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8. Foot and Ankle MCQs

Practice Set 341 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 6801

Topic: 8. Foot and Ankle

A 10-year-old child with an untreated, large Dysplasia Epiphysealis Hemimelica (DEH) lesion of the talus presents with worsening foot pain. Radiographs demonstrate significant joint space narrowing and subchondral sclerosis in the tibiotalar joint. What is the most common long-term complication of unmanaged symptomatic DEH?

. Secondary osteoarthritis
. Pathological fracture
. Chronic osteomyelitis
. Malignant degeneration
. Avascular necrosis of the epiphysis

Correct Answer & Explanation

. Secondary osteoarthritis

Explanation

The most common significant long-term complication of DEH is secondary osteoarthritis. This occurs due to the progressive articular incongruity, mechanical block, and altered joint biomechanics caused by the epiphyseal overgrowth.

Question 6802

Topic: 8. Foot and Ankle

An 8-year-old boy presents with progressive restricted subtalar motion and a firm medial hindfoot mass. Radiographs show irregular, multicentric ossification centers adjacent to the talar body that appear to be coalescing. In planning surgical excision for this suspected Dysplasia Epiphysealis Hemimelica, the surgeon must be aware that the mass often blends indistinguishably with which structure?

. The Achilles tendon insertion
. The adjacent normal articular cartilage
. The medial malleolar physis
. The posterior tibial neurovascular bundle
. The deltoid ligament origins

Correct Answer & Explanation

. The adjacent normal articular cartilage

Explanation

In DEH, the abnormal cartilaginous overgrowth typically blends seamlessly with the adjacent normal native articular cartilage of the epiphysis. This makes determining the exact resection margins challenging and requires meticulous technique to avoid damaging the true joint surface.

Question 6803

Topic: 8. Foot and Ankle
A 5-year-old boy presents with a limp and midfoot pain for the past 3 weeks. There is no history of trauma. Radiographs reveal sclerosis and flattening of the tarsal navicular. What is the most appropriate management?
. Surgical core decompression
. Short leg walking cast for 4-6 weeks
. Corticosteroid injection
. Open reduction and internal fixation
. Total talonavicular fusion

Correct Answer & Explanation

. Short leg walking cast for 4-6 weeks

Explanation

Köhler's disease is a self-limiting avascular necrosis of the tarsal navicular. Management is conservative, with a short leg walking cast for 4-6 weeks providing excellent symptomatic relief.

Question 6804

Topic: 8. Foot and Ankle
Köhler's disease most commonly affects which demographic group?
. Adolescent females aged 12-16
. Adult males aged 30-40
. Boys aged 4-8
. Girls aged 8-10
. Infants under 2 years

Correct Answer & Explanation

. Boys aged 4-8

Explanation

Köhler's disease predominantly affects boys between the ages of 4 and 8 years. It is an osteochondrosis of the tarsal navicular caused by compressive forces during ossification.

Question 6805

Topic: 8. Foot and Ankle
A 6-year-old boy is diagnosed with Köhler's disease. His parents are concerned about long-term deformity of the foot. Which of the following represents the most likely long-term outcome?
. Severe midfoot osteoarthritis
. Permanent flattening of the medial longitudinal arch
. Complete spontaneous reconstitution of the navicular
. High likelihood of requiring arthrodesis in adulthood
. Chronic regional pain syndrome

Correct Answer & Explanation

. Complete spontaneous reconstitution of the navicular

Explanation

Köhler's disease has an excellent prognosis. The navicular predictably undergoes complete spontaneous reconstitution with no long-term deformity or disability.

Question 6806

Topic: 8. Foot and Ankle
What is the primary pathophysiological mechanism thought to cause Köhler's disease?
. Bacterial infection of the navicular
. Autoimmune destruction of the midfoot cartilage
. Mechanical compression of the delayed-ossifying navicular leading to ischemia
. Genetic mutation in type I collagen
. Repetitive traction apophysitis of the tibialis posterior insertion

Correct Answer & Explanation

. Mechanical compression of the delayed-ossifying navicular leading to ischemia

Explanation

The tarsal navicular is the last tarsal bone to ossify. Mechanical compression between the already ossified talus and cuneiforms leads to temporary ischemia and osteonecrosis.

Question 6807

Topic: 8. Foot and Ankle
A 7-year-old boy presents with dorsal midfoot pain. Radiographs show fragmentation and sclerosis of the navicular. Which of the following best distinguishes Köhler's disease from Freiberg's infraction?
. Köhler's involves the metatarsal head, Freiberg's involves the navicular
. Köhler's involves the navicular, Freiberg's involves the metatarsal head
. Köhler's is surgical, Freiberg's is non-operative
. Köhler's affects adolescents, Freiberg's affects toddlers
. There is no clinical or radiographic difference

Correct Answer & Explanation

. Köhler's involves the navicular, Freiberg's involves the metatarsal head

Explanation

Köhler's disease is osteochondrosis of the tarsal navicular, typically seen in young boys. Freiberg's infraction is osteochondrosis of a metatarsal head, more common in adolescent females.

