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8. Foot and Ankle MCQs

Practice Set 342 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 6821

Topic: 8. Foot and Ankle

A 35-year-old male sustains a high-energy motor vehicle collision resulting in a displaced talar neck fracture. During the surgical approach and subsequent fixation, the surgeon must be mindful of the unique anatomical characteristics of the involved bone to preserve its tenuous blood supply. Which of the following is a distinct anatomical feature of the fractured bone that directly influences its vascularity and biomechanical role?

. It serves as the primary attachment site for the spring ligament.
. It provides insertion for the posterior tibial tendon.
. It lacks any tendinous or muscular attachments.
. It articulates directly with the medial cuneiform.
. It forms the primary insertion for the Achilles tendon.

Correct Answer & Explanation

. It lacks any tendinous or muscular attachments.

Explanation

Correct Answer: C. It lacks any tendinous or muscular attachments.The talus is a unique bone in the human body as it serves as a critical keystone for weight transmission between the leg and the foot but is entirely devoid of muscular or tendinous attachments. Its stability and movement are dictated entirely by its articular contours and complex ligamentous tethers. This lack of soft tissue attachment makes the talus particularly vulnerable to avascular necrosis following fractures (especially talar neck fractures), as its blood supply is heavily reliant on the capsular and ligamentous anastomotic rings rather than muscular perforators.

Question 6822

Topic: 8. Foot and Ankle

A 45-year-old female presents with chronic midfoot pain and difficulty during the push-off phase of gait. Biomechanical evaluation reveals dysfunction in the transition of the foot from a flexible structure to a rigid lever. Which of the following joints is primarily responsible for locking to provide this rigid lever for propulsion?

. Subtalar joint
. Transverse tarsal joint
. Tarsometatarsal joint
. Metatarsophalangeal joint
. Tibiotalar joint

Correct Answer & Explanation

. Transverse tarsal joint

Explanation

Correct Answer: B. Transverse tarsal jointThe transverse tarsal joint, also known as Chopart's joint, consists of the talonavicular and calcaneocuboid articulations. Biomechanically, it plays a pivotal role in the gait cycle. During the heel-strike and early stance phase, the subtalar joint everts, which aligns the axes of the talonavicular and calcaneocuboid joints in a parallel fashion. This unlocks the transverse tarsal joint, allowing the midfoot to become flexible and act as a shock absorber. During the push-off phase, the subtalar joint inverts, causing the axes of the transverse tarsal joint to become non-parallel (divergent). This locks the midfoot, transforming it into a rigid lever essential for efficient forward propulsion.

Question 6823

Topic: 8. Foot and Ankle

A 28-year-old marathon runner presents with lateral ankle pain and weakness. Clinical examination reveals diminished eversion strength and a noticeable dorsal elevation of the first metatarsal during weight-bearing. Pathology of which of the following tendons is most likely responsible for this specific combination of findings?

. Tibialis anterior
. Peroneus brevis
. Peroneus longus
. Extensor hallucis longus
. Posterior tibial tendon

Correct Answer & Explanation

. Peroneus longus

Explanation

Correct Answer: C. Peroneus longusThe peroneus longus originates from the proximal lateral fibula, courses posterior to the lateral malleolus, and travels obliquely across the plantar aspect of the foot to insert on the plantar posterolateral aspect of the medial cuneiform and the base of the first metatarsal. Its primary functions are eversion of the foot and plantarflexion of the first ray. Weakness or rupture of the peroneus longus leads to a loss of first ray plantarflexion, resulting in a dorsal elevation of the first metatarsal during weight-bearing, as well as diminished eversion strength. The peroneus brevis everts the foot but inserts on the base of the fifth metatarsal, not affecting the first ray.

Question 6824

Topic: 8. Foot and Ankle

A public health study is evaluating the prevalence of forefoot deformities in various demographic groups to allocate orthopedic resources. According to epidemiological data, what is the approximate prevalence of hallux valgus in the adult population over the age of 65?

