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8. Foot and Ankle MCQs

Practice Set 304 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 6061

Topic: 8. Foot and Ankle
A 38-year-old roofer falls 15 feet, sustaining a Sanders Type III intra-articular calcaneus fracture. An extensile lateral approach is planned for open reduction and internal fixation. To prevent full-thickness flap necrosis, the surgeon must carefully protect the primary blood supply to the corner of this flap. Which vessel is most critical?
. Medial calcaneal artery
. Lateral tarsal artery
. Lateral calcaneal artery
. Dorsalis pedis artery
. Posterior tibial artery

Correct Answer & Explanation

. Lateral calcaneal artery

Explanation

The extensile lateral approach to the calcaneus relies on a full-thickness subperiosteal flap. The critical blood supply to the apex of this flap is the lateral calcaneal artery, a branch of the peroneal artery.

Question 6062

Topic: Forefoot

A 22-year-old football lineman presents with severe pain at the 1st MTP joint after another player fell on the back of his heel while his foot was planted and dorsiflexed. MRI reveals a complete rupture of the plantar plate with proximal retraction of the sesamoids by 10 mm. What is the most appropriate management for this Grade 3 Turf Toe injury?

. Stiff-soled shoe with a Morton's extension for 8 weeks
. Taping the toe in plantarflexion and immediate return to play
. Primary surgical repair of the plantar plate and capsuloligamentous complex
. First MTP joint arthrodesis
. Cheilectomy and sesamoidectomy

Correct Answer & Explanation

. Primary surgical repair of the plantar plate and capsuloligamentous complex

Explanation

Grade 3 turf toe injuries involve a complete tear of the plantar plate complex with sesamoid retraction. Surgical repair is indicated in high-level athletes to restore push-off strength and prevent progressive hallux valgus or rigidus deformities.

Question 6063

Topic: 8. Foot and Ankle

A 28-year-old skier presents with lateral ankle pain and a popping sensation behind the lateral malleolus after catching an edge. On examination, the peroneal tendons can be subluxated anteriorly over the fibula with resisted dorsiflexion and eversion. What is the classic mechanism of injury for this condition?

. Sudden forced plantarflexion and inversion of a relaxed foot
. Sudden forced dorsiflexion of an inverted foot resulting in reflex peroneal contraction
. Direct blunt trauma to the lateral malleolus
. Chronic repetitive microtrauma from distance running
. Axial loading of a plantarflexed foot

Correct Answer & Explanation

. Sudden forced dorsiflexion of an inverted foot resulting in reflex peroneal contraction

Explanation

Acute superior peroneal retinaculum (SPR) tears typically occur due to sudden forced dorsiflexion of an inverted foot. This triggers a violent reflex contraction of the peroneal muscles, avulsing or tearing the SPR and allowing the tendons to subluxate.

Question 6064

Topic: 8. Foot and Ankle

A 14-year-old male complains of recurrent lateral ankle sprains and a painful, rigid flatfoot.

A lateral radiograph reveals an elongated anterior process of the calcaneus (the "anteater nose" sign). Which type of tarsal coalition does this patient most likely have?

. Talocalcaneal coalition
. Calcaneonavicular coalition
. Talonavicular coalition
. Calcaneocuboid coalition
. Cubonavicular coalition

Correct Answer & Explanation

. Calcaneonavicular coalition

Explanation

The "anteater nose" sign on a lateral radiograph is pathognomonic for a calcaneonavicular coalition, representing a tubular elongation of the anterior process of the calcaneus. Talocalcaneal coalitions are classically associated with the "C-sign".

Question 6065

Topic: 8. Foot and Ankle

A 45-year-old woman complains of burning pain in the third webspace of her right foot, exacerbated by wearing narrow shoes. On examination, a painful click is elicited when squeezing the metatarsal heads together while applying plantar pressure to the interspace (Mulder's sign). During surgical excision of this presumed neuroma, which ligament must typically be transected to decompress the area?

. Plantar fascia
. Deep transverse metatarsal ligament
. Superficial transverse metatarsal ligament
. Plantar plate
. Lisfranc ligament

Correct Answer & Explanation

. Deep transverse metatarsal ligament

Explanation

Morton's neuroma is an entrapment neuropathy of the common digital nerve. Surgical excision or decompression requires division of the deep transverse metatarsal ligament, under which the nerve is compressed.