Question 6808

Topic: Midfoot & Hindfoot
A 5-year-old boy presents with a limp and midfoot pain. A radiograph is shown. What is the most appropriate management?
. Immediate surgical excision of the affected bone
. Talonavicular arthrodesis
. Short-leg walking cast for 4-6 weeks
. Extracorporeal shockwave therapy
. Corticosteroid injection

Correct Answer & Explanation

. Short-leg walking cast for 4-6 weeks

Explanation

The radiograph demonstrates Köhler's disease, an osteochondrosis of the navicular. It is self-limiting, and symptomatic relief with a short-leg walking cast for 4-6 weeks is the treatment of choice for significant pain.

Question 6809

Topic: 8. Foot and Ankle
Köhler's disease primarily affects the tarsal navicular bone. Why is the navicular particularly susceptible to this osteochondrosis?
. It is the last tarsal bone to ossify and is subjected to high compressive forces.
. It has a tenuous blood supply derived purely from a single distal artery.
. It lacks any ligamentous attachments, leading to instability.
. It ossifies through intramembranous ossification rather than endochondral.
. It is frequently subjected to avulsion fractures by the tibialis anterior.

Correct Answer & Explanation

. It is the last tarsal bone to ossify and is subjected to high compressive forces.

Explanation

The tarsal navicular is the last bone in the foot to ossify. During its late ossification, it is squeezed between the already ossified talus and cuneiforms, making it vulnerable to compressive forces and transient ischemia.

Question 6810

Topic: 8. Foot and Ankle
Which of the following radiographic findings is the hallmark of Köhler's disease?
. A fragmented, flattened, and sclerotic appearance of the tarsal navicular
. Subchondral lucency of the talar dome
. Cystic changes in the calcaneus
. Periosteal reaction along the metatarsals
. A crescent sign in the cuboid

Correct Answer & Explanation

. A fragmented, flattened, and sclerotic appearance of the tarsal navicular

Explanation

The classic radiographic appearance of Köhler's disease shows a narrow, dense, sclerotic, and sometimes fragmented tarsal navicular bone, which typically reconstitutes its normal architecture over 1 to 3 years.

Question 6811

Topic: 8. Foot and Ankle
A 5-year-old boy presents with a mild limp and midfoot pain. Radiographs demonstrate sclerosis and flattening of the tarsal navicular. What is the most appropriate initial management?
. Surgical core decompression
. Immobilization in a short leg cast for 4-6 weeks
. Talonavicular arthrodesis
. Corticosteroid injection
. Operative pinning of the navicular

Correct Answer & Explanation

. Immobilization in a short leg cast for 4-6 weeks

Explanation

Köhler's disease is a self-limiting avascular necrosis of the tarsal navicular seen in young children. Treatment is symptomatic, often utilizing a short leg walking cast for 4-6 weeks for severe pain.

Question 6812

Topic: 8. Foot and Ankle
The pathogenesis of the condition shown in the radiograph is most closely linked to which of the following mechanical factors?
. Delayed ossification of the navicular under compressive loads
. Repetitive avulsion by the tibialis posterior
. Subchondral cyst formation from altered gait mechanics
. Synovial hypertrophy leading to vascular occlusion
. Congenital tarsal coalition

Correct Answer & Explanation

. Delayed ossification of the navicular under compressive loads

Explanation

Köhler's disease occurs because the tarsal navicular is the last tarsal bone to ossify. Its cartilaginous precursor is susceptible to compressive shear forces between the talus and cuneiforms, leading to transient ischemia.

Question 6813

Topic: Midfoot & Hindfoot
A worried mother brings her 4-year-old son to the clinic after he began walking with a limp. Imaging confirms Köhler's disease. Which of the following statements is most accurate regarding long-term prognosis?
. He is at high risk for early-onset talonavicular osteoarthritis
. Surgical decompression is required to prevent navicular collapse
. The condition typically resolves completely with no long-term sequelae
. He will likely require a triple arthrodesis in early adulthood
. Lifelong custom orthotics are mandatory

Correct Answer & Explanation

. The condition typically resolves completely with no long-term sequelae

Explanation

Köhler's disease has an excellent prognosis. The condition typically resolves clinically and radiographically within 1-2 years with no residual deformity or long-term risk of osteoarthritis.

Question 6814

Topic: 8. Foot and Ankle
A 5-year-old boy presents with a 3-week history of a painful limp and swelling over the dorsal midfoot. He has point tenderness over the medial arch. Radiographs are obtained as shown. If a trial of rest and supportive shoes fails to alleviate his severe limping, what is the most appropriate next step in management?
. Surgical drilling of the tarsal navicular
. Talo-navicular arthrodesis
. Short-leg walking cast for 4 to 6 weeks
. Corticosteroid injection into the talonavicular joint
. Core decompression of the navicular

Correct Answer & Explanation

. Short-leg walking cast for 4 to 6 weeks

Explanation

The clinical and radiographic presentation is classic for Köhler's disease (osteochondrosis of the navicular). It is self-limiting; however, if symptoms are severe and fail observation, a short-leg walking cast for 4-6 weeks effectively unloads the bone and resolves symptoms.

