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8. Foot and Ankle MCQs

Practice Set 348 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 6941

Topic: 8. Foot and Ankle

A patient presents with lateral ankle pain and weakness in eversion. During physical examination, the function of the peroneus longus is specifically tested. In addition to hindfoot eversion, what is the primary biomechanical function of the peroneus longus?

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

Correct Answer & Explanation

. Plantarflexion of the first ray

Explanation

Correct Answer: BThe peroneus longus and brevis are the primary evertors of the foot. However, the peroneus longus tendon courses under the cuboid and traverses the plantar aspect of the midfoot to insert on the plantar-lateral aspect of the medial cuneiform and the base of the first metatarsal. Because of this unique anatomical course, its contraction not only everts the hindfoot but also strongly plantarflexes the first ray, which is critical for stabilizing the medial column during the push-off phase of gait.

Question 6942

Topic: 8. Foot and Ankle

A 45-year-old female presents with progressive flattening of her medial longitudinal arch and medial midfoot pain. Which of the following ligamentous structures is primarily responsible for supporting the talar head and the medial longitudinal arch?

. Anterior talofibular ligament
. Calcaneofibular ligament
. Plantar calcaneocuboid ligament
. Plantar calcaneonavicular ligament
. Long plantar ligament

Correct Answer & Explanation

. Plantar calcaneonavicular ligament

Explanation

Correct Answer: DThe spring ligament, also known as the plantar calcaneonavicular ligament, is a critical static stabilizer of the medial longitudinal arch. It spans from the sustentaculum tali of the calcaneus to the navicular, forming a sling that supports the head of the talus. Failure or attenuation of the spring ligament is a key component in the pathophysiology of adult-acquired flatfoot deformity (posterior tibial tendon dysfunction).

Question 6943

Topic: 8. Foot and Ankle

During the normal gait cycle, the foot must transition from a flexible structure to a rigid lever. Which joint complex is primarily responsible for allowing the midfoot to lock into a rigid lever for propulsion and unlock for adaptability?

. Subtalar joint
. Transverse tarsal joint
. Tarsometatarsal (Lisfranc) joint
. Metatarsophalangeal joints
. Tibiotalar joint

Correct Answer & Explanation

. Transverse tarsal joint

Explanation

Correct Answer: BThe transverse tarsal joint, also known as Chopart's joint, consists of the talonavicular and calcaneocuboid articulations. Biomechanically, the axes of these two joints become parallel when the hindfoot is everted, making the midfoot flexible to accommodate uneven terrain. When the hindfoot inverts (as during the push-off phase of gait), the axes become divergent, locking the midfoot into a rigid lever to allow for efficient forward propulsion.

Question 6944

Topic: 8. Foot and Ankle

A 25-year-old athlete sustains a twisting injury to the ankle. Plain radiographs are negative for fracture, but there is high clinical suspicion for a syndesmotic injury. According to the provided text, which of the following imaging modalities is preferred for evaluating the soft tissue integrity of the syndesmosis, and what is used to assess dynamic instability?

. CT scan for soft tissue integrity; MRI for dynamic instability
. Ultrasound for soft tissue integrity; CT scan for dynamic instability
. MRI for soft tissue integrity; stress radiographs for dynamic instability
. Bone scan for soft tissue integrity; weight-bearing radiographs for dynamic instability
. Stress radiographs for soft tissue integrity; MRI for dynamic instability

Correct Answer & Explanation

. MRI for soft tissue integrity; stress radiographs for dynamic instability

Explanation

Correct Answer: CThe text explicitly states that Magnetic Resonance Imaging (MRI) is the preferred modality for evaluating soft tissue injuries, including syndesmotic tears, deltoid ligament ruptures, and osteochondral lesions. However, to assess dynamic instability of the syndesmosis, stress radiographs (such as external rotation stress views) are indicated. CT scans are excellent for evaluating bony architecture and fracture comminution but are less sensitive for isolated soft tissue injuries compared to MRI.

Question 6945

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. What is the primary biomechanical rationale for this critical step?

. It prevents subluxation of the peroneal tendons.
. It dictates the width of the ankle mortise.
. It restores the tension of the Achilles tendon.
. It prevents impingement of the anterior inferior tibiofibular ligament.
. It ensures proper tracking of the extensor digitorum longus.

Correct Answer & Explanation

. It dictates the width of the ankle mortise.