. 5%
. 15%
. 23%
. >35%
. >50%

Correct Answer & Explanation

. >35%

Explanation

Correct Answer: D. >35%Hallux valgus is a highly prevalent progressive forefoot deformity characterized by lateral deviation of the hallux and medial deviation of the first metatarsal. Epidemiological data indicate that its prevalence increases significantly with age. It affects approximately 23% of adults aged 18-65 years and over 35% of individuals over the age of 65. The condition is frequently associated with pain, difficulty with shoe wear, and altered gait mechanics, often necessitating surgical correction when conservative measures fail.

Question 6825

Topic: 8. Foot and Ankle

A 40-year-old female sustains a pronation-external rotation ankle injury resulting in a bimalleolar equivalent fracture. MRI confirms a complete rupture of the medial ligamentous complex. Which of the following components is part of the deep layer of this complex, providing primary resistance to lateral talar excursion?

. Tibiocalcaneal ligament
. Tibionavicular ligament
. Superficial posterior tibiotalar ligament
. Deep anterior tibiotalar ligament
. Spring ligament

Correct Answer & Explanation

. Deep anterior tibiotalar ligament

Explanation

Correct Answer: D. Deep anterior tibiotalar ligamentThe deltoid ligament is a robust medial stabilizing complex of the ankle, divided into superficial and deep layers. The superficial layer includes the tibiocalcaneal, tibionavicular, and superficial posterior tibiotalar ligaments, which primarily resist hindfoot eversion. The deep layer is composed of the deep anterior tibiotalar and deep posterior tibiotalar ligaments. The deep layer is intra-articular and serves as the primary restraint to lateral translation and external rotation of the talus within the ankle mortise. The spring ligament supports the talar head but is not part of the deltoid complex.

Question 6826

Topic: 8. Foot and Ankle

A 32-year-old male undergoes surgical fixation for a comminuted Weber C fibula fracture with associated syndesmotic disruption. During the procedure, the surgeon prioritizes anatomical reduction of the fibula using a specialized plate. Failure to restore the anatomical length of the fibula in this scenario will most directly result in which of the following biomechanical consequences?

. Decreased dorsiflexion due to anterior impingement
. Widening of the ankle mortise and altered tibiotalar contact pressures
. Subtalar joint stiffness and loss of inversion
. Over-tensioning of the calcaneofibular ligament
. Medial subluxation of the talus

Correct Answer & Explanation

. Widening of the ankle mortise and altered tibiotalar contact pressures

Explanation

Correct Answer: B. Widening of the ankle mortise and altered tibiotalar contact pressuresThe fibula acts as the lateral buttress of the ankle mortise. Anatomical restoration of fibular length, alignment, and rotation is the most critical step in the operative management of ankle fractures. Shortening of the fibula allows the talus to shift and tilt laterally, leading to a widened ankle mortise. Even a 1 mm lateral shift of the talus can reduce the tibiotalar contact area by up to 42%, exponentially increasing contact pressures and predisposing the joint to rapid post-traumatic osteoarthritis. Therefore, restoring fibular length dictates the width and congruency of the ankle mortise.

Question 6827

Topic: Ankle Trauma & Sports

A 29-year-old professional athlete undergoes MRI evaluation for chronic anterolateral ankle pain following a rotational injury. The imaging reveals a chronic tear of the primary anterior stabilizer of the distal tibiofibular syndesmosis. Which of the following ligaments is most likely injured?

. Anterior talofibular ligament
. Anterior inferior tibiofibular ligament
. Interosseous ligament
. Transverse ligament
. Calcaneofibular ligament

Correct Answer & Explanation

. Anterior inferior tibiofibular ligament

Explanation

Correct Answer: B. Anterior inferior tibiofibular ligamentThe tibiofibular syndesmosis is a complex ligamentous structure that maintains the integrity of the distal tibiofibular articulation. It is composed of four main ligaments: the anterior inferior tibiofibular ligament (AITFL), the posterior inferior tibiofibular ligament (PITFL), the interosseous ligament, and the transverse ligament. The AITFL is the most commonly injured component in rotational ankle injuries (specifically external rotation) and serves as the primary anterior stabilizer of the syndesmosis. The ATFL and CFL are part of the lateral collateral ligament complex of the ankle, not the syndesmosis.

Question 6828

Topic: Forefoot

A 68-year-old female presents with progressive medial forefoot pain and difficulty with shoe wear. Clinical examination reveals a prominent medial eminence and lateral deviation of the great toe. Based on epidemiological data, what is the approximate prevalence of this condition in adults over the age of 65?

