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8. Foot and Ankle MCQs

Practice Set 8 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 141

Topic: 8. Foot and Ankle

Which of the following conditions is not associated with an increased risk of cavus foot:

. Freidreich ataxia
. Spina bifida
. C harcot-Marie-Tooth disease
. Tethered cord
. C alcaneonavicular coalition

Correct Answer & Explanation

. C alcaneonavicular coalition

Explanation

Calcaneonavicular coalition is typically associated with a planovalgus foot. Freidreich ataxia, spina bifida, Charcot-Marie-Tooth disease, and tethered cord are often associated with a cavus foot.

Question 142

Topic: 8. Foot and Ankle

Following triple arthrodesis, total ankle range of motion is:

. Not affected because the tibiotalar joint is not fused in a triple arthrodesis
. Is increased because it must compensate for the loss of motion through the hindfoot joints
. Is increased in plantarflexion only; dorsiflexion is unchanged
. Is decreased in both dorsiflexion and plantarflexion
. Is decreased in plantarflexion only; dorsiflexion is unchanged

Correct Answer & Explanation

. Is decreased in plantarflexion only; dorsiflexion is unchanged

Explanation

Total ankle motion is a combination of tibiotalar motion as well as motion in the hindfoot joints. A 10-year follow-up study by Smith and colleagues evaluated the change in range of motion following triple arthrodesis. The authors found a 27% loss of ankle plantarflexion following triple arthrodesis, but no loss of dorsiflexion. Despite this loss of motion, 93% of patients were satisfied at average 10-year follow-up.

Question 143

Topic: 8. Foot and Ankle

A 13-year-old boy presents with rigid flatfeet and a history of recurrent ankle sprains. Radiographs show an 'anteater nose' sign. Which of the following is the most likely diagnosis?

. Talocalcaneal coalition
. Calcaneonavicular coalition
. Congenital vertical talus
. Accessory navicular
. Sever's disease

Correct Answer & Explanation

. Talocalcaneal coalition

Explanation

The 'anteater nose' sign on an oblique radiograph of the foot is pathognomonic for a calcaneonavicular coalition. Talocalcaneal coalitions are typically identified by the 'C-sign' on a lateral radiograph.

Question 144

Topic: 8. Foot and Ankle

Which of the following conditions is represented in the clinical photographs (Slide 1, Slide 2):

. Ectrodactyly
. C onstriction band syndrome
. Macrodactyly
. Microdactyly
. C lubfoot

Correct Answer & Explanation

. Ectrodactyly

Explanation

This patient has ectrodactyly, which is a condition characterized by the central absence of rays. Ectrodactyly, also known as cleft foot or lobster- claw, may affect the upper or lower extremities. The incidence is rare (approximately 1/90,000 live births). The condition may result from a defect in the apical ectodermal ridge. Associated anomalies are not always present but may include cleft hand, deafness, tibial hemimelia, or urinary tract anomalies. Patients with ectrodactyly have nearly normal function, as long as the foot is not so wide as to prohibit normal shoe wear. If shoe wear is difficult, then the foot can be reconstructed using flaps to close the cleft and metatarsal osteotomies as indicated.

Question 145

Topic: 8. Foot and Ankle

A 13-year-old boy presents with recurrent ankle sprains and rigid flat feet. CT scan confirms a calcaneonavicular coalition. If conservative management fails, what is the surgical treatment of choice for a coalition comprising less than 50% of the joint space with no degenerative changes?

. Triple arthrodesis
. Subtalar arthrodesis
. Resection of the coalition and interposition of the extensor digitorum brevis
. Calcaneal lengthening osteotomy
. Talonavicular arthrodesis

Correct Answer & Explanation

. Resection of the coalition and interposition of the extensor digitorum brevis

Explanation

Symptomatic calcaneonavicular coalitions failing nonoperative treatment are treated with resection and interposition (e.g., EDB muscle or fat) to prevent recurrence. This is preferred over arthrodesis if there is no advanced arthritis.

Question 146

Topic: 8. Foot and Ankle

A 15-year-old boy complains of vague, chronic ankle pain and a history of frequent sprains. Clinical examination reveals a rigid flatfoot. Lateral radiographs demonstrate a positive 'C-sign'. Which of the following is the most likely diagnosis?

. Calcaneonavicular coalition
. Talocalcaneal coalition
. Symptomatic accessory navicular
. Posterior tibial tendon insufficiency
. Congenital vertical talus

Correct Answer & Explanation

. Talocalcaneal coalition

Explanation

The 'C-sign' on a lateral foot radiograph is formed by the continuous bony outline of the talar dome and the sustentaculum tali. It is a classic radiographic indicator of a talocalcaneal coalition.

Question 147

Topic: 8. Foot and Ankle

A 14-year-old adolescent presents with a rigid flatfoot, hindfoot valgus, and frequent ankle sprains. CT scan shows a solid bony bridge between the middle facet of the talus and the calcaneus.

What is the most likely diagnosis?

. Calcaneonavicular coalition
. Talocalcaneal coalition
. Talonavicular coalition
. Naviculocuneiform coalition
. Cuboidonavicular coalition

Correct Answer & Explanation

. Talocalcaneal coalition

Explanation

Talocalcaneal coalitions commonly present in adolescence with a rigid, peroneal spastic flatfoot. The coalition most frequently occurs at the middle facet between the talus and calcaneus.

Question 148

Topic: 8. Foot and Ankle

A 12-year-old boy presents with recurrent ankle sprains and a painful, rigid flatfoot.