Question 6066

Topic: 8. Foot and Ankle

Osteochondral lesions of the talus (OCDs) commonly occur following ankle sprains or fractures. According to the "DIAL a PIMP" mnemonic, what is the classic mechanism of injury and morphological characteristic of a posteromedial talar dome lesion?

. Dorsiflexion and inversion; shallow and wafer-shaped
. Dorsiflexion and eversion; deep and cup-shaped
. Plantarflexion and inversion; deep and cup-shaped
. Plantarflexion and eversion; shallow and wafer-shaped
. Axial loading; large osteochondral fragmentation

Correct Answer & Explanation

. Plantarflexion and inversion; deep and cup-shaped

Explanation

The mnemonic 'DIAL a PIMP' stands for Dorsiflexion Inversion AnteroLateral (shallow/wafer lesions) and Plantarflexion Inversion PosteroMedial (deep/cup-shaped lesions). Posteromedial lesions are more common and less likely to spontaneously displace.

Question 6067

Topic: 8. Foot and Ankle

A 60-year-old patient with long-standing, poorly controlled diabetes presents with a deep, foul-smelling ulcer under the first metatarsal head that probes to bone. What is the most expected microbiologic profile of this chronic, limb-threatening deep foot infection?

. Monomicrobial Staphylococcus aureus
. Monomicrobial Pseudomonas aeruginosa
. Monomicrobial Streptococcus pyogenes
. Polymicrobial including aerobic Gram-positive cocci, Gram-negative bacilli, and anaerobes
. Polymicrobial consisting exclusively of fungal and mycobacterial organisms

Correct Answer & Explanation

. Polymicrobial including aerobic Gram-positive cocci, Gram-negative bacilli, and anaerobes

Explanation

Chronic, deep diabetic foot infections, particularly those with necrosis or foul odor, are notoriously polymicrobial. They typically involve a combination of aerobic Gram-positive organisms (like S. aureus), Gram-negative bacilli, and obligate anaerobes.

Question 6068

Topic: 8. Foot and Ankle

A 65-year-old patient with end-stage post-traumatic ankle arthritis is being evaluated for a Total Ankle Arthroplasty (TAA). Which of the following is considered an absolute contraindication for TAA?

. Age greater than 60 years
. Body Mass Index (BMI) of 28
. Severe peripheral neuropathy with loss of protective sensation (Charcot)
. Mild associated subtalar arthritis
. A previous medial malleolar fracture treated with ORIF 20 years ago

Correct Answer & Explanation

. Severe peripheral neuropathy with loss of protective sensation (Charcot)

Explanation

Absolute contraindications to Total Ankle Arthroplasty include active infection, severe peripheral neuropathy (Charcot arthropathy), avascular necrosis of >50% of the talar body, and severe uncorrectable malalignment.

Question 6069

Topic: 8. Foot and Ankle

A 14-year-old female dancer complains of insidious forefoot pain, specifically at the base of the second toe. Radiographs show sclerosis, flattening, and early fragmentation of the second metatarsal head. Which condition is most likely, and what is the underlying pathophysiology?

. Sever's disease; apophysitis of the calcaneus
. Kohler's disease; avascular necrosis of the navicular
. Frieberg's infraction; avascular necrosis of the metatarsal head
. Iselin's disease; apophysitis of the 5th metatarsal base
. Morton's neuroma; perineural fibrosis of the digital nerve

Correct Answer & Explanation

. Frieberg's infraction; avascular necrosis of the metatarsal head

Explanation

Frieberg's infraction is avascular necrosis of a metatarsal head, most commonly the second. It frequently occurs in adolescent females engaged in activities that repetitively load the forefoot, such as dancing.

Question 6070

Topic: Ankle Trauma & Sports

During surgical stabilization of an acute syndesmotic injury of the ankle, a thorough understanding of the native anatomy is required. Which of the following ligaments provides the greatest biomechanical strength and resistance to diastasis of the distal tibiofibular joint?

