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8. Foot and Ankle MCQs

Practice Set 347 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 6921

Topic: 8. Foot and Ankle

A 22-year-old basketball player sustains an inversion ankle sprain while landing from a jump. The ankle was in a plantarflexed position at the time of injury. Which of the following ligaments is the primary restraint to anterior translation of the talus within the mortise in this specific foot position?

. Calcaneofibular ligament
. Posterior talofibular ligament
. Anterior talofibular ligament
. Deltoid ligament
. Anterior inferior tibiofibular ligament

Correct Answer & Explanation

. Anterior talofibular ligament

Explanation

Correct Answer: Anterior talofibular ligamentThe anterior talofibular ligament (ATFL) is the weakest of the lateral ankle ligaments and the most commonly injured in an inversion sprain. Biomechanically, when the ankle is in plantarflexion, the ATFL is taut and serves as the primary restraint to anterior translation of the talus. The calcaneofibular ligament (CFL) becomes the primary restraint when the ankle is in dorsiflexion.

Question 6922

Topic: 8. Foot and Ankle

A 45-year-old man presents with acute onset of severe low back pain radiating down the posterolateral aspect of his left leg to the dorsum of his foot. Physical examination reveals 3/5 strength in great toe extension and decreased sensation over the first dorsal web space. The patellar and Achilles tendon reflexes are symmetric and 2+. Which of the following nerve roots is most likely compressed?

. L3
. L4
. L5
. S1
. S2

Correct Answer & Explanation

. L5

Explanation

Correct Answer: L5This patient presents with a classic L5 radiculopathy. The L5 nerve root supplies motor innervation to the extensor hallucis longus (great toe extension) and provides sensory innervation to the dorsum of the foot, specifically the first dorsal web space. The L4 root is associated with the patellar reflex and anterior tibialis (ankle dorsiflexion), while the S1 root is associated with the Achilles reflex, gastrocnemius (ankle plantarflexion), and sensation to the lateral aspect of the foot.

Question 6923

Topic: 8. Foot and Ankle

A 45-year-old male sustains an acute Achilles tendon rupture during a tennis match. The rupture most commonly occurs in a hypovascular 'watershed' region. Approximately how far proximal to the calcaneal insertion is this zone located?

. 0 to 1 cm
. 2 to 6 cm
. 7 to 10 cm
. 11 to 14 cm
. At the musculotendinous junction

Correct Answer & Explanation

. 2 to 6 cm

Explanation

Correct Answer: 2 to 6 cmThe Achilles tendon has a hypovascular zone located approximately 2 to 6 cm proximal to its insertion on the calcaneus. This 'watershed' area receives less blood supply compared to the proximal and distal portions of the tendon, making it the most susceptible region to degeneration and acute rupture, particularly in middle-aged individuals engaging in episodic athletic activities.

Question 6924

Topic: 8. Foot and Ankle

A patient presents with an L5 radiculopathy due to a paracentral disc herniation at L4-L5. Which of the following physical examination findings is most specific to an isolated L5 nerve root deficit?

. Weakness in ankle plantarflexion and an absent Achilles reflex
. Weakness in great toe extension and decreased sensation over the first dorsal web space
. Weakness in knee extension and an absent patellar reflex
. Weakness in hip flexion and decreased sensation over the anterior thigh
. Weakness in hip adduction and decreased sensation over the medial thigh

Correct Answer & Explanation

. Weakness in great toe extension and decreased sensation over the first dorsal web space

Explanation

Correct Answer: BAn L5 radiculopathy classically presents with weakness in the extensor hallucis longus (great toe extension), weakness in ankle dorsiflexion (tibialis anterior, though L4 also contributes), and sensory deficits over the dorsum of the foot, specifically the first dorsal web space. The Achilles reflex is mediated by S1, and the patellar reflex is mediated by L4.

Question 6925

Topic: 8. Foot and Ankle

A 22-year-old athlete sustains a midfoot injury. Weight-bearing radiographs reveal a 3 mm diastasis between the base of the first and second metatarsals. The primary ligament ruptured in this injury connects which two anatomical 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
. Lateral cuneiform to the cuboid
. Navicular to the medial cuneiform

Correct Answer & Explanation

. Medial cuneiform to the base of the second metatarsal

Explanation

The Lisfranc ligament is a robust 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 structural stability of the tarsometatarsal complex.

Question 6926

Topic: 8. Foot and Ankle

A 30-year-old worker drops a heavy box on his midfoot. Weight-bearing radiographs demonstrate a 3 mm diastasis between the base of the first and second metatarsals. The Lisfranc ligament, critical for stability in this region, connects which two osseous structures?

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

Correct Answer & Explanation

. Medial cuneiform and base of the second metatarsal

Explanation

The Lisfranc ligament is a strong interosseous ligament that originates on the lateral aspect of the medial cuneiform and inserts on the medial aspect of the base of the second metatarsal. It is vital for midfoot stability because there is no direct ligamentous connection between the bases of the first and second metatarsals.