. 5%
. 15%
. 23%
. 35%
. 50%

Correct Answer & Explanation

. 35%

Explanation

Correct Answer: 35%Forefoot deformities such as hallux valgus are exceedingly common and their prevalence increases with age. According to the provided text, hallux valgus affects approximately 23% of adults aged 18-65 and over 35% in those over the age of 65. This high prevalence in the older population frequently necessitates surgical correction due to progressive pain and difficulty with shoe wear.

Question 6829

Topic: 8. Foot and Ankle

A 35-year-old male sustains a high-energy motor vehicle collision resulting in a talar neck fracture. The talus is unique among the bones of the foot and ankle due to its specific anatomical characteristics, which predispose it to avascular necrosis. Which of the following statements accurately describes the muscular attachments to the talus?

. The tibialis posterior tendon inserts on the medial tubercle.
. The flexor hallucis longus muscle originates from the posterior process.
. The extensor digitorum brevis originates from the lateral process.
. The talus has no muscular attachments.
. The plantaris tendon inserts on the posterior aspect.

Correct Answer & Explanation

. The talus has no muscular attachments.

Explanation

Correct Answer: The talus has no muscular attachments.The talus is a unique bone in the human body because it serves as a keystone transmitting forces from the leg to the foot, yet it has absolutely no muscular or tendinous attachments. Its stability relies entirely on its articular congruency and ligamentous support. This lack of muscular attachments, combined with the fact that a large portion of its surface is covered by articular cartilage, makes its blood supply tenuous and highly susceptible to disruption, leading to a high risk of avascular necrosis following fractures.

Question 6830

Topic: 8. Foot and Ankle

During the normal gait cycle, the foot transitions from a flexible structure to a rigid lever to allow for efficient propulsion during terminal stance. Which of the following joints is primarily responsible for this locking and unlocking mechanism of the midfoot?

. Subtalar joint
. Transverse tarsal joint
. Tarsometatarsal joint
. Metatarsophalangeal joint
. Tibiotalar joint

Correct Answer & Explanation

. Transverse tarsal joint

Explanation

Correct Answer: Transverse tarsal jointThe transverse tarsal joint, also known as Chopart's joint, consists of the calcaneocuboid and talonavicular articulations. As described in the text, this joint complex allows the midfoot to lock into a rigid lever for efficient propulsion during the toe-off phase of gait. Conversely, it can unlock to provide adaptability and shock absorption when the foot needs to accommodate uneven surfaces.

Question 6831

Topic: 8. Foot and Ankle

A 55-year-old female presents with a progressive flatfoot deformity. She has pain along the medial aspect of her ankle and is unable to perform a single-leg heel raise. The medial longitudinal arch is supported by both passive and dynamic structures. Which of the following muscles provides dynamic support to the medial longitudinal arch?

. Extensor hallucis longus
. Peroneus brevis
. Tibialis anterior
. Peroneus longus
. Flexor digitorum brevis

Correct Answer & Explanation

. Peroneus longus

Explanation

Correct Answer: Peroneus longusThe medial longitudinal arch is vital for efficient gait and energy conservation. It is supported passively by ligaments such as the plantar fascia and the spring ligament. Dynamically, it is supported by the action of specific muscles, including the tibialis posterior, the intrinsic foot muscles, and the peroneus longus. The peroneus longus tendon courses under the cuboid and across the plantar aspect of the foot to insert on the medial cuneiform and first metatarsal, thereby helping to stabilize and support the medial arch.

Question 6832

Topic: 8. Foot and Ankle

A 42-year-old male is scheduled for open reduction and internal fixation of a bimalleolar ankle fracture. The surgeon plans to address the lateral malleolus first. To optimize visualization and access to the lateral malleolus while the patient is in the supine position, which of the following positioning maneuvers is most appropriate?

. Placing a bump under the contralateral hip to externally rotate the operative leg.
. Placing a bump under the ipsilateral hip to internally rotate the operative leg.
. Positioning the patient in the lateral decubitus position.
. Flexing the knee to 90 degrees and placing the foot flat on the table.
. Applying continuous skeletal traction through the calcaneus.