. Anterior inferior tibiofibular ligament (AITFL)
. Posterior inferior tibiofibular ligament (PITFL)
. Interosseous ligament
. Anterior talofibular ligament (ATFL)
. Calcaneofibular ligament (CFL)

Correct Answer & Explanation

. Posterior inferior tibiofibular ligament (PITFL)

Explanation

The syndesmotic complex consists of the AITFL, PITFL, transverse ligament, and interosseous ligament/membrane. Biomechanical studies demonstrate that the Posterior Inferior Tibiofibular Ligament (PITFL) provides the strongest restraint, accounting for approximately 42% of the total strength against syndesmotic widening, followed by the AITFL (35%) and the interosseous ligament (22%).

Question 6071

Topic: 8. Foot and Ankle

Recent high-level evidence regarding the management of acute Achilles tendon ruptures suggests that the re-rupture rates between non-operative and operative management become statistically similar when which of the following postoperative protocols is utilized?

. Prolonged cast immobilization in equinus for 8 weeks
. Early functional rehabilitation with weight-bearing in a dynamic brace
. Strict non-weight-bearing for 6 weeks followed by passive stretching
. Immediate use of a walking boot fixed strictly at neutral dorsiflexion
. Local corticosteroid injections combined with eccentric loading

Correct Answer & Explanation

. Early functional rehabilitation with weight-bearing in a dynamic brace

Explanation

Level I evidence demonstrates that early functional rehabilitation with dynamic bracing and early weight-bearing equalizes the re-rupture rate between operative and non-operative management of Achilles tendon ruptures, while reducing other complications.

Question 6072

Topic: 8. Foot and Ankle

A 35-year-old recreational basketball player suffers an acute Achilles tendon rupture. He considers non-operative management with a functional rehabilitation protocol versus surgical repair. According to recent high-level evidence, which of the following statements comparing these two approaches is most accurate?

. Surgical repair has a significantly higher re-rupture rate.
. Functional rehabilitation provides identical plantar flexion strength as surgical repair.
. There is no significant difference in re-rupture rates when an early functional rehabilitation protocol is utilized.
. Non-operative management has a higher risk of deep vein thrombosis.
. Surgical repair has a lower risk of sural nerve injury.

Correct Answer & Explanation

. There is no significant difference in re-rupture rates when an early functional rehabilitation protocol is utilized.

Explanation

Modern functional rehabilitation protocols utilizing early weight-bearing have demonstrated re-rupture rates comparable to surgical repair. Surgical repair, however, carries inherently higher risks of complications such as infection and sural nerve injury.

Question 6073

Topic: 8. Foot and Ankle
A 30-year-old male sustains a severe multiligament knee injury (KD III-M) after a motorcycle accident. After closed reduction in the emergency department, his ankle-brachial index (ABI) is measured at 0.8. What is the most appropriate next step in management?
. Observation and repeat ABI in 4 hours
. Immediate CT angiography (CTA)
. Immediate popliteal artery bypass
. MR angiography of the lower extremity
. Application of a knee-spanning external fixator

Correct Answer & Explanation

. Immediate CT angiography (CTA)

Explanation

An ABI less than 0.9 after a knee dislocation is highly suspicious for a vascular injury, particularly to the popliteal artery. The definitive next step in evaluation is a CT angiography (CTA) to confirm the presence and level of arterial injury.

Question 6074

Topic: Ankle Trauma & Sports

A 24-year-old soccer player sustains a high ankle sprain. On examination, he has a positive squeeze test and external rotation stress test. Which ligament is the primary restraint to anterior translation of the distal fibula relative to the tibia?

. Anterior inferior tibiofibular ligament (AITFL)
. Posterior inferior tibiofibular ligament (PITFL)
. Interosseous ligament
. Anterior talofibular ligament (ATFL)
. Calcaneofibular ligament (CFL)

Correct Answer & Explanation

. Anterior inferior tibiofibular ligament (AITFL)

Explanation

The anterior inferior tibiofibular ligament (AITFL) is the most commonly injured structure in a syndesmotic 'high ankle' sprain. It serves as the primary restraint to anterior translation and external rotation of the distal fibula.

