital vertical talus creates a rigid rocker-bottom foot deformity. Radiographically, the hallmark is a rigid dorsal dislocation of the navicular upon a vertically oriented, plantarflexed talus.

Question 5776

Topic: 8. Foot and Ankle

A 12-year-old girl complains of vague, recurrent foot pain and frequent ankle sprains. Examination shows a rigid flatfoot with no arch reconstitution on toe-standing. Radiographs reveal a "C sign" on the lateral view. What is the most likely diagnosis?

. Calcaneonavicular coalition
. Talocalcaneal coalition
. Symptomatic accessory navicular
. Posterior tibial tendon dysfunction
. Severe flexible flatfoot

Correct Answer & Explanation

. Calcaneonavicular coalition

Explanation

A talocalcaneal coalition often presents as a rigid flatfoot in early adolescence. It is radiographically characterized by the "C sign" on a lateral view, formed by the medial outline of the talar dome and the inferior outline of the sustentaculum tali.

Question 5777

Topic: 8. Foot and Ankle

A 25-year-old football player sustains an axial load to a plantarflexed foot.

Weight-bearing radiographs reveal a 3 mm diastasis between the base of the first and second metatarsals. What is the primary stabilizing structure of this articulation?

. Dorsal Lisfranc ligament
. Plantar Lisfranc ligament
. Interosseous Lisfranc ligament
. Plantar fascia
. Spring ligament

Correct Answer & Explanation

. Dorsal Lisfranc ligament

Explanation

The Lisfranc ligament complex connects the medial cuneiform to the base of the second metatarsal. It has three components: dorsal, interosseous, and plantar. The interosseous Lisfranc ligament is the strongest and thickest primary stabilizer of the joint. The dorsal ligament is the weakest.

Question 5778

Topic: 8. Foot and Ankle

A 40-year-old man sustains a sudden "pop" in the back of his heel while playing tennis. Which of the following physical examination maneuvers is the most sensitive and specific for diagnosing a complete acute Achilles tendon rupture?

. O'Brien test
. Thompson test
. Silfverskiold test
. Kleiger test
. Anterior drawer test

Correct Answer & Explanation

. O'Brien test

Explanation

The Thompson test (calf squeeze test) is the most reliable clinical sign for a complete Achilles tendon rupture. Squeezing the calf muscle belly in a prone patient normally elicits passive plantar flexion of the ankle. Lack of this plantar flexion response indicates a loss of continuity of the Achilles tendon.

Question 5779

Topic: 8. Foot and Ankle

According to the Lauge-Hansen classification, a pronation-external rotation (PER) ankle fracture is characterized by a specific sequential pattern of structural failure. What is the very first structure to fail in a PER injury?

. Anterior inferior tibiofibular ligament (AITFL)
. Medial malleolus or deltoid ligament
. High fibular shaft
. Posterior inferior tibiofibular ligament (PITFL)
. Lateral collateral ligament complex

Correct Answer & Explanation

. Anterior inferior tibiofibular ligament (AITFL)

Explanation

In the Lauge-Hansen classification, the first word describes the position of the foot and the second describes the deforming force. In a Pronation-External Rotation (PER) injury, the foot is pronated, putting the medial structures under tension. Thus, Stage 1 is a transverse fracture of the medial malleolus or rupture of the deltoid ligament. This is followed by AITFL injury (Stage 2), high fibula fracture (Stage 3), and PITFL/posterior malleolus injury (Stage 4).

Question 5780

Topic: 8. Foot and Ankle

A 20-year-old collegiate football player sustains a midfoot injury after an axial load was applied to his plantarflexed foot. On exam, there is plantar ecchymosis. Radiographs reveal a widening of the space between the medial and middle cuneiforms and a "fleck sign". The primary stabilizing ligament injured in this condition connects which two osseous structures?

. Medial cuneiform to the base of the first metatarsal
. Lateral cuneiform to the base of the third metatarsal
. Medial cuneiform to the base of the second metatarsal
. Middle cuneiform to the base of the second metatarsal
. Navicular to the medial cuneiform

Correct Answer & Explanation

. Medial cuneiform to the base of the first metatarsal

Explanation

The Lisfranc ligament is an interosseous ligament that runs from the lateral aspect of the medial cuneiform to the medial aspect of the base of the second metatarsal. It is critical for stabilizing the midfoot, and its rupture is indicated by the "fleck sign" (a bony avulsion at its attachment).

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