Menu

8. Foot and Ankle MCQs

Practice Set 322 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 6421

Topic: 8. Foot and Ankle

A 13-year-old boy presents with a painful, rigid flatfoot and a history of recurrent ankle sprains. Lateral radiographs of the foot demonstrate a continuous bony outline connecting the talar dome and the sustentaculum tali (the 'C-sign'). What is the most likely diagnosis, and which anatomical structure is primarily involved?

. Calcaneonavicular coalition; anterior process of the calcaneus
. Talocalcaneal coalition; middle facet of the subtalar joint
. Talocalcaneal coalition; posterior facet of the subtalar joint
. Naviculocuneiform coalition; medial cuneiform
. Accessory navicular syndrome; posterior tibial tendon insertion

Correct Answer & Explanation

. Talocalcaneal coalition; middle facet of the subtalar joint

Explanation

The 'C-sign' on a lateral foot radiograph is indicative of a talocalcaneal coalition. This coalition most commonly involves the middle facet of the subtalar joint.

Question 6422

Topic: 8. Foot and Ankle

A 'Fleck sign' on an AP radiograph of the foot is highly suggestive of a Lisfranc injury. This sign represents an avulsion fracture of the Lisfranc ligament from the base of which bone?

. Medial cuneiform
. Middle cuneiform
. Lateral cuneiform
. First metatarsal
. Second metatarsal

Correct Answer & Explanation

. Second metatarsal

Explanation

The Lisfranc ligament connects the lateral aspect of the medial cuneiform to the medial base of the second metatarsal. A 'Fleck sign' represents a bony avulsion of this ligament, usually from the medial base of the second metatarsal, strongly indicating a subtle or severe Lisfranc joint disruption.

Question 6423

Topic: 8. Foot and Ankle

Acute ruptures of the Achilles tendon most commonly occur in a specific 'watershed' region of decreased vascularity. Where is this region located relative to the calcaneal insertion?

. At the musculotendinous junction
. 0 to 2 cm proximal to the insertion
. 2 to 6 cm proximal to the insertion
. 8 to 10 cm proximal to the insertion
. At the calcaneal insertion itself

Correct Answer & Explanation

. 2 to 6 cm proximal to the insertion

Explanation

The Achilles tendon has a relative hypovascular zone located approximately 2 to 6 cm proximal to its insertion on the calcaneus. This watershed area is the most frequent site for degenerative changes and subsequent acute ruptures.

Question 6424

Topic: Midfoot & Hindfoot
A 55-year-old diabetic male presents with a swollen, erythematous, painless foot. Radiographs demonstrate severe osteochondral fragmentation, subluxation, and intra-articular bony debris. What stage of Charcot arthropathy does this represent?
. Eichenholtz Stage 0
. Eichenholtz Stage I
. Eichenholtz Stage II
. Eichenholtz Stage III
. Eichenholtz Stage IV

Correct Answer & Explanation

. Eichenholtz Stage I

Explanation

Eichenholtz Stage I (Fragmentation/Development) is characterized by acute inflammation, joint debris, subluxation, and fragmentation on radiographs. Stage II represents coalescence, and Stage III represents consolidation/reconstruction.

Question 6425

Topic: 8. Foot and Ankle

A 60-year-old patient with long-standing poorly controlled diabetes presents with a red, hot, and severely swollen foot. Radiographs demonstrate no acute fracture or periosteal reaction. What is the most reliable, rapid bedside clinical maneuver to differentiate acute Charcot arthropathy from a deep infection?

. Immediate measurement of WBC count and CRP
. Aspiration of the tibiotalar joint
. Elevation of the extremity above heart level for 10-15 minutes
. Administration of a single dose of intravenous antibiotics
. Palpation of pedal pulses and ABI measurement

Correct Answer & Explanation

. Elevation of the extremity above heart level for 10-15 minutes

Explanation

Elevation of the leg for 10-15 minutes will typically resolve the erythema and swelling associated with the hyperemic phase of acute Charcot arthropathy. In contrast, the redness associated with an active infection (cellulitis/osteomyelitis) will persist.

Question 6426

Topic: 8. Foot and Ankle

During a posterior approach to the hip (Kocher-Langenbeck), the surgeon identifies and protects the sciatic nerve. Which portion of the sciatic nerve is most vulnerable to iatrogenic injury during retractor placement in this approach, and what specific deficit would result?

