Menu

8. Foot and Ankle MCQs

Practice Set 297 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 5921

Topic: Midfoot & Hindfoot

A 42-year-old runner complains of chronic, recalcitrant heel pain that radiates into the medial plantar arch. MRI reveals isolated atrophy of the abductor digiti minimi muscle. Entrapment of which of the following nerves is the most likely cause?

. Medial calcaneal nerve
. First branch of the lateral plantar nerve
. Medial plantar nerve
. Sural nerve
. Saphenous nerve

Correct Answer & Explanation

. Medial calcaneal nerve

Explanation

The first branch of the lateral plantar nerve (Baxter's nerve) innervates the abductor digiti minimi. Entrapment of this nerve causes chronic heel pain and isolated muscle atrophy visible on MRI.

Question 5922

Topic: 8. Foot and Ankle

A 60-year-old male with chronic insertional Achilles tendinopathy undergoes surgical debridement. During the procedure, 60% of the Achilles tendon insertion is detached to remove the degenerative tissue and Haglund's deformity. What is the most appropriate next step?

. Primary repair of the Achilles tendon with heavy non-absorbable suture
. Gastrocnemius recession
. Flexor hallucis longus (FHL) tendon transfer
. Peroneus brevis tendon transfer
. Tibialis anterior tendon transfer

Correct Answer & Explanation

. Primary repair of the Achilles tendon with heavy non-absorbable suture

Explanation

When more than 50% of the Achilles tendon insertion is compromised or detached during debridement, tendon augmentation is indicated. The flexor hallucis longus (FHL) is the preferred transfer due to its proximity, strength, and in-phase firing.

Question 5923

Topic: Forefoot

A 50-year-old male presents with painful, limited dorsiflexion of the right hallux. Radiographs reveal advanced narrowing of the 1st MTP joint, large dorsal osteophytes, and less than 50% of the joint space remaining (Coughlin and Shurnas Grade 3). What is the most reliable surgical option for long-term pain relief?

. Dorsal cheilectomy
. Moberg osteotomy
. Keller arthroplasty
. First MTP joint arthrodesis
. Silicone implant arthroplasty

Correct Answer & Explanation

. Dorsal cheilectomy

Explanation

First MTP joint arthrodesis is the gold standard for advanced hallux rigidus (Grade 3 and 4), providing the most reliable long-term pain relief and functional improvement. Cheilectomy is generally reserved for Grade 1 or 2 disease with preserved joint space.

Question 5924

Topic: 8. Foot and Ankle

A 26-year-old skier presents with lateral ankle pain and a snapping sensation behind the lateral malleolus. On examination, active ankle dorsiflexion and eversion reproduce the snapping. Which anatomic structure is most likely incompetent?

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

Correct Answer & Explanation

. Anterior talofibular ligament

Explanation

Peroneal tendon subluxation is caused by an injury to the superior peroneal retinaculum (SPR), often occurring during forceful dorsiflexion and eversion. Surgical repair of the SPR with or without fibular groove deepening is usually required for symptomatic cases.

Question 5925

Topic: Midfoot & Hindfoot

In the operative management of a purely ligamentous Lisfranc injury, current literature suggests which of the following regarding primary arthrodesis compared to open reduction and internal fixation (ORIF)?

. ORIF has a significantly lower rate of reoperation
. Primary arthrodesis yields better functional outcomes and fewer reoperations for hardware removal
. There is no difference in outcomes or reoperation rates
. Primary arthrodesis leads to an unacceptably high rate of adjacent segment disease within 2 years
. ORIF is preferred due to preserved midfoot motion and better athletic performance

Correct Answer & Explanation

. ORIF has a significantly lower rate of reoperation

Explanation

Studies have shown that primary arthrodesis for purely ligamentous Lisfranc injuries provides comparable or superior functional outcomes and a significantly lower reoperation rate compared to ORIF, which often requires routine hardware removal and may fail.

