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8. Foot and Ankle MCQs

Practice Set 305 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 6081

Topic: 8. Foot and Ankle
A 30-year-old male falls from a height and sustains a Hawkins type III fracture of the talar neck. Which of the following best describes the disruption of blood supply associated with this specific injury pattern?
. Artery of the tarsal canal only
. Artery of the tarsal canal and deltoid branches
. Artery of the tarsal canal, deltoid branches, and dorsal pedis branches
. Peroneal artery branches
. Posterior tibial artery main trunk

Correct Answer & Explanation

. Artery of the tarsal canal, deltoid branches, and dorsal pedis branches

Explanation

A Hawkins type III fracture involves subluxation or dislocation of the subtalar, tibiotalar, and talonavicular joints. This disrupts all three major sources of blood supply to the talar body, leading to a near 100% risk of avascular necrosis.

Question 6082

Topic: 8. Foot and Ankle

A 24-year-old football player sustains a hyper-plantarflexion injury to his midfoot. Radiographs show a small avulsion fracture at the base of the second metatarsal (Fleck sign). The primary stabilizing ligament injured connects the base of the second metatarsal to which other structure?

. Medial cuneiform
. Middle cuneiform
. Lateral cuneiform
. Cuboid
. Navicular

Correct Answer & Explanation

. Medial cuneiform

Explanation

The Lisfranc ligament connects the medial cuneiform to the base of the second metatarsal. A "Fleck sign" represents an avulsion of this ligament and indicates a severe midfoot injury requiring operative stabilization.

Question 6083

Topic: 8. Foot and Ankle

A 28-year-old female sustains a traumatic knee dislocation. Following closed reduction, her foot is warm and pink, but her Ankle-Brachial Index (ABI) is 0.8. What is the most appropriate next step in management?

. Discharge with close outpatient follow-up
. Immediate above-knee amputation
. Observation with serial clinical exams
. CT angiography of the lower extremity
. Fasciotomy of the leg

Correct Answer & Explanation

. CT angiography of the lower extremity

Explanation

Knee dislocations have a high association with popliteal artery injuries. An ABI less than 0.9, even with a warm foot, warrants advanced vascular imaging like a CT angiogram to rule out an intimal tear or flow-limiting lesion.

Question 6084

Topic: 8. Foot and Ankle

A 45-year-old roofer falls 15 feet, sustaining a displaced intra-articular calcaneus fracture. Radiographs reveal a decreased Bohler's angle. What two lines are used to measure Bohler's angle on a lateral radiograph?

. Line from anterior process to highest point of posterior facet, and line from posterior facet to superior edge of the tuberosity
. Line from inferior calcaneal tuberosity to anterior process, and line to the sustentaculum tali
. Line along the medial talar dome to the calcaneal tuberosity, and line to the cuboid
. Line from the lateral malleolus to the posterior facet, and line to the anterior process
. Line from the base of the 5th metatarsal to the posterior facet, and line to the talar neck

Correct Answer & Explanation

. Line from anterior process to highest point of posterior facet, and line from posterior facet to superior edge of the tuberosity

Explanation

Bohler's angle is formed by a line drawn from the highest point of the anterior process to the highest point of the posterior facet, intersecting with a line drawn from the posterior facet to the superior edge of the calcaneal tuberosity. Normal is 20-40 degrees.

Question 6085

Topic: 8. Foot and Ankle
A 45-year-old construction worker falls and sustains a closed displaced intra-articular calcaneus fracture (Sanders Type III). He undergoes ORIF via an extensile lateral approach. Which complication is most frequently associated with this specific surgical approach?
. Sural nerve injury or wound edge necrosis
. Superficial peroneal nerve injury
. Nonunion of the posterior facet
. Tibialis anterior tendon rupture
. Tarsal tunnel syndrome

Correct Answer & Explanation

. Sural nerve injury or wound edge necrosis

Explanation

The extensile lateral approach to the calcaneus places the sural nerve at high risk of injury during flap elevation. Wound healing complications at the apex of the incision and sural nerve paresthesias are the most common morbidities associated with this approach.

