Menu

8. Foot and Ankle MCQs

Practice Set 329 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 6561

Topic: 8. Foot and Ankle

The Achilles tendon is highly susceptible to spontaneous rupture, frequently occurring at a 'watershed' area of relatively poor vascularity. Where is this critical hypovascular zone located anatomically?

. Exactly at its tendinous insertion onto the calcaneal tuberosity
. Approximately 2 to 6 cm proximal to the calcaneal insertion
. At the musculotendinous junction of the gastrocnemius
. Approximately 8 to 12 cm proximal to the calcaneal insertion
. Deep within the paratenon enveloping the soleus muscle fibers

Correct Answer & Explanation

. Approximately 2 to 6 cm proximal to the calcaneal insertion

Explanation

The Achilles tendon receives its blood supply from three main sources: the musculotendinous junction proximally, the osseous insertion distally, and the surrounding paratenon. A recognized 'watershed' zone of hypovascularity exists approximately 2 to 6 cm proximal to its insertion on the calcaneus. This zone correlates strongly with the area of most significant tendon degeneration and is the most frequent anatomical site for spontaneous acute Achilles tendon ruptures.

Question 6562

Topic: 8. Foot and Ankle

The primary stabilizing structure of the second tarsometatarsal joint complex is the Lisfranc ligament. Which of the following best describes the precise anatomic attachments of the Lisfranc ligament?

. Originates on the medial cuneiform and inserts on the base of the second metatarsal
. Originates on the intermediate cuneiform and inserts on the base of the second metatarsal
. Originates on the medial cuneiform and inserts on the base of the first metatarsal
. Originates on the intermediate cuneiform and inserts on the base of the first metatarsal
. Originates on the lateral cuneiform and inserts on the base of the third metatarsal

Correct Answer & Explanation

. Originates on the medial cuneiform and inserts on the base of the second metatarsal

Explanation

The Lisfranc ligament is an oblique, stout intra-articular ligament that provides the primary dorsal-plantar and transverse stability to the midfoot. It originates from the lateral aspect of the medial cuneiform and inserts onto the medial aspect of the base of the second metatarsal. Notably, there is no direct ligamentous connection between the first and second metatarsal bases.

Question 6563

Topic: 8. Foot and Ankle

A 30-year-old male sustains a hyperplantarflexion injury to his foot resulting in midfoot swelling and pain. Radiographs demonstrate a 'fleck sign' at the base of the second metatarsal. The primary ligament injured in this condition connects which two bony structures?

. Medial cuneiform to the base of the 1st metatarsal
. Medial cuneiform to the base of the 2nd metatarsal
. Intermediate cuneiform to the base of the 2nd metatarsal
. Lateral cuneiform to the cuboid
. Cuboid to the base of the 4th metatarsal

Correct Answer & Explanation

. Medial cuneiform to the base of the 2nd metatarsal

Explanation

The Lisfranc ligament is an intra-articular ligament that connects the lateral aspect of the medial cuneiform to the medial aspect of the base of the 2nd metatarsal. It is critical for the stability of the tarsometatarsal (Lisfranc) joint. The 'fleck sign' is an avulsion fracture at the attachment of this ligament.

Question 6564

Topic: Midfoot & Hindfoot

A 55-year-old female presents with medial foot pain and a progressive flatfoot deformity. Examination reveals a flexible hindfoot valgus, a 'too-many-toes' sign, and inability to perform a single-limb heel rise. Weight-bearing radiographs show 40% talonavicular uncovering. According to the Johnson and Strom classification modified by Myerson, which of the following surgical interventions is most appropriate for this stage IIb deformity?

. Medial displacement calcaneal osteotomy (MDCO) and flexor digitorum longus (FDL) transfer alone
. Lateral column lengthening (Evans osteotomy), MDCO, and FDL transfer
. Triple arthrodesis
. Talonavicular arthrodesis alone
. Gastrocnemius recession alone

Correct Answer & Explanation

. Lateral column lengthening (Evans osteotomy), MDCO, and FDL transfer

Explanation

The patient has a Stage IIb posterior tibial tendon dysfunction (PTTD), characterized by a flexible deformity with significant forefoot abduction (>30% talonavicular uncovering). Stage IIa is treated with FDL transfer and MDCO. Stage IIb requires the addition of a lateral column lengthening (such as an Evans osteotomy) to correct the severe forefoot abduction.

