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8. Foot and Ankle MCQs

Practice Set 4 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 61

Topic: 8. Foot and Ankle

Which of the following is a non-weight-bearing bone of the lower leg?

. Tibia
. Fibula
. Femur
. Patella
. Talus

Correct Answer & Explanation

. Fibula

Explanation

The fibula primarily serves as a site for muscle attachment and helps stabilize the ankle, but it does not bear significant weight. The tibia is the main weight-bearing bone of the lower leg.

Question 62

Topic: 8. Foot and Ankle

The most common site for a stress fracture in runners is the:

. Femur
. Fibula
. Tibia
. Metatarsals
. Calcaneus

Correct Answer & Explanation

. Tibia

Explanation

The tibia, specifically the proximal or mid-shaft, is a very common site for stress fractures in runners due to repetitive loading during impact activities. Metatarsals are also common.

Question 63

Topic: 8. Foot and Ankle

What is the common term for inflammation of the plantar fascia?

. Achilles tendonitis
. Tarsal tunnel syndrome
. Morton's neuroma
. Plantar fasciitis
. Bunions

Correct Answer & Explanation

. Plantar fasciitis

Explanation

Plantar fasciitis is a common cause of heel pain, resulting from inflammation and microtears in the plantar fascia at its attachment to the calcaneus.

Question 64

Topic: 8. Foot and Ankle

Which medication class is associated with an increased risk of Achilles tendon rupture?

. NSAIDs
. Fluoroquinolone antibiotics
. Corticosteroids
. Beta-blockers
. Statins

Correct Answer & Explanation

. Fluoroquinolone antibiotics

Explanation

Fluoroquinolone antibiotics (e.g., ciprofloxacin, levofloxacin) are known to be associated with an increased risk of tendinopathy and tendon rupture, particularly of the Achilles tendon.

Question 65

Topic: 8. Foot and Ankle

What is the initial management for an acute Achilles tendon rupture?

. Immobilization in plantarflexion and referral to orthopedics
. Immediate surgical repair
. Weight-bearing exercise
. Corticosteroid injection
. Massage therapy

Correct Answer & Explanation

. Immobilization in plantarflexion and referral to orthopedics

Explanation

Initial management for an acute Achilles tendon rupture involves immobilization of the ankle in plantarflexion to approximate the tendon ends, followed by prompt orthopedic evaluation to determine if surgical or non-surgical treatment is best.

Question 66

Topic: 8. Foot and Ankle

A patient presents to the trauma bay with a knee dislocation that has just been reduced. The physical examination is notable for an Ankle-Brachial Index (ABI) of 0.85. What is the most appropriate next step in management?

. Observation with serial clinical examinations every 4 hours
. Immediate surgical exploration of the popliteal artery
. CT angiography of the lower extremity
. Duplex ultrasound in 24 hours
. Application of a hinged knee brace and discharge

Correct Answer & Explanation

. CT angiography of the lower extremity

Explanation

An ABI less than 0.9 in the setting of a knee dislocation is highly suspicious for an intimal tear or occlusion of the popliteal artery. CT angiography is the recommended next step to definitively evaluate the vascular status before potential intervention.

Question 67

Topic: 8. Foot and Ankle

The anterior talofibular ligament (ATFL) functions as the primary restraint to anterior translation of the talus within the ankle mortise. It achieves its maximum tension and primary restraining function when the ankle is in what position?

. Maximal dorsiflexion
. Neutral position
. Plantarflexion
. Eversion
. Abduction

Correct Answer & Explanation

. Plantarflexion

Explanation

The ATFL is oriented vertically and becomes tightest when the ankle is in plantarflexion, making it the primary restraint to anterior talar translation in this position.

Question 68

Topic: 8. Foot and Ankle

Which of the following is considered the most common complication following surgical repair of an acute Achilles tendon rupture when compared to nonoperative management?

. Higher re-rupture rate
. Decreased plantarflexion strength
. Sural nerve injury and wound complications
. Deep vein thrombosis
. Anterior talofibular ligament laxity

Correct Answer & Explanation

. Sural nerve injury and wound complications

Explanation

Operative management of Achilles tendon ruptures has a historically lower re-rupture rate but carries a significantly higher risk of wound complications and iatrogenic nerve injury, specifically to the sural nerve.