Question 6086

Topic: 8. Foot and Ankle

A 26-year-old female sustains a purely ligamentous Lisfranc injury confirmed on weight-bearing radiographs. Which specific ligamentous anatomy is disrupted in a classic Lisfranc injury?

. Medial cuneiform to the base of the first metatarsal
. Medial cuneiform to the base of the second metatarsal
. Cuboid to the base of the fourth metatarsal
. Navicular to the medial cuneiform
. Intermediate cuneiform to the third metatarsal

Correct Answer & Explanation

. Medial cuneiform to the base of the second metatarsal

Explanation

The primary Lisfranc ligament is a strong, oblique interosseous ligament that connects the medial cuneiform to the base of the second metatarsal. It is the keystone stabilizer of the midfoot, and its rupture leads to significant tarsometatarsal instability.

Question 6087

Topic: 8. Foot and Ankle

A 40-year-old male weekend warrior sustains an acute midsubstance Achilles tendon rupture. He elects to undergo a percutaneous repair to minimize wound complications. The surgeon must be meticulously aware of the sural nerve trajectory during lateral suture placement. What is the typical anatomic course of the sural nerve relative to the Achilles tendon?

. It crosses the tendon from medial to lateral approximately 5 cm proximal to the calcaneal insertion
. It crosses the lateral border of the tendon from lateral to medial approximately 10-12 cm proximal to the calcaneal insertion
. It runs strictly along the medial border of the Achilles tendon down to the calcaneus
. It runs in the deep interval between the Achilles tendon and the flexor hallucis longus
. It pierces the tendon centrally at the musculotendinous junction

Correct Answer & Explanation

. It crosses the lateral border of the tendon from lateral to medial approximately 10-12 cm proximal to the calcaneal insertion

Explanation

The sural nerve courses distally in the posterior calf and crosses the lateral border of the Achilles tendon (coursing from lateral to midline/medial relative to the lateral edge) approximately 10 to 12 cm proximal to its insertion on the calcaneus. Because it sits in the subcutaneous tissues closely applied to the lateral/posterolateral aspect of the tendon, it is at high risk of entrapment or laceration during percutaneous or minimally invasive Achilles repair when passing sutures from the lateral side.

Question 6088

Topic: 8. Foot and Ankle

As the Achilles tendon descends toward its insertion on the calcaneus, how do the constituent fibers of the gastrocnemius and soleus typically rotate?

. Internally 90 degrees, such that gastrocnemius fibers insert laterally
. Externally 90 degrees, such that gastrocnemius fibers insert medially
. Internally 90 degrees, such that soleus fibers insert laterally
. Externally 90 degrees, such that soleus fibers insert laterally
. They do not rotate; gastrocnemius inserts superiorly and soleus inferiorly

Correct Answer & Explanation

. Internally 90 degrees, such that gastrocnemius fibers insert laterally

Explanation

The Achilles tendon fibers undergo a 90-degree internal rotation as they descend to the calcaneus. The superficial fibers originating from the gastrocnemius rotate to insert on the lateral aspect of the posterior calcaneal tuberosity, while the deep fibers from the soleus rotate to insert on the medial aspect.

Question 6089

Topic: 8. Foot and Ankle

An athlete sustains a syndesmotic ('high') ankle sprain. According to classic biomechanical studies, which ligament is typically the first to fail during the external rotation mechanism of injury?

. Anterior inferior tibiofibular ligament (AITFL)
. Posterior inferior tibiofibular ligament (PITFL)
. Interosseous ligament
. Deltoid ligament
. Calcaneofibular ligament

Correct Answer & Explanation

. Anterior inferior tibiofibular ligament (AITFL)

Explanation

During an external rotation injury, the fibula is externally rotated away from the tibia. The anterior inferior tibiofibular ligament (AITFL) is the most anterior structure of the syndesmosis and is placed under the greatest tension, making it the first ligament to tear in the typical sequential failure of the syndesmosis.

Question 6090

Topic: 8. Foot and Ankle

A 42-year-old male opts for non-operative management with early functional rehabilitation for an acute Achilles tendon rupture. Which of the following is the most significant advantage of this approach compared to traditional open surgical repair?