Question 6565

Topic: 8. Foot and Ankle

In the evaluation of a suspected Lisfranc injury, which of the following ligamentous connections defines the primary component of the Lisfranc ligament complex?

. First metatarsal base to the second metatarsal base
. Medial cuneiform to the base of the second metatarsal
. Middle cuneiform to the base of the second metatarsal
. Lateral cuneiform to the base of the third metatarsal
. Cuboid to the base of the fourth metatarsal

Correct Answer & Explanation

. Medial cuneiform to the base of the second metatarsal

Explanation

The Lisfranc ligament complex connects the medial cuneiform to the base of the second metatarsal. There is no direct transverse ligamentous connection between the bases of the first and second metatarsals, making this interval mechanically vulnerable.

Question 6566

Topic: 8. Foot and Ankle

The Lisfranc ligament connects which two osseous structures in the foot?

. 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
. Lateral cuneiform to the base of the third metatarsal
. Navicular to the medial cuneiform

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 base of the second metatarsal. Its disruption is a hallmark of a Lisfranc fracture-dislocation.

Question 6567

Topic: 8. Foot and Ankle

During a minimally invasive (percutaneous) repair of an acute Achilles tendon rupture using a standard jig, which neurological structure is at greatest risk of iatrogenic injury?

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

Correct Answer & Explanation

. Sural nerve

Explanation

The sural nerve crosses from medial to lateral along the posterior calf and lies in close proximity to the lateral border of the Achilles tendon in the distal third of the leg. It is at significant risk of entrapment or laceration during percutaneous Achilles tendon repairs, particularly when placing sutures in the proximal lateral tendon stump.

Question 6568

Topic: Midfoot & Hindfoot
A patient with diabetes mellitus and peripheral neuropathy presents with a warm, swollen, and erythematous foot. Radiographs reveal absorption of fine bone debris, early sclerosis, and fusion of the tarsometatarsal joints. According to the Eichenholtz classification of Charcot arthropathy, this represents which stage?
. Stage 0 (Prodromal)
. Stage I (Developmental/Fragmentation)
. Stage II (Coalescence)
. Stage III (Reconstruction/Consolidation)
. Stage IV (Chronic ulceration)

Correct Answer & Explanation

. Stage II (Coalescence)

Explanation

The Eichenholtz classification describes the natural history of Charcot arthropathy. Stage II (Coalescence) is characterized by decreased warmth/swelling clinically, and radiographically by the absorption of fine intra-articular debris, early sclerosis, and fusion of large fragments. Stage I (Fragmentation) shows active debris formation, subluxation, and fracture. Stage III (Consolidation) shows mature bony remodeling, rounded bone ends, and stable deformity.

Question 6569

Topic: Midfoot & Hindfoot

A diabetic patient presents with a swollen, erythematous foot and a rocker-bottom deformity. Radiographs show bone fragmentation, periarticular debris, and joint subluxation. What Eichenholtz stage of Charcot arthropathy does this represent?

. Stage 0 (Inflammatory)
. Stage 1 (Developmental/Fragmentation)
. Stage 2 (Coalescence)
. Stage 3 (Reconstruction/Consolidation)
. Stage 4 (Resolution)

Correct Answer & Explanation

. Stage 1 (Developmental/Fragmentation)

Explanation

Eichenholtz Stage 1 (Developmental/Fragmentation) is characterized by acute inflammation, osteopenia, bone fragmentation, and joint subluxation. Stage 2 involves coalescence of fragments, while Stage 3 is the consolidation and remodeling phase.

Question 6570

Topic: Midfoot & Hindfoot

A 55-year-old diabetic patient presents with a swollen, erythematous, and warm foot without systemic signs of infection. Radiographs show periarticular debris, fragmentation, and subluxation of the midfoot. According to the Eichenholtz classification, what is the most appropriate initial management for this stage?

. Immediate open reduction and internal fixation
. Total contact casting and non-weight bearing
. Below-knee amputation
. Intravenous antibiotics
. Custom orthotic shoe wear only

Correct Answer & Explanation

. Total contact casting and non-weight bearing

Explanation

The patient is in Eichenholtz Stage I (Developmental/Fragmentation) of Charcot arthropathy. The standard of care is immediate immobilization with a total contact cast and strict non-weight bearing to prevent further deformity until the acute inflammatory phase resolves.

