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8. Foot and Ankle MCQs

Practice Set 5 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 81

Topic: 8. Foot and Ankle

When evaluating a patient with an acutely dislocated knee, the initial ankle-brachial index (ABI) is calculated to be 0.85. What is the next most appropriate step in management?

. Observation and repeat ABI in 4 hours
. Discharge with a hinged knee brace and outpatient follow-up
. CT angiography of the lower extremity
. Immediate blind surgical exploration of the popliteal fossa
. Application of a bridging external fixator alone

Correct Answer & Explanation

. CT angiography of the lower extremity

Explanation

An ABI less than 0.90 after a knee dislocation is highly suspicious for a popliteal artery injury. Advanced imaging, such as CT angiography or standard angiography, is immediately indicated.

Question 82

Topic: 8. Foot and Ankle

Findings associated with severe quadriceps contusions include:

. Markedly decreased knee range of motion
. Septic knee effusion
. Two-thirds of normal knee range of motion
. Decreased hip range of motion
. Decreased ankle range of motion

Correct Answer & Explanation

. Markedly decreased knee range of motion

Explanation

A severe quadriceps contusion is defined as having less then one-third the normal knee range of motion and can be accompanied by a sympathetic knee effusion and, sometimes, a mild extensor lag. Two-thirds the normal knee range of motion is classified as a moderate quadriceps contusion.

Question 83

Topic: 8. Foot and Ankle

The initial recommended treatment for a grade 3 acute lateral ankle sprain is:

. Acute lateral ankle reconstruction
. Acute lateral ankle repair (modified Brostrom)
. Functional bracing and rehabilitation
. Nonweight bearing cast for 3 months
. Weight bearing cast for 6 weeks

Correct Answer & Explanation

. Functional bracing and rehabilitation

Explanation

A review of 12 prospective studies comparing surgery, casting, and functional bracing with early range of motion revealed 75% to 100% excellent or good results regardless of treatment. The final recommendation was functional bracing.

Question 84

Topic: 8. Foot and Ankle

Earlier return to work and sport is reported after which treatment for acute lateral ligament sprain:

. Acute lateral ankle reconstruction
. Acute lateral ankle repair (modified Brostrom)
. Functional bracing and rehabilitation
. Nonweight bearing cast for 3 months
. Weight bearing cast for 6 weeks

Correct Answer & Explanation

. Functional bracing and rehabilitation

Explanation

Studies comparing surgery, immobilization, and early weight bearing and range of motion have shown that early weight bearing and range of motion result in earlier return to sport and work when compared to acute operative management or cast immobilization.

Question 85

Topic: 8. Foot and Ankle

Which of the following leads to lower success rates after lateral ankle ligament repair (modified Brostrom):

. Recurrent instability
. Younger age
. Male gender
. Generalized ligamentous laxity
. History of bilateral ankle sprains

Correct Answer & Explanation

. Generalized ligamentous laxity

Explanation

Patients with generalized ligamentous laxity have fewer satisfactory results after a modified Brostrom repair. Overall, 91% of patients had good to excellent results after this procedure, but none of the five patients with generalized ligamentous laxity had an excellent result.

Question 86

Topic: 8. Foot and Ankle

With regard to the level of athletics, which group of patients can be expected to have less satisfactory results after lateral ankle repair using a modified Brostrom technique:

. Professional dancers
. Recreational athletes
. Non-athletes
. Professional athletes
. All groups can be expected to have similar success

Correct Answer & Explanation

. All groups can be expected to have similar success

Explanation

In a series of 28 ankles undergoing a modified Brostrom repair for lateral ankle instability, there were no significant differences in outcome whether the patients were professional dancers, athletes, or non-athletes.

Question 87

Topic: 8. Foot and Ankle

The foot and ankle position that is most likely to result in disruption of the anterior talofibular ligament is:

. Plantarflexion and eversion
. Dorsiflexion and inversion
. Plantarflexion and inversion
. Dorsiflexion and eversion
. The anterior talofibular ligament is uncommonly injured after an ankle sprain.

Correct Answer & Explanation

. Plantarflexion and inversion

Explanation

Strain in the anterior talofibular ligament increases with plantarflexion, inversion, and internal rotation. It is the primary restraint to anterior displacement, internal rotation, and inversion of the talus at all angles of flexion and is the most commonly injured ligament as a result of inversion ankle sprains.

