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8. Foot and Ankle MCQs

Practice Set 43 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 841

Topic: 8. Foot and Ankle

A 45-year-old man presents with severe, intractable foot pain after a heavy object fell on his foot. Examination reveals tense swelling and extreme pain with passive toe extension. Which surgical approach is most commonly recommended to fully decompress all 9 compartments of the foot?

. A single dorsal incision centered over the third metatarsal
. Two dorsal incisions and one medial incision
. A single large plantar incision
. Two plantar incisions
. One medial and one lateral incision

Correct Answer & Explanation

. Two dorsal incisions and one medial incision

Explanation

To adequately release all nine compartments of the foot (interosseous, central, medial, lateral, and calcaneal), the classic recommended approach utilizes two dorsal incisions and one medial utility incision.

Question 842

Topic: 8. Foot and Ankle

A 30-year-old patient sustains a severe ankle injury that cannot be reduced in the emergency department. Radiographs demonstrate a Bosworth fracture-dislocation. What is the defining anatomic characteristic of this injury?

. Proximal fibula fracture with rupture of the interosseous membrane
. Avulsion of the posterior malleolus with a complete syndesmotic tear
. Dislocation of the proximal tibiofibular joint
. Entrapment of the proximal fibular fragment behind the posterior tubercle of the tibia
. Pure ligamentous dislocation of the talus without any associated fractures

Correct Answer & Explanation

. Entrapment of the proximal fibular fragment behind the posterior tubercle of the tibia

Explanation

A Bosworth fracture-dislocation is characterized by the proximal fragment of the fractured fibula becoming rigidly entrapped behind the posterior tibial tubercle. This prevents closed reduction and necessitates emergent open reduction.

Question 843

Topic: 8. Foot and Ankle

A 22-year-old football player complains of midfoot pain after his plantarflexed foot was axially loaded. An AP radiograph reveals a small osseous fragment in the space between the bases of the first and second metatarsals, known as the 'fleck sign'. This represents an avulsion of the Lisfranc ligament from which bone?

. Base of the first metatarsal
. Base of the second metatarsal
. Medial cuneiform
. Intermediate cuneiform
. Cuboid

Correct Answer & Explanation

. Base of the second metatarsal

Explanation

The 'fleck sign' is pathognomonic for a Lisfranc injury and represents a bony avulsion of the Lisfranc ligament from its attachment at the base of the second metatarsal.

Question 844

Topic: 8. Foot and Ankle

Which of the following conditions is a well-recognized late sequela of an unrecognized or untreated foot compartment syndrome?

. Acquired flatfoot deformity
. Claw toe deformity
. Hallux valgus
. Tarsal coalition
. Metatarsus adductus

Correct Answer & Explanation

. Claw toe deformity

Explanation

Untreated compartment syndrome of the foot typically leads to ischemic contracture of the intrinsic muscles. This muscle imbalance results in a classic claw toe deformity.

Question 845

Topic: 8. Foot and Ankle

When utilizing the dual dorsal incision technique for foot fasciotomies, the surgical incisions are classically placed over or adjacent to which specific structures?

. The first and fifth metatarsals
. Slightly medial to the second metatarsal and slightly lateral to the fourth metatarsal
. Directly over the second and fourth metatarsals
. Directly over the first and third metatarsals
. Over the talonavicular and calcaneocuboid joints

Correct Answer & Explanation

. Slightly medial to the second metatarsal and slightly lateral to the fourth metatarsal

Explanation

The two dorsal incisions for foot fasciotomy are placed slightly medial to the second metatarsal and slightly lateral to the fourth metatarsal. This allows access to the interosseous compartments and the deep central compartment.

Question 846

Topic: 8. Foot and Ankle

A 28-year-old male undergoes a midfoot arthrodesis for a severe Lisfranc injury. To preserve essential midfoot accommodation and flexibility during gait, which tarsometatarsal (TMT) joints should purposefully be spared from fusion?

. 1st TMT joint
. 2nd TMT joint
. 3rd TMT joint
. 4th and 5th TMT joints
. Naviculocuneiform joint

Correct Answer & Explanation

. 4th and 5th TMT joints

Explanation

The 4th and 5th TMT joints are highly mobile and act to accommodate uneven terrain. Arthrodesis of these lateral columns is generally avoided to prevent a stiff, painful foot.

Question 847

Topic: Ankle Trauma & Sports
A 35-year-old skier presents with an ankle fracture resulting from a pronation-abduction (PA) mechanism. What is the characteristic morphology of the fibular fracture in a Lauge-Hansen PA stage III injury?
. Transverse fracture at or below the syndesmosis
. Short oblique fracture extending from anterior-inferior to posterior-superior
. High spiral fracture of the proximal fibula
. Comminuted or short oblique fibular fracture with a lateral butterfly fragment at the level of the joint
. Avulsion fracture of the fibular tip

Correct Answer & Explanation

. Comminuted or short oblique fibular fracture with a lateral butterfly fragment at the level of the joint

Explanation

A pronation-abduction injury classically results in a transverse or comminuted fibular fracture at the level of the syndesmosis, often presenting with a lateral butterfly fragment due to bending forces.