. Tibial division; inability to plantarflex the ankle
. Tibial division; loss of sensation over the medial sole of the foot
. Peroneal division; inability to dorsiflex the ankle
. Peroneal division; loss of sensation over the lateral heel
. Femoral division; inability to extend the knee

Correct Answer & Explanation

. Peroneal division; inability to dorsiflex the ankle

Explanation

The common peroneal division of the sciatic nerve is located more laterally and its fibers are tethered and more superficial, making it more susceptible to compression or traction injuries during a posterior hip approach. Injury leads to foot drop (inability to dorsiflex the ankle).

Question 6427

Topic: 8. Foot and Ankle

A 58-year-old male with poorly controlled diabetes mellitus presents with a swollen, erythematous, and warm right foot without open ulcerations. Radiographs show periarticular osteopenia, early bone fragmentation, and subluxation of the tarsometatarsal joints. According to the Eichenholtz classification of Charcot arthropathy, what is the most appropriate initial management?

. Intravenous antibiotics and emergent surgical debridement
. Total contact casting and strict non-weight-bearing
. Primary arthrodesis of the midfoot
. Custom orthotic shoe wear and weight-bearing as tolerated
. Excision of the affected metatarsal bases

Correct Answer & Explanation

. Total contact casting and strict non-weight-bearing

Explanation

The patient is in Eichenholtz Stage I (Developmental/Fragmentation) of Charcot arthropathy, characterized by erythema, swelling, warmth, and radiographic evidence of osteopenia, fragmentation, and subluxation. The gold standard treatment in the acute (Stage I) phase is immobilization in a total contact cast (TCC) and strict non-weight-bearing to prevent further deformity until the acute inflammatory phase resolves and the foot enters Stage II (Coalescence).

Question 6428

Topic: 8. Foot and Ankle

A 22-year-old athlete 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. An avulsion fracture (Fleck sign) is noted. The primary ligament injured in this classic Lisfranc injury connects which two osseous structures?

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

Correct Answer & Explanation

. Medial cuneiform to the base of the second metatarsal

Explanation

The Lisfranc ligament is a strong interosseous ligament that connects the lateral aspect of the medial cuneiform to the medial aspect of the base of the second metatarsal. It is critical for the stability of the midfoot arch. Disruption leads to diastasis between the first and second rays. The 'Fleck sign' represents a bony avulsion of this ligament from the base of the second metatarsal.

Question 6429

Topic: 8. Foot and Ankle
A 55-year-old diabetic patient presents with a red, hot, swollen foot. Radiographs show periarticular osteopenia, debris, and fragmentation of the midfoot without frank dislocation. According to the Eichenholtz classification, what is the most appropriate initial management?
. Intravenous antibiotics and emergent surgical debridement
. Total contact casting and non-weight bearing
. Open reduction and internal fixation of the midfoot
. Midfoot arthrodesis with autogenous bone grafting
. Custom orthotic shoe wear with rigid sole

Correct Answer & Explanation

. Total contact casting and non-weight bearing

Explanation

The patient is in Eichenholtz Stage I (Development/Fragmentation) of Charcot arthropathy, characterized by a red, hot, swollen foot, joint laxity, subluxation, and radiographic fragmentation. The standard of care for acute Stage I Charcot is immobilization and offloading, typically using a total contact cast (TCC), until the foot progresses through Stage II (Coalescence) to Stage III (Consolidation).

Question 6430

Topic: 8. Foot and Ankle

The Lisfranc ligament is a critical stabilizing structure of the midfoot. Which of the following best describes its exact anatomical attachments?

. From the plantar aspect of the medial cuneiform to the plantar base of the second metatarsal
. From the dorsal aspect of the medial cuneiform to the dorsal base of the second metatarsal
. From the plantar aspect of the intermediate cuneiform to the plantar base of the second metatarsal
. From the plantar aspect of the medial cuneiform to the plantar base of the third metatarsal
. From the base of the first metatarsal to the base of the second metatarsal

Correct Answer & Explanation

. From the plantar aspect of the medial cuneiform to the plantar base of the second metatarsal

Explanation

The Lisfranc ligament is a strong interosseous ligament that runs from the lateral aspect of the medial cuneiform to the medial aspect of the base of the second metatarsal, specifically located on the plantar aspect. There is no direct ligamentous connection between the base of the first and second metatarsals, making the Lisfranc ligament crucial for stabilizing the second metatarsal in its keystone position.