Correct Answer & Explanation

. Placing a bump under the ipsilateral hip to internally rotate the operative leg.

Explanation

Correct Answer: Placing a bump under the ipsilateral hip to internally rotate the operative leg.When positioning a patient supine for an open reduction and internal fixation of a lateral malleolus fracture, the natural external rotation of the lower extremity can make access to the lateral side difficult. Placing a bump under the ipsilateral hip internally rotates the leg, bringing the lateral malleolus more anteriorly. This significantly facilitates surgical access, visualization, and maneuverability for the anterolateral approach.

Question 6833

Topic: 8. Foot and Ankle

During the open reduction and internal fixation of a displaced lateral malleolus fracture, the surgeon meticulously restores the anatomical length of the fibula. Failure to restore fibular length most directly affects which of the following biomechanical parameters of the ankle?

. The tension of the Achilles tendon
. The width of the ankle mortise
. The excursion of the flexor hallucis longus
. The locking mechanism of the transverse tarsal joint
. The moment arm of the tibialis anterior

Correct Answer & Explanation

. The width of the ankle mortise

Explanation

Correct Answer: The width of the ankle mortiseAnatomical reduction of the fibula is paramount in ankle fracture surgery. The text explicitly states that restoration of fibular length is critical because it dictates the width of the ankle mortise. Shortening or malrotation of the fibula leads to a widened mortise, which alters tibiotalar contact mechanics, decreases the contact area, and significantly increases peak joint contact stresses, predisposing the patient to early post-traumatic osteoarthritis.

Question 6834

Topic: 8. Foot and Ankle

A 28-year-old runner presents with lateral ankle pain and weakness. Clinical examination reveals intact eversion but weakness in plantarflexion of the first ray. Which of the following tendons is most likely injured or dysfunctional?

. Peroneus brevis
. Tibialis anterior
. Extensor hallucis longus
. Peroneus longus
. Flexor hallucis longus

Correct Answer & Explanation

. Peroneus longus

Explanation

Correct Answer: Peroneus longusThe peroneus longus and brevis are the primary evertors of the foot, located in the lateral compartment of the leg. However, the peroneus longus has an additional, unique critical function. Because it courses under the cuboid and across the plantar aspect of the foot to insert on the base of the first metatarsal and medial cuneiform, it acts as a strong plantarflexor of the first ray. The peroneus brevis inserts on the base of the fifth metatarsal and does not share this function.

Question 6835

Topic: 8. Foot and Ankle

A 45-year-old marathon runner presents with midfoot pain. Biomechanical analysis of his gait reveals an inability to transition his foot into a rigid lever during the push-off phase. Which of the following joint complexes is primarily responsible for this specific biomechanical function?

. Subtalar joint
. Transverse tarsal joint
. Tarsometatarsal joint
. Metatarsophalangeal joint
. Tibiotalar joint

Correct Answer & Explanation

. Transverse tarsal joint

Explanation

Correct Answer: B (Transverse tarsal joint)The transverse tarsal joint (also known as Chopart's joint), which consists of the talonavicular and calcaneocuboid joints, plays a critical role in the biomechanics of the foot. During the gait cycle, it allows the midfoot to lock into a rigid lever for effective propulsion during the toe-off phase. Conversely, it unlocks to provide adaptability and shock absorption during heel strike. The subtalar joint primarily acts as a mobile adaptor allowing inversion and eversion, while the tibiotalar joint acts as a hinge for dorsiflexion and plantarflexion.

Question 6836

Topic: 8. Foot and Ankle

A 28-year-old male sustains a high-energy motor vehicle collision resulting in a severely comminuted fracture of a tarsal bone. During preoperative planning, the surgeon notes that the fractured bone is unique because it serves as a keystone for force transmission but lacks any direct tendinous insertions. Which bone is injured?

. Calcaneus
. Navicular
. Cuboid
. Talus
. Medial cuneiform

Correct Answer & Explanation

. Talus

Explanation

Correct Answer: D (Talus)The talus is a unique bone within the foot and ankle complex because it has absolutely no muscular or tendinous attachments. It serves as a critical keystone, transmitting forces from the leg (tibia and fibula) down to the foot. Because it lacks soft tissue attachments, its blood supply is tenuous and relies entirely on capsular and ligamentous structures, making it highly susceptible to avascular necrosis following displaced fractures.