. Lower absolute rate of re-rupture
. Decreased incidence of sural nerve injury
. Increased peak plantar flexion strength
. Elimination of tendon elongation
. Prevention of deep vein thrombosis

Correct Answer & Explanation

. Decreased incidence of sural nerve injury

Explanation

Non-operative management with early functional rehab avoids surgical complications, most notably iatrogenic sural nerve injury and wound infections. Modern functional bracing protocols have achieved re-rupture rates comparable to operative intervention.

Question 6091

Topic: 8. Foot and Ankle
A 28-year-old male sustains a KD-III-M knee dislocation. He presents with a foot drop and inability to evert the foot. Electromyography (EMG) at 6 weeks shows no motor unit potentials in the tibialis anterior. What is the most appropriate management regarding the nerve injury?
. Immediate nerve exploration and grafting
. Continued observation with an AFO for 3 months
. Tendon transfer using the posterior tibial tendon
. Below-knee amputation
. Fasciotomy of the anterior compartment

Correct Answer & Explanation

. Continued observation with an AFO for 3 months

Explanation

Common peroneal nerve palsy complicates up to 25% of knee dislocations. Observation and supportive care with an AFO are indicated initially, as spontaneous recovery can occur within 3 to 6 months before considering nerve exploration or tendon transfers.

Question 6092

Topic: 8. Foot and Ankle

A 22-year-old football player sustains a syndesmotic ankle sprain. Intraoperative evaluation using the Cotton test indicates instability. The surgeon opts for suture button fixation over syndesmotic screws. What is the primary biomechanical advantage of dynamic suture button fixation?

. Rigid immobilization of the distal tibiofibular joint
. Prevention of early weight-bearing
. Maintenance of physiologic tibiofibular micro-motion during dorsiflexion
. Increased risk of hardware failure requiring removal
. Compression of the medial clear space only

Correct Answer & Explanation

. Maintenance of physiologic tibiofibular micro-motion during dorsiflexion

Explanation

Suture button fixation allows for dynamic stabilization, preserving the normal physiologic widening and micro-motion of the distal tibiofibular syndesmosis during ankle dorsiflexion. It also reduces the need for routine hardware removal.

Question 6093

Topic: 8. Foot and Ankle

The spring ligament complex is a critical static stabilizer of the longitudinal arch of the foot. Which of the following accurately describes its primary origin and insertion?

. Calcaneal tuberosity to the base of the first metatarsal
. Sustentaculum tali to the navicular
. Medial malleolus to the sustentaculum tali
. Navicular tuberosity to the medial cuneiform
. Talus to the navicular tuberosity

Correct Answer & Explanation

. Sustentaculum tali to the navicular

Explanation

The spring ligament (plantar calcaneonavicular ligament) originates on the sustentaculum tali of the calcaneus and inserts on the plantar and medial aspect of the navicular. It forms a 'sling' for the talar head and is a crucial static stabilizer of the medial longitudinal arch, frequently injured or attenuated in adult-acquired flatfoot deformity.

Question 6094

Topic: 8. Foot and Ankle

Which structure provides the greatest resistance to distal tibiofibular diastasis and is considered the primary stabilizer of the ankle syndesmosis?

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

Correct Answer & Explanation

. Posterior inferior tibiofibular ligament (PITFL)

Explanation

The posterior inferior tibiofibular ligament (PITFL) is the strongest ligament of the syndesmosis and provides the greatest resistance (approximately 42%) to tibiofibular diastasis. The AITFL contributes about 35%, and the interosseous ligament contributes about 22%.

Question 6095

Topic: 8. Foot and Ankle

In an unstable syndesmotic injury of the ankle, the ligamentous complex is disrupted. Biomechanical studies indicate that one specific ligament provides the greatest percentage of resistance to fibular diastasis. Which ligament is this?

. Anterior inferior tibiofibular ligament (AITFL)
. Posterior inferior tibiofibular ligament (PITFL)
. Interosseous ligament
. Inferior transverse ligament
. Deltoid ligament

Correct Answer & Explanation

. Posterior inferior tibiofibular ligament (PITFL)

Explanation

The posterior inferior tibiofibular ligament (PITFL) is the strongest component of the syndesmosis, providing approximately 42% of the resistance to diastasis. The AITFL provides about 35%, and the interosseous ligament provides about 22%.