Question 69

Topic: 8. Foot and Ankle
A 28-year-old soccer player sustains an inversion ankle sprain and later develops chronic lateral ankle instability. Which of the following surgical procedures utilizes the peroneus brevis tendon to reconstruct the lateral ligaments, but is associated with restricted subtalar motion?
. Brostrรถm-Gould procedure
. Chrisman-Snook procedure
. Internal brace augmentation
. Tarsal tunnel release
. Kidner procedure

Correct Answer & Explanation

. Chrisman-Snook procedure

Explanation

The Chrisman-Snook procedure is a non-anatomic tenodesis using a split peroneus brevis tendon to reconstruct the ATFL and CFL. It is known to restrict subtalar motion and alter normal biomechanics compared to anatomic repairs.

Question 70

Topic: 8. Foot and Ankle

A patient presents to the emergency department with an obviously deformed, dislocated knee following a high-velocity trauma. The foot is cool and pulseless. The immediate first step in management is:

. CT angiography of the lower extremity
. Immediate closed reduction of the knee
. Surgical exploration by vascular surgery
. Ankle-brachial index (ABI) measurement
. Application of an external fixator

Correct Answer & Explanation

. Immediate closed reduction of the knee

Explanation

In the setting of an acute, unreduced knee dislocation with vascular compromise, immediate closed reduction must be performed first. This restores anatomic alignment and often relieves tension or kinking of the popliteal artery.

Question 71

Topic: 8. Foot and Ankle

High ankle sprains (syndesmotic injuries) typically require a longer return-to-play timeframe compared to lateral ankle sprains. Which mechanism of injury is classically responsible for an isolated syndesmotic sprain?

. Plantarflexion and internal inversion
. Dorsiflexion and external rotation
. Plantarflexion and external rotation
. Direct axial loading in neutral
. Hyperplantarflexion

Correct Answer & Explanation

. Dorsiflexion and external rotation

Explanation

Syndesmotic injuries are classically caused by a forced dorsiflexion and external rotation mechanism. This motion forces the wider anterior dome of the talus into the mortise, spreading the distal tibiofibular joint.

Question 72

Topic: 8. Foot and Ankle

A 35-year-old male sustains an acute Achilles tendon rupture. Compared to conservative management with an accelerated functional rehabilitation protocol, surgical repair is statistically associated with which of the following outcome profiles?

. Lower re-rupture rate and higher wound complications
. Higher re-rupture rate and lower wound complications
. Similar re-rupture rate and lower wound complications
. Lower re-rupture rate and lower wound complications
. Similar re-rupture rate and similar wound complications

Correct Answer & Explanation

. Lower re-rupture rate and higher wound complications

Explanation

Current meta-analyses indicate that surgical repair of acute Achilles ruptures slightly decreases the re-rupture rate compared to functional bracing but significantly increases the risk of complications such as wound breakdown and infection.

Question 73

Topic: 8. Foot and Ankle
A patient presents with a traumatic multi-ligamentous knee dislocation (KD-III) that reduced spontaneously. Pedal pulses are palpable and symmetric. The ankle-brachial index (ABI) is measured at 0.85. What is the most appropriate next step in management?
. Discharge to home with close outpatient follow-up
. Hospital admission for serial neurovascular checks alone
. CT angiography of the lower extremity
. Immediate surgical exploration of the popliteal artery
. Duplex ultrasound of the lower extremity in 1 week

Correct Answer & Explanation

. CT angiography of the lower extremity

Explanation

An ABI less than 0.90 following a knee dislocation is highly suspicious for a vascular injury, even if pedal pulses are palpable. CT angiography is definitively indicated to evaluate for an intimal tear or popliteal artery occlusion.

Question 74

Topic: 8. Foot and Ankle

Which of the following radiographic parameters on a standard AP or Mortise view of the ankle is considered the most reliable indicator of a syndesmotic injury?

. Tibiofibular overlap less than 1 mm on the mortise view
. Tibiofibular clear space greater than 5 mm on the AP view
. Medial clear space greater than 4 mm on the mortise view
. Talocrural angle less than 78 degrees
. Talar tilt greater than 10 degrees

Correct Answer & Explanation

. Tibiofibular clear space greater than 5 mm on the AP view

Explanation

A tibiofibular clear space greater than 5 mm measured on AP or mortise views 1 cm proximal to the joint line is the most reliable radiographic parameter for diagnosing a syndesmosis injury. Tibiofibular overlap is highly dependent on ankle rotation.

Question 75

Topic: 8. Foot and Ankle

A 30-year-old male presents after a high-energy dashboard injury resulting in a knee dislocation that spontaneously reduced. His pedal pulses are palpable. What is the most appropriate initial screening tool to evaluate for an occult popliteal artery injury?