Question 6837

Topic: 8. Foot and Ankle

A 50-year-old female presents with lateral ankle pain and weakness following a sprain. Clinical examination reveals weak eversion of the foot. Further manual muscle testing demonstrates a specific, profound weakness in actively plantarflexing the first ray. Which of the following tendons is most likely dysfunctional?

. Peroneus brevis
. Peroneus longus
. Tibialis posterior
. Flexor hallucis longus
. Extensor hallucis longus

Correct Answer & Explanation

. Peroneus longus

Explanation

Correct Answer: B (Peroneus longus)Both the peroneus longus and peroneus brevis are responsible for eversion of the foot. However, the peroneus longus tendon has a unique anatomical course; it travels under the cuboid to insert on the plantar aspect of the base of the first metatarsal and the medial cuneiform. Because of this insertion, it acts as the primary plantarflexor of the first ray. Weakness in both eversion and first ray plantarflexion isolates the peroneus longus as the dysfunctional structure.

Question 6838

Topic: 8. Foot and Ankle

A 68-year-old female presents to the clinic complaining of medial forefoot pain and difficulty fitting into her shoes due to a progressive deformity. Based on epidemiological data, what is the approximate prevalence of hallux valgus deformity in adults over the age of 65?

. 5%
. 15%
. 23%
. 35%
. 50%

Correct Answer & Explanation

. 35%

Explanation

Correct Answer: D (35%)Forefoot deformities, particularly hallux valgus, are highly prevalent in the general population and increase in frequency with age. According to epidemiological data, hallux valgus affects approximately 23% of adults aged 18-65 and over 35% in individuals over the age of 65. This high prevalence contributes significantly to the burden of orthopedic foot and ankle surgical practice due to associated pain and shoe wear difficulties.

Question 6839

Topic: 8. Foot and Ankle

A 42-year-old male is scheduled for open reduction and internal fixation of a bimalleolar ankle fracture. The surgeon plans to fix the lateral malleolus first. To optimize visualization and access to the lateral malleolus while the patient is in the supine position, which of the following positioning maneuvers is most appropriate?

. Placing a bump under the contralateral hip to externally rotate the operative leg
. Placing a bump under the ipsilateral hip to internally rotate the operative leg
. Positioning the patient in the lateral decubitus position
. Flexing the knee to 90 degrees and placing the foot flat on the table
. Applying a skeletal traction pin through the calcaneus

Correct Answer & Explanation

. Placing a bump under the ipsilateral hip to internally rotate the operative leg

Explanation

Correct Answer: B (Placing a bump under the ipsilateral hip to internally rotate the operative leg)When positioning a patient supine for a bimalleolar ankle fracture, placing a bump under the ipsilateral hip internally rotates the lower extremity. This maneuver brings the lateral malleolus more anteriorly, significantly facilitating access, visualization, and hardware placement for the lateral approach. It allows the surgeon to address both the lateral and medial sides without needing to reposition the patient intraoperatively.

Question 6840

Topic: 8. Foot and Ankle

A 30-year-old male undergoes surgical fixation of a comminuted Weber B fibula fracture. Postoperatively, the patient experiences chronic ankle pain and instability. Radiographs reveal a widened clear space and lateral talar shift. The surgeon realizes that anatomical reduction of the fibula was not fully achieved. Failure to restore which specific anatomical parameter of the fibula most directly leads to widening of the ankle mortise?

. Anterior bow
. Fibular length
. Medial cortical thickness
. Syndesmotic recess depth
. Fibular rotation

Correct Answer & Explanation

. Fibular length

Explanation

Correct Answer: B (Fibular length)Restoration of fibular length is the most critical step during the fixation of lateral malleolus fractures because the fibula dictates the width of the ankle mortise. Even a small amount of fibular shortening leads to lateral subluxation of the talus, widening of the mortise, drastically altered joint contact mechanics, and the rapid onset of post-traumatic arthritis. Anatomical length must be restored before addressing syndesmotic or medial-sided injuries.

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