Question 88

Topic: 8. Foot and Ankle

What is the mechanism of injury that leads to the clinical diagnosis of "turf toe":

. Forced lateral stress
. Forced medial stress
. Forced plantarflexion
. Forced compression of the first MTP
. Forced dorsiflexion

Correct Answer & Explanation

. Forced dorsiflexion

Explanation

Turf toe is a sprain of the plantar capsuloligamentous complex of the first MTP joint that is associated with play on artificial playing surfaces. The classic mechanism of injury is a forced hyperextension injury to the 1st MTP joint. Dorsiflexion in excess of a normal range of motion can lead to varying degrees of soft tissue capsular disruption or injury to the articular cartilage and subchondral bone. Factors that predispose a player to injury are increasing age, number of years in professional football, pes planus, and decreased range of motion in the ankle and/or 1st MTP joint.

Question 89

Topic: 8. Foot and Ankle

During a football tackle, a player sustains an injury to the distal tibiofibular syndesmosis. What is the most common mechanism of injury for a 'high ankle sprain'?

. Inversion and plantarflexion of the foot
. External rotation of the foot relative to the tibia
. Direct axial loading with the ankle in neutral
. Internal rotation of the foot with the ankle dorsiflexed

Correct Answer & Explanation

. External rotation of the foot relative to the tibia

Explanation

The most common mechanism for a syndesmotic (high ankle) sprain is forced external rotation of the foot on the tibia. This often occurs while the ankle is dorsiflexed, causing the talus to separate the distal fibula from the tibia.

Question 90

Topic: 8. Foot and Ankle

An athlete sustains a syndesmotic injury (high ankle sprain) during a tackle. What is the most common biomechanical mechanism of injury associated with this condition?

. Inversion of a plantarflexed foot
. Eversion of a plantarflexed foot
. External rotation of a dorsiflexed foot
. Internal rotation of a plantarflexed foot
. Direct axial loading of a neutral ankle

Correct Answer & Explanation

. External rotation of a dorsiflexed foot

Explanation

High ankle (syndesmotic) sprains typically occur via a forceful external rotation applied to a dorsiflexed ankle. This specific action wedges the wider anterior talar dome into the mortise, violently spreading the distal tibiofibular syndesmosis.

Question 91

Topic: 8. Foot and Ankle

A 21-year-old collegiate basketball player sustains an inversion ankle injury. He has tenderness over the anterior inferior tibiofibular ligament (AITFL) and a positive squeeze test. What is the most sensitive imaging modality or dynamic test for diagnosing a syndesmotic injury?

. Anteroposterior radiograph
. Mortise radiograph
. External rotation stress radiograph
. Gravity stress view
. Weight-bearing MRI

Correct Answer & Explanation

. External rotation stress radiograph

Explanation

The external rotation stress radiograph is a highly reliable dynamic test to evaluate for syndesmotic widening (high ankle sprain) by opening the medial clear space and demonstrating tibiofibular diastasis.

Question 92

Topic: 8. Foot and Ankle

A 35-year-old recreational tennis player has chronic, recalcitrant Achilles tendinopathy. MRI shows a focal area of tendinosis 4 cm proximal to the calcaneal insertion. What is the blood supply to this watershed area of the Achilles tendon?

. Posterior tibial artery
. Peroneal artery
. Anterior tibial artery
. Medial plantar artery
. Sural artery

Correct Answer & Explanation

. Peroneal artery

Explanation

The watershed area of the Achilles tendon is located 2-6 cm proximal to its insertion and is relatively hypovascular. Its primary blood supply in this region is derived from the peroneal artery.

Question 93

Topic: 8. Foot and Ankle

A 22-year-old pole vaulter presents with deep posterior ankle pain with extreme plantarflexion. Radiographs reveal an os trigonum. What structure is most at risk during an endoscopic excision of the os trigonum?

. Tibial nerve
. Sural nerve
. Flexor hallucis longus tendon
. Achilles tendon
. Peroneal brevis tendon

Correct Answer & Explanation

. Flexor hallucis longus tendon

Explanation

The flexor hallucis longus (FHL) tendon runs directly medial to the os trigonum. It is the structure most intimately associated with it and is at risk during surgical excision if medial dissection is not carefully controlled.

Question 94

Topic: 8. Foot and Ankle

During surgical evaluation of a midfoot injury, the surgeon identifies an avulsion fracture at the base of the second metatarsal (the "fleck sign"). The Lisfranc ligament, which is disrupted in this injury, natively connects which two osseous structures?

. Medial cuneiform to the base of the second metatarsal
. Middle cuneiform to the base of the second metatarsal
. Medial cuneiform to the base of the first metatarsal
. Cuboid to the base of the fourth metatarsal
. 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 runs from the lateral aspect of the medial cuneiform to the medial aspect of the base of the second metatarsal. It is critical for the stability of the tarsometatarsal articulation, and its avulsion produces the classic "fleck sign."