. CT angiography
. MR angiography
. Ankle-brachial index (ABI)
. Duplex ultrasound
. Routine serial clinical examinations

Correct Answer & Explanation

. Ankle-brachial index (ABI)

Explanation

Ankle-brachial index (ABI) is the most appropriate initial screening tool for vascular injury following knee dislocation. An ABI of less than 0.9 mandates further investigation with CT angiography or prompt surgical exploration.

Question 76

Topic: 8. Foot and Ankle

A 25-year-old male is brought to the emergency department after a high-speed motorcycle accident. Clinical examination reveals a grossly deformed knee that is reduced under sedation. Post-reduction Ankle-Brachial Index (ABI) is 0.85. What is the most appropriate next step in management?

. Discharge with a knee immobilizer and outpatient MRI
. Immediate surgical exploration of the popliteal artery
. CT angiography of the lower extremity
. Observation and repeat ABI in 4 hours
. Perform a duplex ultrasound in the emergency department

Correct Answer & Explanation

. CT angiography of the lower extremity

Explanation

An ABI of < 0.9 after a knee dislocation is highly suspicious for a vascular injury and mandates further imaging with CT angiography. Immediate surgical exploration without imaging is generally reserved for hard signs of vascular ischemia, such as absent pulses, an expanding hematoma, or active pulsatile bleeding.

Question 77

Topic: 8. Foot and Ankle

A 40-year-old male sustains an acute Achilles tendon rupture playing basketball. When comparing operative to non-operative management with early functional rehabilitation, which statement is true?

. Non-operative management has a significantly higher re-rupture rate with early functional rehab.
. Operative management carries a higher risk of wound complications and infection.
. Operative management yields significantly superior plantar flexion strength at 2 years.
. Non-operative management requires 8 weeks of strict non-weight-bearing.
. There is a 50% re-rupture rate in the non-operative group.

Correct Answer & Explanation

. Operative management carries a higher risk of wound complications and infection.

Explanation

Recent literature shows that with early functional rehabilitation, re-rupture rates between operative and non-operative groups are similar. However, operative management consistently carries a higher risk of soft-tissue complications such as infection and wound breakdown.

Question 78

Topic: 8. Foot and Ankle

Recent high-level evidence comparing operative versus non-operative management of acute Achilles tendon ruptures, when utilizing modern early functional rehabilitation protocols, concludes that:

. Operative treatment significantly reduces re-rupture rates compared to non-operative treatment
. Non-operative treatment has a significantly higher rate of deep vein thrombosis
. Re-rupture rates are similar, but operative treatment carries higher wound complication rates
. Operative treatment results in significantly greater peak plantarflexion strength at 1 year
. Non-operative treatment leads to significantly lower rates of return to sport

Correct Answer & Explanation

. Re-rupture rates are similar, but operative treatment carries higher wound complication rates

Explanation

When early weight-bearing and functional rehabilitation protocols are used, re-rupture rates between operative and non-operative groups are essentially equal. However, operative management carries a higher risk of complications such as infection and nerve injury.

Question 79

Topic: Ankle Trauma & Sports

During an arthroscopic Brostrom-Gould procedure for chronic ankle instability, which structure is utilized to augment the repair of the anterior talofibular ligament?

. Peroneus brevis tendon
. Inferior extensor retinaculum
. Superior peroneal retinaculum
. Plantaris tendon
. Anterior tibialis tendon

Correct Answer & Explanation

. Inferior extensor retinaculum

Explanation

The modified Brostrom-Gould procedure involves an anatomic repair of the ATFL and CFL, augmented by pulling the inferior extensor retinaculum over the repair. This provides a secondary restraint and limits excessive inversion.

Question 80

Topic: 8. Foot and Ankle
A patient sustains a KD III knee dislocation. The ankle-brachial index (ABI) in the emergency department is 0.85. What is the next most appropriate step in management?
. Immediate surgical exploration of the popliteal artery
. CT angiography of the lower extremity
. Duplex ultrasonography
. Observation with serial neurovascular checks
. Application of a spanning external fixator

Correct Answer & Explanation

. CT angiography of the lower extremity

Explanation

An ABI < 0.9 in the setting of a knee dislocation is highly suspicious for a vascular injury and requires definitive vascular imaging, typically CT angiography. Immediate exploration is reserved for hard signs of ischemia, such as absent pulses or an expanding hematoma.

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