Explanation

Correct Answer: BAnatomical reduction of the fibula is paramount in ankle fracture surgery. The text highlights that restoration of fibular length is critical because it dictates the width of the ankle mortise. Shortening or malrotation of the fibula leads to lateral shift and external rotation of the talus within the mortise. Even a 1 mm lateral shift of the talus can significantly decrease the tibiotalar contact area, leading to altered biomechanics and early post-traumatic arthritis.

Question 6946

Topic: 8. Foot and Ankle

A patient sustains a laceration to the anterior aspect of the lower leg, resulting in an isolated injury to the deep peroneal nerve. Which of the following clinical findings would be expected?

. Loss of sensation over the lateral aspect of the foot and weakness in eversion
. Loss of sensation over the entire dorsum of the foot and weakness in plantarflexion
. Loss of sensation in the first web space and weakness in dorsiflexion
. Loss of sensation on the plantar aspect of the foot and weakness in toe flexion
. Loss of sensation over the medial malleolus and weakness in inversion

Correct Answer & Explanation

. Loss of sensation in the first web space and weakness in dorsiflexion

Explanation

Correct Answer: CThe common peroneal nerve bifurcates into the superficial and deep peroneal nerves. The deep peroneal nerve provides motor innervation to the muscles of the anterior compartment of the leg (tibialis anterior, extensor hallucis longus, extensor digitorum longus, and peroneus tertius), which are responsible for ankle and toe dorsiflexion. It also provides sensory innervation to the first web space of the foot. Therefore, an isolated injury to the deep peroneal nerve results in weakness in dorsiflexion (foot drop) and sensory loss in the first web space.

Question 6947

Topic: Forefoot

Based on the provided text, 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 50%

Correct Answer & Explanation

. Over 35%

Explanation

Correct Answer: DAccording to the provided text, forefoot deformities such as hallux valgus are highly prevalent. They affect approximately 23% of adults aged 18-65 and over 35% in the population over the age of 65. This high prevalence underscores the significant burden of this condition, which often requires surgical correction due to pain and difficulty with shoe wear.

Question 6948

Topic: Forefoot

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

. 10%
. 23%
. 35%
. 50%
. 65%

Correct Answer & Explanation

. 35%

Explanation

Correct Answer: 35%According to the provided text, forefoot deformities such as hallux valgus affect approximately 23% of adults aged 18-65 and over 35% in those over 65. This high prevalence often leads to pain and shoe wear difficulties, frequently requiring surgical correction.

Question 6949

Topic: 8. Foot and Ankle

Which of the following tarsal bones is characterized by a complete absence of muscular attachments?

. Calcaneus
. Navicular
. Cuboid
. Talus
. Medial cuneiform

Correct Answer & Explanation

. Talus

Explanation

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

Question 6950

Topic: 8. Foot and Ankle

In addition to hindfoot eversion, what is the primary biomechanical function of the peroneus longus tendon during the gait cycle?

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

Correct Answer & Explanation

. Plantarflexion of the first ray

Explanation

Correct Answer: Plantarflexion of the first rayThe peroneus longus and brevis tendons are responsible for eversion of the foot. Additionally, because the peroneus longus tendon courses under the cuboid to insert on the base of the first metatarsal and medial cuneiform, it acts as a primary plantarflexor of the first ray, which is critical for stabilizing the medial column during the push-off phase of gait.

Question 6951

Topic: 8. Foot and Ankle

Which joint complex is primarily responsible for allowing the midfoot to transition between a flexible structure for shock absorption and a rigid lever for propulsion during gait?

. 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 (Chopart's joint), which consists of the calcaneocuboid and talonavicular joints, works in concert with the subtalar joint. It allows the midfoot to unlock for adaptability and shock absorption during heel strike, and lock into a rigid lever for efficient propulsion during toe-off.

Question 6952

Topic: 8. Foot and Ankle

Dysfunction of which of the following tendons is the primary driver in the pathogenesis of adult-acquired flatfoot deformity?

. Flexor hallucis longus
. Tibialis anterior
. Peroneus brevis
. Posterior tibial tendon
. Achilles tendon

Correct Answer & Explanation

. Posterior tibial tendon

Explanation

Correct Answer: Posterior tibial tendonThe posterior tibial tendon is crucial for inversion of the foot and dynamic support of the medial longitudinal arch. Its dysfunction or rupture is the primary cause of adult-acquired flatfoot deformity, leading to progressive collapse of the arch and subsequent hindfoot valgus and forefoot abduction.