Question 95

Topic: 8. Foot and Ankle

A 22-year-old athlete sustains an axial load to a plantarflexed foot. Radiographs reveal the medial border of the second metatarsal base does not align with the middle cuneiform, and a "fleck sign" is present. Which ligament is primarily disrupted?

. The ligament connecting the first metatarsal to the medial cuneiform
. The ligament connecting the medial cuneiform to the base of the second metatarsal
. The ligament connecting the second metatarsal to the middle cuneiform
. The interosseous ligament between the second and third metatarsals
. The plantar fascia insertion at the first metatarsophalangeal joint

Correct Answer & Explanation

. The ligament connecting the medial cuneiform to the base of the second metatarsal

Explanation

The Lisfranc ligament is an interosseous ligament connecting the medial cuneiform to the base of the second metatarsal. The "fleck sign" is pathognomonic for an avulsion fracture at the attachment site of this critical stabilizing structure.

Question 96

Topic: 8. Foot and Ankle

How is an anterior drawer test performed to evaluate the competence of the anterior talofibular ligament in a patient with a possible ankle sprain:

. Knee bent, ankle dorsiflexed
. Knee bent, ankle neutral
. Knee bent, ankle plantar flexed
. Knee extended ankle neutral
. Knee extended ankle plantar flexed

Correct Answer & Explanation

. Knee bent, ankle plantar flexed

Explanation

The anterior drawer test should be performed with the patient sitting, the knee bent, and the ankle plantar flexed in a position of comfort. Flexing the knee relaxes the gastrocnemius. Plantar flexion relaxes the peroneals. The tibia is braced with one hand and the hindfoot is gently brought forward. The amount of anterior translation is compared between feet.

Question 97

Topic: 8. Foot and Ankle

A 35-year-old male sustains an acute Achilles tendon rupture. In comparing operative versus nonoperative management with early functional rehabilitation, current literature demonstrates:

. Significantly higher re-rupture rates in the nonoperative group
. Higher rates of deep infection in the nonoperative group
. No significant difference in re-rupture rates but higher soft-tissue complication rates in the operative group
. Significantly higher plantar flexion strength in the operative group
. Slower return to work in the operative group

Correct Answer & Explanation

. No significant difference in re-rupture rates but higher soft-tissue complication rates in the operative group

Explanation

Recent studies comparing operative vs. nonoperative management with early functional rehab show no significant difference in re-rupture rates. However, operative management has higher rates of soft-tissue complications.

Question 98

Topic: 8. Foot and Ankle

A 30-year-old male sustains a multiligament knee injury. An Ankle-Brachial Index (ABI) is measured at 0.8. What is the most appropriate next step in management?

. Immediate reduction and splinting
. Serial ABI measurements every 4 hours
. CT angiography of the lower extremity
. Immediate surgical exploration of the popliteal artery
. MR angiography of the lower extremity

Correct Answer & Explanation

. CT angiography of the lower extremity

Explanation

An ABI less than 0.9 after a knee dislocation is highly suspicious for a popliteal artery injury. A CT angiogram is indicated as the next step to definitively diagnose the exact location and extent of vascular injury.

Question 99

Topic: 8. Foot and Ankle

During surgical stabilization of a high ankle sprain (syndesmotic injury) in an athlete, what is the biomechanical advantage of using a suture-button construct over traditional static screw fixation?

. It requires removal prior to return to play
. It rigidifies the distal tibiofibular joint completely
. It allows physiologic motion of the fibula in the incisura fibularis during dorsiflexion
. It prevents late diastasis by stimulating cross-synostosis
. It eliminates the need for intraoperative fluoroscopy

Correct Answer & Explanation

. It allows physiologic motion of the fibula in the incisura fibularis during dorsiflexion

Explanation

Suture-button constructs provide dynamic stabilization, allowing normal physiologic external rotation and superior translation of the fibula during ankle dorsiflexion. They also typically eliminate the need for routine hardware removal.

Question 100

Topic: 8. Foot and Ankle

In acute Achilles tendon ruptures, recent high-level evidence comparing non-operative management utilizing early functional rehabilitation to surgical repair demonstrates:

. Significantly higher re-rupture rates in the non-operative group
. Significantly higher wound complication rates in the non-operative group
. Equivalent re-rupture rates but higher deep infection rates in the operative group
. Equivalent re-rupture rates between both groups with fewer total complications in the non-operative group
. Better ultimate plantar flexion strength in the non-operative group

Correct Answer & Explanation

. Equivalent re-rupture rates between both groups with fewer total complications in the non-operative group

Explanation

Modern meta-analyses show that when early functional rehabilitation (weight-bearing and early ROM) is employed, non-operative management has re-rupture rates equivalent to surgery. Furthermore, non-operative treatment completely avoids surgical complications such as infection and wound breakdown.

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