Question 848

Topic: 8. Foot and Ankle

Recent biomechanical studies suggest that open reduction and internal fixation of a posterior malleolus fracture in the setting of a syndesmotic injury provides which of the following mechanical advantages?

. Decreases the need to repair the anterior talofibular ligament
. Restores syndesmotic stability equivalent to or better than a trans-syndesmotic screw
. Eliminates the need for medial malleolus fixation
. Prevents the development of anterior ankle impingement
. Re-establishes the functional pull of the Achilles tendon

Correct Answer & Explanation

. Restores syndesmotic stability equivalent to or better than a trans-syndesmotic screw

Explanation

Anatomical fixation of the posterior malleolus restores the footprint of the posterior inferior tibiofibular ligament (PITFL). This restores syndesmotic stability, often obviating the need for syndesmotic screws.

Question 849

Topic: Ankle Trauma & Sports

A 20-year-old gymnast complains of medial ankle pain and proximal lateral calf pain after landing awkwardly. Radiographs reveal a widened medial clear space and a proximal third fibula fracture. What is the appropriate surgical management for this Maisonneuve injury?

. Non-operative management in a short leg cast
. Open reduction and internal fixation of the proximal fibula only
. Syndesmotic reduction and stabilization with screws or suture buttons
. Medial malleolus pinning only
. Primary arthrodesis of the distal tibiofibular joint

Correct Answer & Explanation

. Syndesmotic reduction and stabilization with screws or suture buttons

Explanation

A Maisonneuve fracture involves disruption of the medial structures, interosseous membrane, and proximal fibula, leading to an unstable syndesmosis. The primary treatment relies on anatomical reduction and fixation of the syndesmosis.

Question 850

Topic: 8. Foot and Ankle

Which of the following describes the anatomical attachments of the Lisfranc ligament?

. 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 base of the third metatarsal
. Cuboid to the base of the fourth metatarsal

Correct Answer & Explanation

. Medial cuneiform to the base of the second metatarsal

Explanation

The Lisfranc ligament is a strong interosseous ligament that connects the medial cuneiform to the base of the second metatarsal. It is critical for the stability of the midfoot arch.

Question 851

Topic: 8. Foot and Ankle

The Lisfranc ligament is a crucial stabilizing structure of the midfoot. Anatomically, it connects which of the following two osseous structures?

. Medial cuneiform to the base of the 1st metatarsal
. Lateral aspect of the medial cuneiform to the medial aspect of the 2nd metatarsal base
. Middle cuneiform to the base of the 2nd metatarsal
. Lateral cuneiform to the base of the 3rd metatarsal
. Cuboid to the base of the 4th metatarsal

Correct Answer & Explanation

. Lateral aspect of the medial cuneiform to the medial aspect of the 2nd metatarsal base

Explanation

The Lisfranc ligament is an intra-articular ligament that courses from the lateral aspect of the medial cuneiform to the medial aspect of the second metatarsal base. It is essential for the stability of the tarsometatarsal articulation.

Question 852

Topic: 8. Foot and Ankle

A patient suffers an unrecognized foot compartment syndrome following a crush injury. Months later, what is the most common late clinical sequela resulting from intrinsic muscle ischemia and contracture?

. Hallux valgus
. Claw toes
. Pes planovalgus
. Hammer toes
. Drop foot

Correct Answer & Explanation

. Claw toes

Explanation

Unrecognized foot compartment syndrome leads to ischemic contracture of the intrinsic muscles of the foot. This most classically results in a rigid claw toe deformity.

Question 853

Topic: 8. Foot and Ankle

According to the Lauge-Hansen classification, what is the first sequential structural failure in a Supination-External Rotation (SER) type ankle fracture?

. Rupture of the anterior inferior tibiofibular ligament (AITFL)
. Spiral fracture of the lateral malleolus
. Rupture of the posterior inferior tibiofibular ligament (PITFL)
. Transverse fracture of the medial malleolus
. Rupture of the deltoid ligament

Correct Answer & Explanation

. Rupture of the anterior inferior tibiofibular ligament (AITFL)

Explanation

In the Lauge-Hansen SER mechanism, the sequence is: (1) AITFL rupture, (2) spiral fibular fracture, (3) PITFL rupture or posterior malleolus fracture, and (4) medial malleolus fracture or deltoid rupture.

Question 854

Topic: Midfoot & Hindfoot

Recent randomized controlled trials comparing open reduction internal fixation (ORIF) to primary arthrodesis for Lisfranc injuries have shown primary arthrodesis is most strongly indicated for which specific injury pattern?