Question 6096

Topic: 8. Foot and Ankle

The primary blood supply to the body of the talus is derived from the artery of the tarsal canal. This artery is typically a direct branch of which major vessel?

. Anterior tibial artery
. Dorsalis pedis artery
. Posterior tibial artery
. Peroneal artery
. Sural artery

Correct Answer & Explanation

. Posterior tibial artery

Explanation

The artery of the tarsal canal provides the majority of the blood supply to the talar body. It typically arises from the posterior tibial artery about 1-2 cm proximal to its bifurcation into the medial and lateral plantar arteries. It forms an anastomotic sling with the artery of the sinus tarsi.

Question 6097

Topic: 8. Foot and Ankle

From anteromedial to posterolateral, what is the correct anatomical order of structures passing through the tarsal tunnel beneath the flexor retinaculum?

. Tibialis posterior, Flexor digitorum longus, Posterior tibial artery, Tibial nerve, Flexor hallucis longus
. Tibialis posterior, Flexor hallucis longus, Posterior tibial artery, Tibial nerve, Flexor digitorum longus
. Flexor digitorum longus, Tibialis posterior, Posterior tibial artery, Tibial nerve, Flexor hallucis longus
. Tibialis posterior, Flexor digitorum longus, Tibial nerve, Posterior tibial artery, Flexor hallucis longus
. Flexor hallucis longus, Posterior tibial artery, Tibial nerve, Flexor digitorum longus, Tibialis posterior

Correct Answer & Explanation

. Tibialis posterior, Flexor digitorum longus, Posterior tibial artery, Tibial nerve, Flexor hallucis longus

Explanation

The well-known mnemonic 'Tom, Dick, AND Very Nervous Harry' corresponds to the order of structures from anteromedial to posterolateral behind the medial malleolus: Tibialis posterior, flexor Digitorum longus, Artery (posterior tibial), Vein, Nerve (tibial), and flexor Hallucis longus.

Question 6098

Topic: 8. Foot and Ankle

The Achilles tendon features a relative avascular 'watershed' zone that is particularly prone to tendinopathy and rupture. Where is this zone typically located in relation to its insertion on the calcaneus?

. 0 to 1 cm proximal
. 2 to 6 cm proximal
. 8 to 10 cm proximal
. At the musculotendinous junction
. Directly at the calcaneal enthesis

Correct Answer & Explanation

. 2 to 6 cm proximal

Explanation

The watershed area of the Achilles tendon is a region of relative hypovascularity located approximately 2 to 6 cm proximal to its insertion on the calcaneal tuberosity. This zone is supplied by a tenuous network from the peroneal and posterior tibial arteries, predisposing it to degeneration and rupture.

Question 6099

Topic: 8. Foot and Ankle

The lateral compartment of the lower leg contains muscles primarily responsible for foot eversion. Which major nerve courses directly through this compartment?

. Deep peroneal nerve
. Superficial peroneal nerve
. Sural nerve
. Tibial nerve
. Saphenous nerve

Correct Answer & Explanation

. Superficial peroneal nerve

Explanation

The lateral compartment of the leg contains the peroneus longus and peroneus brevis muscles, and the superficial peroneal nerve. The deep peroneal nerve is located in the anterior compartment, while the tibial nerve resides in the posterior compartment.

Question 6100

Topic: 8. Foot and Ankle

During a minimally invasive percutaneous repair of a ruptured Achilles tendon, the sural nerve is at risk of iatrogenic injury. At the level of the lateral malleolus, what is the typical anatomical location of the sural nerve relative to the Achilles tendon?

. 1.5 cm medial to the medial border
. 1.5 cm lateral to the lateral border
. Directly anterior to the tendon
. 3.0 cm lateral to the lateral border
. Directly posterior to the tendon

Correct Answer & Explanation

. 1.5 cm lateral to the lateral border

Explanation

The sural nerve generally crosses the lateral border of the Achilles tendon approximately 10 cm proximal to its insertion. At the level of the lateral malleolus, it lies approximately 1 to 1.5 cm lateral to the tendon's lateral border.

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