Question 5926

Topic: Midfoot & Hindfoot

A 58-year-old male with long-standing, poorly controlled type 2 diabetes presents with a unilaterally swollen, red, and warm foot. Radiographs demonstrate fragmentation of the midfoot with subluxation, but no skin ulceration. Inflammatory markers are mildly elevated. What is the most appropriate initial management?

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

Correct Answer & Explanation

. Total contact casting and non-weight-bearing

Explanation

The patient is in Eichenholtz Stage I (developmental/acute) of Charcot arthropathy, characterized by fragmentation and joint subluxation. The mainstay of acute treatment to prevent further deformity is strict immobilization with a total contact cast and offloading.

Question 5927

Topic: 8. Foot and Ankle
A 55-year-old female presents with progressive flattening of her left foot. Examination reveals a flexible hindfoot valgus, inability to perform a single-leg heel rise, and forefoot abduction that uncovers >40% of the talar head. Which of the following surgical strategies is most appropriate?
. Isolated flexor digitorum longus (FDL) transfer to the navicular
. FDL transfer, medial displacement calcaneal osteotomy (MDCO), and Achilles lengthening
. FDL transfer, lateral column lengthening, and medial split tibialis anterior transfer
. Triple arthrodesis
. Talonavicular arthrodesis only

Correct Answer & Explanation

. FDL transfer, lateral column lengthening, and medial split tibialis anterior transfer

Explanation

This presentation describes Stage IIb posterior tibial tendon dysfunction (PTTD), marked by a flexible deformity with significant forefoot abduction. Treatment requires an FDL transfer combined with a lateral column lengthening (e.g., Evans osteotomy) to correct the forefoot abduction.

Question 5928

Topic: Midfoot & Hindfoot

A 45-year-old runner presents with chronic, severe heel pain refractory to conservative management, including corticosteroid injections. Pain is maximal at the medial aspect of the heel and radiates distally. Examination reveals tenderness over the first branch of the lateral plantar nerve. This nerve provides motor innervation to which of the following muscles?

. Abductor hallucis
. Flexor digitorum brevis
. Quadratus plantae
. Abductor digiti minimi
. Flexor hallucis brevis

Correct Answer & Explanation

. Abductor hallucis

Explanation

The first branch of the lateral plantar nerve (Baxter's nerve) courses between the abductor hallucis and quadratus plantae, providing motor innervation to the abductor digiti minimi. Entrapment can mimic or coexist with plantar fasciitis.

Question 5929

Topic: 8. Foot and Ankle

During evaluation of a patient with a severe cavovarus foot deformity, the examiner places the patient's foot on a 1-inch block with the first metatarsal hanging freely off the medial edge. The hindfoot varus corrects to neutral. What does this test signify?

. The hindfoot deformity is fixed and requires a calcaneal osteotomy.
. The hindfoot varus is driven by a rigid, plantarflexed first ray.
. There is a primary disruption of the spring ligament.
. The tibialis posterior tendon is ruptured or incompetent.
. A triple arthrodesis is strictly indicated.

Correct Answer & Explanation

. The hindfoot deformity is fixed and requires a calcaneal osteotomy.

Explanation

The Coleman block test distinguishes between forefoot-driven and hindfoot-driven varus. Correction of hindfoot varus when the first ray is dropped indicates a flexible hindfoot driven by a rigid plantarflexed first ray.

Question 5930

Topic: Forefoot

A 38-year-old female presents with symptomatic hallux valgus. Radiographs show a hallux valgus angle (HVA) of 35 degrees, an intermetatarsal angle (IMA) of 16 degrees, and significant hypermobility at the first tarsometatarsal (TMT) joint. Which of the following procedures is most appropriate?

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

Correct Answer & Explanation

. Distal chevron osteotomy

Explanation

The Lapidus procedure (first TMT arthrodesis) is indicated for moderate to severe hallux valgus, particularly when accompanied by first ray hypermobility. It provides powerful correction of the IMA and stabilizes the medial column.

Question 5931

Topic: 8. Foot and Ankle

When utilizing the Ponseti method for the correction of idiopathic clubfoot, what is the first component of the deformity that must be addressed?