Question 6815

Topic: 8. Foot and Ankle
Regarding the pathophysiology of Köhler's disease, which of the following statements most accurately describes the sequence of ossification and mechanical vulnerability of the tarsal navicular?
. It is the first tarsal bone to ossify, making it prone to early microtrauma
. It is the last tarsal bone to ossify and is subjected to high compressive forces between the ossified talus and cuneiforms
. It ossifies from multiple eccentric centers that fail to fuse
. It primarily undergoes endochondral ossification dependent entirely on the posterior tibial artery
. It lacks a cartilaginous anlage, leading to primary membranous bone failure

Correct Answer & Explanation

. It is the last tarsal bone to ossify and is subjected to high compressive forces between the ossified talus and cuneiforms

Explanation

The tarsal navicular is the last of the tarsal bones to ossify (around age 3-5). Its late ossification leaves it as a vulnerable cartilaginous structure squeezed between the already ossified talus and cuneiforms, leading to mechanical compression and osteochondrosis.

Question 6816

Topic: 8. Foot and Ankle
A 6-year-old boy complains of midfoot pain and a limp. A radiograph of the foot is obtained. Based on the typical presentation of this disease, what is the expected long-term radiographic and clinical outcome if managed conservatively?
. Progressive flatfoot deformity requiring arthrodesis
. Premature osteoarthritis of the talonavicular joint
. Spontaneous, complete reconstitution of the navicular with no residual disability
. Avascular necrosis of the talar head due to retrograde ischemia
. Tarsal coalition formation between the navicular and cuneiforms

Correct Answer & Explanation

. Spontaneous, complete reconstitution of the navicular with no residual disability

Explanation

Köhler's disease invariably carries an excellent prognosis. The tarsal navicular undergoes spontaneous, complete reconstitution with normal morphology, and patients typically have no long-term clinical sequelae.

Question 6817

Topic: 8. Foot and Ankle
A 5-year-old boy presents with a limp and midfoot pain. Radiographs reveal a sclerotic and flattened navicular. What is the most appropriate management for this condition?
. Surgical excision of the navicular
. Core decompression of the navicular
. Short leg walking cast for 4-6 weeks
. Talonavicular arthrodesis
. Rigid carbon fiber AFO for 1 year

Correct Answer & Explanation

. Short leg walking cast for 4-6 weeks

Explanation

The patient has Köhler's disease, an osteochondrosis of the tarsal navicular in children. It is self-limiting, and treatment with a short leg walking cast for 4 to 6 weeks expedites symptom resolution without long-term sequelae.

Question 6818

Topic: 8. Foot and Ankle
A 5-year-old boy presents with a limp and midfoot pain. Radiographs reveal a sclerotic, flattened tarsal navicular. What is the most appropriate initial management for this condition?
. Navicular excision and talocuneiform fusion
. Short leg walking cast for 4-6 weeks
. Immediate MRI of the midfoot
. Corticosteroid injection into the talonavicular joint
. Core decompression of the navicular

Correct Answer & Explanation

. Short leg walking cast for 4-6 weeks

Explanation

This patient has Köhler's disease, an osteochondrosis of the tarsal navicular. It is a self-limiting condition, and conservative management with a short leg walking cast for 4 to 6 weeks is highly effective for pain relief. Surgical intervention is virtually never indicated.

Question 6819

Topic: 8. Foot and Ankle
Parents of a 4-year-old boy recently diagnosed with Köhler's disease are concerned about his long-term foot function. Which of the following is the most accurate prognostic statement to provide the family?
. The condition typically leads to early-onset midfoot arthritis requiring arthrodesis.
. Surgery is eventually required in over 50% of cases to restore the medial arch.
. The navicular bone will likely reconstitute completely without residual deformity.
. Permanent custom orthotics will be necessary to prevent adult-acquired flatfoot.
. Growth arrest of the medial column is a common and irreversible complication.

Correct Answer & Explanation

. The navicular bone will likely reconstitute completely without residual deformity.

Explanation

Köhler's disease carries an excellent prognosis. The tarsal navicular almost universally reconstitutes to a normal shape and density with conservative care, leaving no residual deformity or long-term disability.

Question 6820

Topic: 8. Foot and Ankle
Osteochondroses can affect various ossification centers in the pediatric foot. While Köhler's disease specifically affects the tarsal navicular, a 14-year-old female dancer presenting with localized pain, swelling, and radiographic sclerosis of the second metatarsal head most likely has which of the following conditions?
. Sever's disease
. Iselin's disease
. Freiberg's infarction
. Panner's disease
. Buschke's disease

Correct Answer & Explanation

. Freiberg's infarction

Explanation

Freiberg's infarction is an avascular necrosis/osteochondrosis of the metatarsal head, most commonly affecting the second metatarsal in adolescent females. Sever's affects the calcaneus, and Iselin's affects the base of the 5th metatarsal.

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