Question 6431

Topic: 8. Foot and Ankle
According to the Lauge-Hansen classification, a pronation-abduction (PAB) injury to the ankle predictably follows a specific sequence. What is the first stage of this injury pattern?
. Rupture of the anterior inferior tibiofibular ligament
. Transverse fracture of the medial malleolus or rupture of the deltoid ligament
. Oblique fracture of the fibula at the level of the syndesmosis
. Transverse fracture of the lateral malleolus
. Rupture of the posterior inferior tibiofibular ligament

Correct Answer & Explanation

. Transverse fracture of the medial malleolus or rupture of the deltoid ligament

Explanation

In the pronation-abduction (PAB) mechanism, the foot is pronated, tensing the medial structures first. The first stage (PAB I) is a transverse fracture of the medial malleolus or rupture of the deltoid ligament. Stage II involves the syndesmotic ligaments, and Stage III is an oblique or bending fracture of the fibula at or above the level of the syndesmosis.

Question 6432

Topic: Midfoot & Hindfoot
A 55-year-old patient with long-standing diabetes mellitus presents with a red, hot, swollen foot. Radiographs reveal periarticular fragmentation, subluxation, and bony debris at the midfoot without frank osteomyelitis. According to the Eichenholtz classification of Charcot arthropathy, what is the appropriate stage and most appropriate initial treatment?
. Stage 0; Intravenous antibiotics
. Stage I; Total contact casting and non-weight bearing
. Stage II; Custom orthotic shoe wear
. Stage III; Arthrodesis of the midfoot
. Stage I; Immediate surgical debridement and internal fixation

Correct Answer & Explanation

. Stage I; Total contact casting and non-weight bearing

Explanation

The patient is in Eichenholtz Stage I (Development/Fragmentation stage), characterized by erythema, swelling, bony debris, fragmentation, and subluxation. The mainstay of initial treatment is strict immobilization and offloading, typically achieved with a total contact cast, until the acute inflammatory phase resolves and coalescence (Stage II) begins.

Question 6433

Topic: 8. Foot and Ankle
A 28-year-old male sustains a Hawkins type III talar neck fracture following a high-energy motor vehicle collision. Which of the following vascular structures is most likely injured, significantly contributing to the risk of avascular necrosis (AVN) in this fracture type?
. Artery of the tarsal canal
. Dorsalis pedis artery
. Artery of the tarsal sinus
. Peroneal artery
. Lateral plantar artery

Correct Answer & Explanation

. Artery of the tarsal canal

Explanation

The artery of the tarsal canal (a branch of the posterior tibial artery) is the dominant blood supply to the talar body. In a Hawkins III fracture (talar neck fracture with subluxation/dislocation of both the subtalar and tibiotalar joints), the major blood supplies (tarsal canal, tarsal sinus, and dorsal talar neck vessels) are frequently disrupted, leading to a high rate of AVN.

Question 6434

Topic: 8. Foot and Ankle
During the healing process of a ruptured Achilles tendon, at what time point does the proliferation phase typically peak, characterized by maximum type III collagen synthesis?
. 1 to 3 days
. 7 to 14 days
. 3 to 4 weeks
. 6 to 8 weeks
. 12 to 16 weeks

Correct Answer & Explanation

. 3 to 4 weeks

Explanation

The proliferation phase of tendon healing typically peaks around 3 to 4 weeks post-injury. During this time, fibroblasts aggressively synthesize Type III collagen, which is later replaced by stronger Type I collagen during the remodeling phase.

Question 6435

Topic: 8. Foot and Ankle

A 45-year-old female is prescribed an antibiotic for a urinary tract infection. Two weeks later, she sustains an acute, spontaneous Achilles tendon rupture while walking up a flight of stairs. Which of the following classes of antibiotics did she most likely receive, and what is its primary mechanism of inducing tendinopathy?

. Aminoglycosides; inhibition of 30S ribosomal subunit
. Cephalosporins; inhibition of peptidoglycan cross-linking
. Tetracyclines; chelation of intracellular calcium
. Fluoroquinolones; upregulation of matrix metalloproteinases (MMPs)
. Macrolides; inhibition of 50S ribosomal subunit

Correct Answer & Explanation

. Fluoroquinolones; upregulation of matrix metalloproteinases (MMPs)

Explanation

Fluoroquinolones (such as ciprofloxacin or levofloxacin) carry a black box warning for tendinopathy and spontaneous tendon rupture, most commonly affecting the Achilles tendon. The pathophysiological mechanism involves the upregulation of matrix metalloproteinases (MMPs), which leads to excessive degradation of Type I collagen, alongside a direct cytotoxic effect on tenocytes and decreased synthesis of new collagen.