. Purely ligamentous Lisfranc injuries
. Bony avulsion of the 2nd metatarsal base
. Open Lisfranc fracture-dislocations
. Injuries in high-level athletes
. Pediatric Lisfranc injuries

Correct Answer & Explanation

. Purely ligamentous Lisfranc injuries

Explanation

Multiple studies (such as those by Ly and Coetzee) have demonstrated that purely ligamentous Lisfranc injuries have better functional outcomes and lower reoperation rates with primary arthrodesis compared to ORIF.

Question 855

Topic: 8. Foot and Ankle

A 65-year-old patient with poorly controlled diabetes and severe peripheral neuropathy sustains an unstable bimalleolar ankle fracture. Which of the following modifications in surgical management is most appropriate to minimize postoperative complications?

. Nonoperative management with prolonged casting
. Standard ORIF with a single lateral plate
. External fixation only until union
. Enhanced ORIF with multiple syndesmotic screws and prolonged immobilization
. Immediate transtibial amputation

Correct Answer & Explanation

. Enhanced ORIF with multiple syndesmotic screws and prolonged immobilization

Explanation

Diabetic patients with neuropathy are at high risk for fixation failure and Charcot arthropathy. Enhanced fixation (e.g., locking plates, multiple syndesmotic screws, hindfoot nails) and prolonged immobilization (2-3 times normal) are recommended.

Question 856

Topic: 8. Foot and Ankle

A "fleck sign" on an AP or internal oblique radiograph of the foot is pathognomonic for a Lisfranc injury. This represents an osseous avulsion of the Lisfranc ligament typically from which location?

. Lateral aspect of the medial cuneiform
. Plantar-medial aspect of the base of the second metatarsal
. Dorsal aspect of the navicular
. Anterior process of the calcaneus
. Base of the fifth metatarsal

Correct Answer & Explanation

. Plantar-medial aspect of the base of the second metatarsal

Explanation

The fleck sign represents a bony avulsion of the Lisfranc ligament, most commonly pulling off a small fragment from the plantar-medial aspect of the base of the second metatarsal.

Question 857

Topic: Ankle Trauma & Sports

In a Pronation-External Rotation (PER) type ankle fracture according to the Lauge-Hansen classification, what is the most characteristic finding of the fibular fracture?

. Transverse fracture below the syndesmosis
. Spiral fracture starting at the joint line and extending posterosuperiorly
. Short oblique or spiral fracture above the level of the syndesmosis
. Transverse fracture at the level of the syndesmosis
. Comminuted fracture of the fibular head

Correct Answer & Explanation

. Short oblique or spiral fracture above the level of the syndesmosis

Explanation

The PER mechanism typically results in a high fibular fracture (Weber C type), which is a short oblique or spiral fracture located above the level of the syndesmosis.

Question 858

Topic: 8. Foot and Ankle

A patient presents with an irreducible fracture-dislocation of the ankle. Radiographs demonstrate a posterior dislocation of the fibula relative to the tibia. What is the pathomechanical block to reduction in this Bosworth fracture?

. Interposition of the posterior tibial tendon
. Entrapment of the proximal fibular fragment behind the posterior tibial tubercle
. Interposition of the deltoid ligament
. Incarceration of the flexor hallucis longus
. Buttonholing through the extensor retinaculum

Correct Answer & Explanation

. Entrapment of the proximal fibular fragment behind the posterior tibial tubercle

Explanation

A Bosworth fracture-dislocation is characterized by the proximal fragment of the fractured fibula becoming rigidly entrapped behind the posterior tubercle of the distal tibia, rendering it irreducible by closed means.

Question 859

Topic: Midfoot & Hindfoot

A 26-year-old athlete with a missed Lisfranc injury from 8 months ago now presents with chronic, debilitating midfoot pain and a severe flatfoot deformity. Weight-bearing radiographs confirm chronic dorsal subluxation of the 2nd TMT joint. What is the most appropriate surgical treatment?

. Open reduction and internal fixation with screws
. Tarsometatarsal joint debridement and primary closure
. Medializing calcaneal osteotomy
. Midfoot corrective arthrodesis of the affected TMT joints
. Primary repair of the Lisfranc ligament

Correct Answer & Explanation

. Midfoot corrective arthrodesis of the affected TMT joints

Explanation

In chronic, missed Lisfranc injuries with fixed deformity and secondary arthritic changes, corrective arthrodesis of the medial column (TMT joints) is required to restore anatomy and eliminate pain.

Question 860

Topic: 8. Foot and Ankle

Which of the following describes the most common mechanism of injury for a subtle, sports-related Lisfranc sprain?

. Direct crush injury to the dorsum of the foot
. Axial loading applied to a plantarflexed foot
. Forced hyperdorsiflexion of the ankle
. Direct forced inversion of the midfoot
. Pronation-abduction of the forefoot

Correct Answer & Explanation

. Axial loading applied to a plantarflexed foot

Explanation

The most common mechanism for sports-related Lisfranc injuries is axial loading onto a plantarflexed foot, which forcibly hyperplantarflexes the midfoot and ruptures the stabilizing ligaments.

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