. Cavus, by supinating the forefoot to align with the hindfoot
. Adductus, by abducting the midfoot on the talus
. Varus, by everting the calcaneus
. Equinus, by immediate percutaneous Achilles tenotomy
. Internal rotation of the tibia, by applying a derotational cast

Correct Answer & Explanation

. Cavus, by supinating the forefoot to align with the hindfoot

Explanation

The Ponseti method follows the CAVE sequence: Cavus, Adductus, Varus, Equinus. The cavus is corrected first by elevating the first ray (supinating the forefoot) to align it with the supinated hindfoot.

Question 5932

Topic: 8. Foot and Ankle

A 65-year-old patient with end-stage post-traumatic ankle osteoarthritis undergoes a tibiotalar arthrodesis. To optimize the patient's postoperative gait, the ankle should be fused in which of the following positions?

. 10 degrees of dorsiflexion, neutral valgus, and 10 degrees of external rotation
. Neutral dorsiflexion, 5 degrees of valgus, and 5 to 10 degrees of external rotation
. 5 degrees of plantarflexion, 5 degrees of varus, and neutral rotation
. 10 degrees of plantarflexion, 5 degrees of valgus, and 5 degrees of internal rotation
. Neutral dorsiflexion, neutral coronal alignment, and 20 degrees of external rotation

Correct Answer & Explanation

. 10 degrees of dorsiflexion, neutral valgus, and 10 degrees of external rotation

Explanation

Optimal positioning for ankle arthrodesis is neutral dorsiflexion (0 degrees), 5 degrees of hindfoot valgus, and 5 to 10 degrees of external rotation (to match the contralateral limb). Plantarflexion or varus positioning leads to poor gait and adjacent joint arthritis.

Question 5933

Topic: 8. Foot and Ankle

A 30-year-old skier sustains an acute dorsiflexion and inversion injury. He complains of posterolateral ankle pain and a snapping sensation behind the lateral malleolus. Disruption of which of the following structures is the primary cause of his symptoms?

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

Correct Answer & Explanation

. Superior peroneal retinaculum

Explanation

The patient has peroneal tendon subluxation. The primary restraint to peroneal tendon subluxation is the superior peroneal retinaculum (SPR), which often avulses from the posterolateral fibular margin during the injury.

Question 5934

Topic: Midfoot & Hindfoot

A 40-year-old laborer sustains a purely ligamentous, unstable Lisfranc injury. Based on high-level evidence, which of the following surgical treatments yields the best long-term clinical outcomes and functional scores for purely ligamentous midfoot injuries?

. Closed reduction and percutaneous K-wire fixation
. Open reduction and flexible suture-button fixation
. Open reduction and internal fixation with transarticular screws
. Dorsal bridge plating across the tarsometatarsal joints
. Primary arthrodesis of the first, second, and third tarsometatarsal joints

Correct Answer & Explanation

. Closed reduction and percutaneous K-wire fixation

Explanation

Current evidence demonstrates that primary arthrodesis of the medial columns (1st, 2nd, and 3rd TMT joints) leads to better functional outcomes and lower reoperation rates than ORIF for purely ligamentous Lisfranc injuries.

Question 5935

Topic: 8. Foot and Ankle

Osteochondral lesions of the talus (OCLT) typically present in distinct locations based on the mechanism of injury. A lesion located on the posteromedial aspect of the talar dome is classically associated with which mechanism?

. Dorsiflexion and eversion
. Plantarflexion and inversion
. Dorsiflexion and inversion
. Plantarflexion and eversion
. Axial loading in neutral alignment

Correct Answer & Explanation

. Dorsiflexion and eversion

Explanation

Posteromedial talar dome lesions are classically caused by a plantarflexion and inversion injury. They are typically deeper, larger, and less likely to displace compared to anterolateral lesions (which are caused by dorsiflexion and inversion).