Question 6927

Topic: 8. Foot and Ankle

During surgical reconstruction of the hindfoot, a resident is reviewing the muscular attachments of the tarsal bones. Which of the following muscles directly inserts onto the talus?

. Tibialis posterior
. Flexor hallucis longus
. Tibialis anterior
. Peroneus brevis
. No muscles attach to this bone

Correct Answer & Explanation

. No muscles attach to this bone

Explanation

Correct Answer: No muscles attach to this boneThe talus is a unique bone within the foot and ankle complex because it has no tendinous or muscular attachments. It serves as a keystone, transmitting forces from the leg to the foot, and relies entirely on its articular surfaces and ligamentous attachments for stability and blood supply.

Question 6928

Topic: Ankle Trauma & Sports

A 24-year-old athlete sustains an inversion injury to the ankle. Which ligament of the lateral collateral complex is most frequently injured in this scenario?

. Calcaneofibular ligament (CFL)
. Posterior talofibular ligament (PTFL)
. Anterior talofibular ligament (ATFL)
. Anterior inferior tibiofibular ligament (AITFL)
. Cervical ligament

Correct Answer & Explanation

. Anterior talofibular ligament (ATFL)

Explanation

Correct Answer: Anterior talofibular ligament (ATFL)The lateral collateral ligament complex of the ankle includes the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL). The ATFL is the weakest of these ligaments and is the most commonly injured structure during a classic inversion and plantarflexion ankle sprain.

Question 6929

Topic: 8. Foot and Ankle

Which of the following best describes the primary kinematic function of the subtalar joint during the gait cycle?

. Primary dorsiflexion and plantarflexion
. Acting as a rigid lever during the initial contact phase
. Inversion and eversion to function as a mobile adaptor on uneven ground
. Internal and external rotation of the tibia
. Flexion and extension of the midfoot

Correct Answer & Explanation

. Inversion and eversion to function as a mobile adaptor on uneven ground

Explanation

Correct Answer: Inversion and eversion to function as a mobile adaptor on uneven groundThe subtalar (talocalcaneal) joint is a complex articulation that primarily allows for inversion and eversion. This motion is critical during the gait cycle, as it allows the foot to act as a 'mobile adaptor' to accommodate uneven terrain and absorb shock during the initial contact and loading response phases.

Question 6930

Topic: Midfoot & Hindfoot

A 55-year-old female presents with progressive flattening of her medial longitudinal arch and pain posterior to the medial malleolus. Dysfunction of which of the following tendons is the most likely primary cause of her deformity?

. Flexor hallucis longus
. Tibialis anterior
. Peroneus longus
. Tibialis posterior
. Flexor digitorum longus

Correct Answer & Explanation

. Tibialis posterior

Explanation

Correct Answer: Tibialis posteriorThe posterior tibial tendon is the primary dynamic stabilizer of the medial longitudinal arch and the main invertor of the midfoot. Its dysfunction is the most common cause of adult-acquired flatfoot deformity, characterized by progressive arch collapse, hindfoot valgus, and forefoot abduction.

Question 6931

Topic: Forefoot

Based on epidemiological data, what is the approximate prevalence of hallux valgus in the adult population over the age of 65?

. Less than 10%
. Approximately 15%
. Approximately 23%
. Over 35%
. Over 60%

Correct Answer & Explanation

. Over 35%

Explanation

Correct Answer: Over 35%Hallux valgus is a highly prevalent forefoot deformity. Epidemiological data indicates it affects approximately 23% of adults aged 18-65, and its prevalence increases significantly with age, affecting over 35% of individuals over the age of 65.

Question 6932

Topic: 8. Foot and Ankle

To optimize surgical access to the lateral malleolus during open reduction and internal fixation in the supine position, which of the following positioning maneuvers is most commonly employed?

. 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
. Flexing the knee to 90 degrees and placing the foot flat on the table
. Positioning the patient in the lateral decubitus position without a bump
. 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 legWhen fixing a lateral malleolus fracture with the patient in the supine position, placing a bump under the ipsilateral hip internally rotates the lower extremity. This brings the lateral malleolus anteriorly, significantly improving visualization and surgical access to the lateral aspect of the fibula.

Question 6933

Topic: 8. Foot and Ankle

The deltoid ligament is a critical stabilizer of the medial ankle. Which of the following ligaments is a component of the deep layer of the deltoid ligament?

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

Correct Answer & Explanation

. Deep anterior tibiotalar ligament

Explanation

Correct Answer: Deep anterior tibiotalar ligamentThe deltoid ligament consists of superficial and deep layers. The superficial layer includes the tibiocalcaneal, tibionavicular, and superficial posterior tibiotalar ligaments. The deep layer, which is the primary restraint to lateral talar shift, includes the deep posterior tibiotalar and deep anterior tibiotalar ligaments.