Question 6571

Topic: 8. Foot and Ankle

In the setting of a suspected midfoot crush injury, a radiographic 'fleck sign' pathognomonically represents an avulsion fracture at the attachment of the Lisfranc ligament. Which of the following accurately describes the anatomical connections of the intact Lisfranc ligament?

. Medial cuneiform to the base of the first metatarsal
. Medial cuneiform to the base of the second metatarsal
. Intermediate cuneiform to the base of the second metatarsal
. Lateral cuneiform to the cuboid
. Cuboid to the base of the fourth metatarsal

Correct Answer & Explanation

. Medial cuneiform to the base of the second metatarsal

Explanation

The Lisfranc ligament is an intra-articular interosseous ligament that travels obliquely from the lateral aspect of the medial cuneiform to the medial base of the second metatarsal. There is no direct ligamentous connection between the bases of the first and second metatarsals.

Question 6572

Topic: 8. Foot and Ankle

During the radiographic evaluation of a suspected Lisfranc injury, the pathognomonic "fleck sign" represents an avulsion of the Lisfranc ligament from which specific osseous structure?

. Medial cuneiform
. Base of the second metatarsal
. Lateral cuneiform
. Base of the first metatarsal
. Cuboid

Correct Answer & Explanation

. Base of the second metatarsal

Explanation

The Lisfranc ligament uniquely connects the medial cuneiform to the base of the second metatarsal. The "fleck sign" is a small bony avulsion fragment seen in the interspace between the first and second metatarsal bases, typically avulsed from the second metatarsal base.

Question 6573

Topic: 8. Foot and Ankle
A 58-year-old diabetic patient presents with a warm, swollen, and erythematous foot without an open ulceration. Radiographs reveal joint subluxation, debris, and fragmentation of the midfoot. According to the Eichenholtz classification, what is the current stage and most appropriate initial management?
. Stage 0; Intravenous antibiotics and I&D
. Stage I; Total contact casting and non-weight bearing
. Stage II; Custom orthotic shoe wear
. Stage III; Arthrodesis of the midfoot
. Stage I; Immediate midfoot amputation

Correct Answer & Explanation

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

Explanation

The patient is in Stage I (Developmental/Fragmentation) of Charcot arthropathy, characterized by a warm, swollen foot with bony fragmentation and debris. The gold standard for initial management is strict immobilization and offloading, typically utilizing a total contact cast.

Question 6574

Topic: Midfoot & Hindfoot
A 55-year-old patient with long-standing diabetes presents with a swollen, erythematous, and warm foot. Radiographs show periarticular fragmentation, debris, and subluxation at the tarsometatarsal joints. According to the Eichenholtz classification, what stage is this Charcot arthropathy?
. 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 bone fragmentation, joint debris, subluxation/dislocation, and loss of joint space. Stage 0 is characterized by clinical warmth/swelling with normal radiographs. Stage II is coalescence, and Stage III is consolidation/remodeling.

Question 6575

Topic: Midfoot & Hindfoot
A 55-year-old female presents with medial foot pain and inability to perform a single-leg heel rise. Examination shows a flexible hindfoot valgus and forefoot abduction. AP radiographs show 40% uncoverage of the talonavicular joint head. Which of the following surgical interventions is most appropriate for this stage IIb adult-acquired flatfoot deformity?
. Triple arthrodesis
. Talonavicular arthrodesis alone
. Flexor digitorum longus (FDL) transfer and medial displacement calcaneal osteotomy (MDCO)
. FDL transfer, MDCO, and lateral column lengthening
. Subtalar arthrodesis

Correct Answer & Explanation

. FDL transfer, MDCO, and lateral column lengthening

Explanation

The patient has a Stage IIb adult-acquired flatfoot deformity (tibialis posterior tendon dysfunction). Stage II indicates a flexible deformity. Stage IIb specifically denotes significant forefoot abduction (typically >30% talonavicular uncoverage). Treatment requires a soft tissue reconstruction (FDL transfer), correction of hindfoot valgus (MDCO), and correction of forefoot abduction (lateral column lengthening, such as an Evans osteotomy). A triple arthrodesis is reserved for Stage III (rigid) deformity.