Question 6953

Topic: 8. Foot and Ankle

During open reduction and internal fixation of a bimalleolar equivalent ankle fracture, why is the precise anatomical restoration of fibular length considered critical?

. It prevents post-operative stiffness of the subtalar joint
. It dictates the width and stability of the ankle mortise
. It ensures proper tensioning of the Achilles tendon
. It prevents iatrogenic injury to the superficial peroneal nerve
. It allows for early weight-bearing without the need for syndesmotic fixation

Correct Answer & Explanation

. It dictates the width and stability of the ankle mortise

Explanation

Correct Answer: It dictates the width and stability of the ankle mortiseThe lateral malleolus acts as a critical buttress for the talus. Restoration of fibular length, rotation, and alignment is paramount because it directly dictates the width of the ankle mortise. Shortening of the fibula leads to lateral talar shift, widening of the mortise, and significantly altered contact stresses, which can rapidly lead to post-traumatic osteoarthritis.

Question 6954

Topic: Forefoot

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

. 15%
. 23%
. 35%
. 50%
. 65%

Correct Answer & Explanation

. 35%

Explanation

Correct Answer: CThe 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 high prevalence often necessitates surgical correction due to pain and shoe wear difficulties.

Question 6955

Topic: 8. Foot and Ankle

The deltoid ligament is a robust structure providing significant medial ankle stability. 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: DThe deltoid ligament is composed of superficial and deep layers. The superficial layer includes the tibiocalcaneal, tibionavicular, and superficial posterior tibiotalar ligaments. The deep layer consists of the deep posterior tibiotalar and deep anterior tibiotalar ligaments.

Question 6956

Topic: 8. Foot and Ankle

In addition to its role in hindfoot eversion, what is the primary biomechanical function of the peroneus longus tendon in the foot?

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

Correct Answer & Explanation

. Plantarflexion of the first ray

Explanation

Correct Answer: BThe text notes that laterally, the peroneus longus and brevis tendons are responsible for eversion, with the peroneus longus also contributing to the plantarflexion of the first ray.

Question 6957

Topic: 8. Foot and Ankle

A patient presents with an inability to dorsiflex the ankle and numbness isolated to the first web space of the foot. 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: BThe common peroneal nerve bifurcates into the superficial and deep peroneal nerves. The deep peroneal nerve provides motor innervation to the anterior compartment muscles (responsible for dorsiflexion) and sensory innervation to the first web space.

Question 6958

Topic: 8. Foot and Ankle

Which two articulations comprise the transverse tarsal joint, allowing the midfoot to lock into a rigid lever for propulsion or unlock for adaptability?

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

Correct Answer & Explanation

. Calcaneocuboid and talonavicular joints

Explanation

Correct Answer: BThe transverse tarsal joint, also known as Chopart's joint, consists of the calcaneocuboid and talonavicular joints. It plays a crucial biomechanical role in allowing the midfoot to lock into a rigid lever for propulsion during toe-off or unlock for adaptability on uneven surfaces.

Question 6959

Topic: 8. Foot and Ankle

The spring ligament is crucial for supporting the talar head and the medial longitudinal arch. Which two bony structures does this ligament connect?

. Talus and navicular
. Calcaneus and cuboid
. Calcaneus and navicular
. Talus and calcaneus
. Navicular and medial cuneiform

Correct Answer & Explanation

. Calcaneus and navicular

Explanation

Correct Answer: CThe spring ligament is anatomically known as the plantar calcaneonavicular ligament. It connects the calcaneus to the navicular bone, forming a critical sling that supports the talar head and maintains the medial longitudinal arch.

Question 6960

Topic: 8. Foot and Ankle

According to the provided text, which imaging modality is preferred for evaluating a suspected deltoid ligament rupture or an osteochondral lesion of the talus?

. Weight-bearing plain radiographs
. Computed Tomography (CT)
. Magnetic Resonance Imaging (MRI)
. Ultrasound
. Stress radiographs

Correct Answer & Explanation

. Magnetic Resonance Imaging (MRI)

Explanation

Correct Answer: CWhile CT scans are invaluable for assessing complex fractures and articular comminution, Magnetic Resonance Imaging (MRI) is the preferred modality for evaluating soft tissue injuries, including syndesmotic tears, deltoid ligament ruptures, osteochondral lesions, and tendon pathologies.

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