Question 6075

Topic: 8. Foot and Ankle
A 34-year-old male sustains a Hawkins III talar neck fracture following a high-speed motor vehicle collision. Which of the following vascular supplies is definitively disrupted in this injury?
. Artery of the tarsal canal only
. Deltoid branches only
. Artery of the tarsal sinus and tarsal canal only
. Artery of the tarsal canal, tarsal sinus, and deltoid branches
. Dorsalis pedis branches only

Correct Answer & Explanation

. Artery of the tarsal canal, tarsal sinus, and deltoid branches

Explanation

A Hawkins III fracture involves a talar neck fracture with both subtalar and tibiotalar dislocations. This severe displacement disrupts all three major sources of blood supply to the talar body, carrying a near 100% risk of avascular necrosis.

Question 6076

Topic: 8. Foot and Ankle

A 24-year-old male presents with midfoot pain after a rotational injury with a planted foot. Radiographs reveal a 'fleck sign'. Between which two osseous structures is this avulsion fragment located?

. Medial cuneiform and 2nd metatarsal base
. Navicular and medial cuneiform
. Lateral cuneiform and cuboid
. 1st and 2nd metatarsal heads
. Talus and navicular

Correct Answer & Explanation

. Medial cuneiform and 2nd metatarsal base

Explanation

The 'fleck sign' represents a bony avulsion of the Lisfranc ligament. This critical interosseous ligament strictly connects the lateral aspect of the medial cuneiform to the medial base of the second metatarsal.

Question 6077

Topic: 8. Foot and Ankle
A 27-year-old snowboarder sustains a Hawkins type III talar neck fracture. What is the approximate risk of avascular necrosis (AVN) of the talar body associated with this specific injury?
. Less than 10%
. 10-25%
. 25-50%
. 75-100%
. AVN does not occur in Hawkins type III

Correct Answer & Explanation

. 75-100%

Explanation

A Hawkins type III fracture involves dislocation of the talar body from both the subtalar and tibiotalar joints. This displacement disrupts all three major blood supplies to the talus, leading to an AVN risk nearing 75-100%.

Question 6078

Topic: 8. Foot and Ankle

A 22-year-old football player sustains a midfoot injury. Radiographs show a "fleck sign" in the first intermetatarsal space. Which ligament is primarily disrupted?

. Dorsal tarsometatarsal ligament
. Plantar ligament between the 1st cuneiform and 2nd metatarsal base
. Plantar ligament between the 2nd cuneiform and 1st metatarsal base
. Interosseous ligament between the medial cuneiform and 2nd metatarsal base
. Spring ligament

Correct Answer & Explanation

. Interosseous ligament between the medial cuneiform and 2nd metatarsal base

Explanation

The "fleck sign" represents a bony avulsion of the Lisfranc ligament. This critical interosseous ligament connects the lateral aspect of the medial cuneiform to the medial base of the second metatarsal and is essential for midfoot stability.

Question 6079

Topic: Midfoot & Hindfoot
A 32-year-old male falls from a roof and sustains a Hawkins Type III talar neck fracture. Which of the following describes the specific dislocations associated with this classification?
. Dislocation of the subtalar joint only
. Dislocation of the tibiotalar joint only
. Dislocation of both the subtalar and tibiotalar joints
. Dislocation of the talonavicular joint only
. Dislocation of the subtalar, tibiotalar, and talonavicular joints

Correct Answer & Explanation

. Dislocation of both the subtalar and tibiotalar joints

Explanation

A Hawkins Type III fracture is defined as a talar neck fracture accompanied by dislocation of both the subtalar and tibiotalar joints. This injury carries a very high risk of avascular necrosis of the talar body due to extensive disruption of its blood supply.

Question 6080

Topic: 8. Foot and Ankle

A 25-year-old athlete complains of severe midfoot pain after a twisting injury. Radiographs reveal widening between the 1st and 2nd metatarsal bases, and a 'fleck sign' is noted in the intermetatarsal space. This radiographic sign represents an avulsion of a ligament from which structure?

. The medial cuneiform
. The lateral cuneiform
. The cuboid
. The base of the 2nd metatarsal
. The navicular

Correct Answer & Explanation

. The base of the 2nd metatarsal

Explanation

The Lisfranc ligament firmly connects the medial cuneiform to the base of the second metatarsal. The 'fleck sign' represents a bony avulsion of this ligament, almost exclusively from the base of the second metatarsal.

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