Question 6576

Topic: Forefoot

A 45-year-old female presents with a painful bunion. Weight-bearing radiographs reveal a hallux valgus angle (HVA) of 38 degrees and an intermetatarsal angle (IMA) of 18 degrees. Clinical examination reveals hypermobility of the first tarsometatarsal (TMT) joint. What is the most appropriate surgical management?

. Distal chevron osteotomy
. Proximal crescentic osteotomy
. First metatarsophalangeal (MTP) arthrodesis
. First tarsometatarsal (TMT) arthrodesis (Lapidus procedure)
. Akin osteotomy

Correct Answer & Explanation

. First tarsometatarsal (TMT) arthrodesis (Lapidus procedure)

Explanation

The Lapidus procedure (arthrodesis of the 1st TMT joint) is indicated for moderate to severe hallux valgus (IMA > 15 degrees) associated with first ray hypermobility. A distal chevron is inadequate for an IMA of 18 degrees. While a proximal osteotomy can correct a large IMA, it does not address the TMT hypermobility, leading to a high recurrence rate. First MTP arthrodesis is typically reserved for severe deformity with osteoarthritis or rheumatoid arthritis.

Question 6577

Topic: 8. Foot and Ankle

A 30-year-old female sustains a midfoot crush injury. Radiographs show widening of the space between the bases of the 1st and 2nd metatarsals, with a small bony avulsion fragment in this interval ("fleck sign"). The torn ligament responsible for this finding typically connects which two structures?

. Base of 1st metatarsal to base of 2nd metatarsal
. Medial cuneiform to the base of the 2nd metatarsal
. Middle cuneiform to the base of the 2nd metatarsal
. Medial cuneiform to the base of the 1st metatarsal
. Navicular to the medial cuneiform

Correct Answer & Explanation

. Medial cuneiform to the base of the 2nd metatarsal

Explanation

The primary Lisfranc ligament connects the lateral aspect of the medial cuneiform to the medial aspect of the base of the second metatarsal. A "fleck sign" in this interval represents an avulsion of this critical stabilizing ligament.

Question 6578

Topic: 8. Foot and Ankle

A 35-year-old recreational athlete is undergoing percutaneous repair of an acute Achilles tendon rupture. Which of the following neurovascular structures is at the highest risk of iatrogenic injury during this procedure?

. Tibial nerve
. Posterior tibial artery
. Sural nerve
. Superficial peroneal nerve
. Saphenous nerve

Correct Answer & Explanation

. Sural nerve

Explanation

The sural nerve crosses from medial to lateral along the posterior aspect of the calf and runs intimately close to the lateral border of the Achilles tendon. It is highly vulnerable to entrapment or laceration during percutaneous or minimally invasive Achilles repairs.

Question 6579

Topic: 8. Foot and Ankle

The primary stabilizing ligament of the tarsometatarsal articulation (Lisfranc ligament) connects which two osseous structures?

. Medial cuneiform to the base of the first metatarsal
. Middle cuneiform to the base of the second metatarsal
. Medial cuneiform to the base of the second metatarsal
. Lateral cuneiform to the base of the third metatarsal
. Cuboid to the base of the fourth metatarsal

Correct Answer & Explanation

. Medial cuneiform to the base of the second metatarsal

Explanation

The Lisfranc ligament is an intra-articular ligament that connects the lateral aspect of the medial cuneiform to the medial base of the second metatarsal. It is critical for the stability of the midfoot arch.

Question 6580

Topic: 8. Foot and Ankle

A 28-year-old male sustains a Hawkins Type II talar neck fracture. Which of the following vascular structures, responsible for providing the majority of the blood supply to the talar body, is most severely compromised in this injury pattern?

. Artery of the tarsal canal
. Artery of the tarsal sinus
. Dorsalis pedis artery
. Deltoid artery
. Peroneal artery

Correct Answer & Explanation

. Artery of the tarsal canal

Explanation

The artery of the tarsal canal, a major branch of the posterior tibial artery, supplies the majority of the blood to the talar body. It is highly susceptible to disruption in displaced talar neck fractures, leading to a high risk of avascular necrosis.

Test Yourself

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

On this Page