Question 5936

Topic: 8. Foot and Ankle

A 55-year-old male undergoes surgical treatment for severe insertional Achilles tendinopathy with a prominent Haglund's deformity. During debridement of the degenerative tendinosis, 60% of the Achilles tendon insertion is detached. What is the recommended concurrent surgical step?

. Primary repair with heavy nonabsorbable suture alone
. V-Y fractional lengthening of the gastrocnemius
. Flexor hallucis longus (FHL) tendon transfer
. Peroneus brevis tendon transfer
. Application of a circular external fixator for gradual distraction

Correct Answer & Explanation

. Primary repair with heavy nonabsorbable suture alone

Explanation

When more than 50% of the Achilles tendon insertion must be detached to adequately debride insertional tendinopathy, augmentation with a Flexor Hallucis Longus (FHL) tendon transfer is recommended to restore strength and prevent rupture.

Question 5937

Topic: Forefoot
A 60-year-old female presents with severe pain and stiffness in her great toe. Radiographs demonstrate complete loss of joint space at the first MTP joint, extensive dorsal osteophytes, and subchondral cysts. She wishes to maintain an active lifestyle involving hiking. What is the gold standard surgical treatment?
. Dorsal cheilectomy
. Keller resection arthroplasty
. Silicone implant arthroplasty
. First metatarsophalangeal joint arthrodesis
. Moberg osteotomy

Correct Answer & Explanation

. First metatarsophalangeal joint arthrodesis

Explanation

This patient has Grade III/IV hallux rigidus. The gold standard surgical procedure for advanced, symptomatic hallux rigidus, especially in active patients, is a first MTP joint arthrodesis, providing reliable pain relief and durability.

Question 5938

Topic: 8. Foot and Ankle

A 15-year-old female dancer presents with pain in her forefoot. Radiographs show sclerosis and flattening of the second metatarsal head. Conservative treatment has failed. What surgical procedure is designed to rotate the plantar viable cartilage dorsally to articulate with the proximal phalanx?

. Plantar closing wedge osteotomy of the metatarsal base
. Resection of the metatarsal head (Mayo procedure)
. Dorsal closing wedge osteotomy of the metatarsal neck
. Osteochondral autograft transfer from the knee
. Percutaneous pinning of the MTP joint

Correct Answer & Explanation

. Plantar closing wedge osteotomy of the metatarsal base

Explanation

This presentation describes Freiberg's infraction. A dorsal closing wedge osteotomy of the metatarsal neck directs the necrotic dorsal articular cartilage away from the joint while bringing the healthy plantar cartilage into articulation.

Question 5939

Topic: 8. Foot and Ankle

A 12-year-old boy presents with frequent ankle sprains and a rigid, flat foot. Examination reveals peroneal spasticity and restricted subtalar motion. Which radiographic view is best suited to confirm the presence of a calcaneonavicular coalition?

. Anteroposterior view of the foot
. 45-degree internal rotation oblique view of the foot
. Harris axial view of the heel
. Weight-bearing lateral view of the ankle
. Mortise view of the ankle

Correct Answer & Explanation

. Anteroposterior view of the foot

Explanation

The 45-degree internal oblique radiograph of the foot is the standard view to identify a calcaneonavicular coalition, classically demonstrating the "anteater sign." The Harris axial view is utilized to evaluate talocalcaneal coalitions.

Question 5940

Topic: 8. Foot and Ankle

During a lateral extensile approach for open reduction and internal fixation of a displaced intra-articular calcaneus fracture, the full-thickness subperiosteal flap is created. Which nerve is most at risk and must be protected in the superior/posterior aspect of the incision?

. Superficial peroneal nerve
. Deep peroneal nerve
. Sural nerve
. Medial calcaneal nerve
. Saphenous nerve

Correct Answer & Explanation

. Superficial peroneal nerve

Explanation

The sural nerve courses posterior to the lateral malleolus and along the lateral aspect of the hindfoot. It is highly vulnerable during the vertical limb and corner-creation of the lateral extensile approach to the calcaneus.

Test Yourself

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

On this Page