Question 6934

Topic: Forefoot

According to the provided epidemiological data, what is the approximate prevalence of hallux valgus in adults over the age of 65?

. Less than 10%
. Approximately 23%
. Greater than 35%
. Approximately 50%
. Greater than 65%

Correct Answer & Explanation

. Greater than 35%

Explanation

Correct Answer: Greater than 35%The text explicitly states that forefoot deformities such as hallux valgus affect approximately 23% of adults aged 18-65 and over 35% in those over 65. This highlights the increasing prevalence of this condition in the aging population.

Question 6935

Topic: 8. Foot and Ankle

In addition to hindfoot eversion, what is the primary biomechanical function of the peroneus longus tendon as it traverses the foot?

. Dorsiflexion of the first ray
. Plantarflexion of the first ray
. Inversion of the midfoot
. Plantarflexion of the lesser toes
. Support of the medial longitudinal arch

Correct Answer & Explanation

. Plantarflexion of the first ray

Explanation

Correct Answer: Plantarflexion of the first rayAccording to the text, the peroneus longus and brevis tendons are responsible for eversion, with the peroneus longus also contributing to plantarflexion of the first ray. This is a critical biomechanical function for forefoot stability during the push-off phase of gait.

Question 6936

Topic: 8. Foot and Ankle

The spring ligament (plantar calcaneonavicular ligament) is a critical static stabilizer of the medial longitudinal arch. Which specific osseous structure does it directly support?

. Cuboid
. Calcaneal tuberosity
. Talar head
. Base of the first metatarsal
. Navicular tuberosity

Correct Answer & Explanation

. Talar head

Explanation

Correct Answer: Talar headThe text notes that within the foot, the spring ligament (plantar calcaneonavicular ligament) supports the talar head and the medial longitudinal arch. Failure of this ligament contributes to adult-acquired flatfoot deformity.

Question 6937

Topic: 8. Foot and Ankle

A patient presents with an inability to dorsiflex the ankle and numbness in the first dorsal web space. Based on the neurovascular anatomy described, which nerve is most likely injured?

. Superficial peroneal nerve
. Deep peroneal nerve
. Sural nerve
. Tibial nerve
. Medial plantar nerve

Correct Answer & Explanation

. Deep peroneal nerve

Explanation

Correct Answer: Deep peroneal nerveThe text describes the deep peroneal nerve as providing sensation to the first web space and motor innervation to the anterior compartment muscles (which are responsible for ankle dorsiflexion and toe extension).

Question 6938

Topic: 8. Foot and Ankle

The transverse tarsal joint allows the midfoot to lock into a rigid lever for propulsion or unlock for adaptability. Which two articulations comprise this joint?

. Talocalcaneal and talonavicular
. Calcaneocuboid and talonavicular
. Talocalcaneal and calcaneocuboid
. Naviculocuneiform and tarsometatarsal
. Subtalar and tibiotalar

Correct Answer & Explanation

. Calcaneocuboid and talonavicular

Explanation

Correct Answer: Calcaneocuboid and talonavicularThe text explicitly defines the transverse tarsal joint as being composed of the calcaneocuboid and talonavicular joints. This joint complex is essential for transitioning the foot from a flexible shock absorber to a rigid lever during the gait cycle.

Question 6939

Topic: 8. Foot and Ankle

The deltoid ligament provides significant medial stability to the ankle. Which of the following ligaments is a component of the deep layer of the deltoid ligament?

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

Correct Answer & Explanation

. Deep anterior tibiotalar ligament

Explanation

Correct Answer: Deep anterior tibiotalar ligamentThe text divides the deltoid ligament into superficial and deep layers. The deep layer is composed of the deep posterior tibiotalar and deep anterior tibiotalar ligaments. The tibiocalcaneal, tibionavicular, and superficial posterior tibiotalar ligaments make up the superficial layer.

Question 6940

Topic: 8. Foot and Ankle

During surgical exposure of the ankle and hindfoot, the surgeon must be aware of the unique anatomical characteristics of the tarsal bones. Which of the following statements regarding the talus is correct?

. It serves as the primary attachment site for the Achilles tendon.
. It provides the distal insertion for the tibialis anterior tendon.
. It is a unique bone that has no muscular attachments.
. It articulates directly with the medial cuneiform.
. It is the largest tarsal bone in the foot.

Correct Answer & Explanation

. It articulates directly with the medial cuneiform.

Explanation

Correct Answer: CThe talus is a unique bone in the human body because it has no muscular or tendinous attachments. It serves as a keystone in the ankle joint, transmitting forces from the tibia and fibula to the foot. Its stability and movement are entirely dependent on its articular geometry and the complex ligamentous structures attaching to it, such as the lateral collateral ligaments, deltoid ligament, and syndesmotic ligaments. The Achilles tendon attaches to the calcaneus, and the tibialis anterior attaches to the medial cuneiform and first metatarsal base.

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