Question 6436

Topic: 8. Foot and Ankle

A 24-year-old football player sustains an axial load to a plantarflexed foot. Weight-bearing radiographs show widening of the interval between the first and second metatarsal bases. A "fleck sign" is noted. This osseous avulsion typically originates from which of the following structures?

. Medial cuneiform
. Base of the second metatarsal
. Intermediate cuneiform
. Lateral aspect of the first metatarsal
. Navicular

Correct Answer & Explanation

. Base of the second metatarsal

Explanation

The Lisfranc ligament is a stout interosseous ligament connecting the lateral aspect of the medial cuneiform to the medial aspect of the base of the second metatarsal. The "fleck sign" represents a bony avulsion of this ligament, which most commonly avulses from the base of the second metatarsal into the intermetatarsal space.

Question 6437

Topic: Midfoot & Hindfoot
A 58-year-old poorly controlled diabetic patient presents with a red, hot, swollen foot without systemic signs of infection. Radiographs reveal prominent periarticular fragmentation, joint subluxation, and bony debris at the midfoot. According to the Eichenholtz classification of Charcot arthropathy, this patient is in which stage?
. Stage 0
. Stage I
. Stage II
. Stage III
. Stage IV

Correct Answer & Explanation

. Stage I

Explanation

Eichenholtz Stage I (Development/Fragmentation) is characterized clinically by a red, hot, swollen foot and radiographically by osteopenia, joint subluxation, bony fragmentation, and debris. Stage II (Coalescence) shows decreased swelling and radiographic absorption of debris. Stage III (Reconstruction) shows consolidated remodeling. Stage 0 features erythema/swelling but normal radiographs.

Question 6438

Topic: Midfoot & Hindfoot
In the Eichenholtz classification of Charcot arthropathy, which stage is characterized clinically by a warm, swollen, erythematous foot, and radiographically by periarticular fragmentation, debris, and subluxation?
. Stage 0
. Stage I (Development/Fragmentation)
. Stage II (Coalescence)
. Stage III (Reconstruction)
. Stage IV (Ulceration)

Correct Answer & Explanation

. Stage I (Development/Fragmentation)

Explanation

Eichenholtz Stage I is the developmental or fragmentation phase, marked by acute inflammation and radiographic evidence of bone debris, fragmentation, and joint subluxation. Stage II involves coalescence, while Stage III represents reconstruction and consolidation.

Question 6439

Topic: 8. Foot and Ankle

A 40-year-old weekend warrior presents with acute heel pain and weakness in plantarflexion after playing basketball. The Thompson test is positive. Which of the following describes the most common location of this pathology?

. Avulsion from the calcaneal tuberosity
. 2-6 cm proximal to the calcaneal insertion
. At the musculotendinous junction
. Mid-substance of the gastrocnemius muscle
. Within the paratenon isolated from the tendon

Correct Answer & Explanation

. 2-6 cm proximal to the calcaneal insertion

Explanation

Achilles tendon ruptures most commonly occur in the watershed area, which is located 2 to 6 cm proximal to the calcaneal insertion. This region has a relatively precarious blood supply, making it susceptible to degeneration and rupture.

Question 6440

Topic: 8. Foot and Ankle

A 22-year-old football player presents with midfoot pain after his foot was axially loaded while plantarflexed. Weight-bearing radiographs show widening of the interval between the first and second metatarsal bases. The Lisfranc ligament connects which two osseous structures?

. First metatarsal base to the second metatarsal base
. Medial cuneiform to the second metatarsal base
. Medial cuneiform to the first metatarsal base
. Middle cuneiform to the second metatarsal base
. Navicular to the medial cuneiform

Correct Answer & Explanation

. Medial cuneiform to the second metatarsal base

Explanation

The Lisfranc ligament is an interosseous ligament that connects the lateral aspect of the medial cuneiform to the medial aspect of the base of the second metatarsal. It provides critical stability to the midfoot arch.

Test Yourself

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

On this Page