CT confirms a calcaneonavicular coalition. What is the most common radiographic sign of this condition seen on a lateral plain film?

. C-sign
. Anteater nose sign
. Talar beak
. Too many toes sign
. Metatarsus adductus

Correct Answer & Explanation

. Anteater nose sign

Explanation

The anteater nose sign is seen on the lateral radiograph and represents an elongated anterior process of the calcaneus, indicative of a calcaneonavicular coalition. The C-sign is typically associated with talocalcaneal coalitions.

Question 149

Topic: 8. Foot and Ankle

During the initial phases of the Ponseti method for correcting clubfoot (talipes equinovarus), the foot is externally rotated/abducted. To avoid creating a midfoot breach, counter-pressure must be correctly applied to which specific anatomical structure?

. Calcaneocuboid joint
. Lateral aspect of the calcaneus
. Lateral aspect of the head of the talus
. Base of the fifth metatarsal
. Medial malleolus

Correct Answer & Explanation

. Lateral aspect of the head of the talus

Explanation

In the Ponseti technique, the deformity is corrected by abducting the supinated foot while applying counter-pressure to the lateral aspect of the head of the talus. Pressing on the calcaneocuboid joint or fifth metatarsal risks blocking the calcaneus from abducting, leading to a midfoot break.

Question 150

Topic: 8. Foot and Ankle

Which of the following is the most specific feature of congenital vertical talus that distinguishes it from other deformities:

. Hindfoot equinus
. Forefoot adduction
. Talonavicular dislocation
. Peroneal tightness
. Increased talonavicular angle

Correct Answer & Explanation

. Talonavicular dislocation

Explanation

The essential lesion in congenital vertical talus is a dorsolateral dislocation of the talonavicular joint.

Question 151

Topic: Midfoot & Hindfoot

An 11-year-old girl presents with bilateral painful flatfeet. A computed tomography image is shown (Slide). The most likely diagnosis is:

. Idiopathic planovalgus feet
. Talocalcaneal coalition
. Degenerative joint disease
. Osteoid osteoma
. Osteochondritis dissecans

Correct Answer & Explanation

. Talocalcaneal coalition

Explanation

This patient has evolving medial talocalcaneal facet coalition. The computed tomography is remarkable for obliquity of the medial facet, along with irregularity and narrowing of this facet, which is not evident on plain radiographs. Normally the medial subtalar facet should be parallel to the posterior facet. Treatment options for this patient include immobilization, resection, or subtalar fusion.

Question 152

Topic: 8. Foot and Ankle
A 3-month-old female infant presents with the dorsum of the foot almost in contact with the anterior tibia. She has no pain with movement; plantar flexion and inversion of the feet are not restricted, but there is difficulty in manipulating the foot to the neutral position. She is normal otherwise. Which of the following treatments is most appropriate:
. Observation ± passive stretching
. Serial casting
. Botulinum toxin to peroneals
. Serial casting and then surgery
. Surgical reduction

Correct Answer & Explanation

. Observation ± passive stretching

Explanation

This is a patient with positional calcaneovalgus, which is a more common condition than congenital vertical talus (CVT). Patients with such deformity should be evaluated carefully and differentiated from the more serious CVT. In calcaneovalgus foot, the problem is in the ankle, which is in calcaneus position. The arch itself may be normal. In CVT, the ankle is normal and the problem is in the foot. The foot is essentially plantigrade, but the arch is reversed. Typically, a deep crease in the sinus tarsi and some forefoot abduction are present. No difference was found between the calcaneovalgus feet that underwent manipulation and casting versus observation alone, when assessed at 3 to 11 years of follow-up. Surgery is never required for a positional calcaneovalgus deformity, which is not true for CVT. Long-term prognosis of positional calcaneovalgus is excellent.

Question 153

Topic: 8. Foot and Ankle

A 12-year-old boy with Charcot-Marie-Tooth disease presents with a progressive rigid cavovarus foot deformity.

Examination reveals a positive Coleman block test indicating hindfoot flexibility. The deformity is primarily driven by the relative overactivity of which muscle?

. Tibialis anterior
. Peroneus brevis
. Peroneus longus
. Extensor hallucis longus
. Gastrocnemius

Correct Answer & Explanation

. Peroneus longus

Explanation

In Charcot-Marie-Tooth disease, the tibialis anterior and peroneus brevis weaken early. The relatively preserved peroneus longus overpowers the tibialis anterior, causing plantarflexion of the first ray and driving the forefoot-driven cavovarus deformity.

Question 154

Topic: 8. Foot and Ankle

A 12-year-old child with spastic diplegic cerebral palsy presents with a progressive crouch gait. Which of the following prior surgical interventions is the most common iatrogenic cause of this gait pattern?

. Hamstring lengthening
. Psoas release
. Achilles tendon lengthening
. Rectus femoris transfer
. Distal femoral extension osteotomy

Correct Answer & Explanation

. Achilles tendon lengthening

Explanation

Over-lengthening of the Achilles tendon leads to calcaneus gait and triceps surae weakness. This causes failure of the plantar flexion-knee extension couple, resulting in an iatrogenic crouch gait.

Question 155

Topic: 8. Foot and Ankle

A 13-year-old boy presents with a rigid flatfoot and frequent recurrent ankle sprains. Radiographs reveal a continuous 'C-sign' on the lateral foot view. Which of the following physical examination findings is most characteristic of this condition?

. Inability to passively dorsiflex the great toe
. Decreased subtalar motion with peroneal spasticity
. Hypoesthesia in the first web space
. Hindfoot varus during the single-leg heel rise test
. A palpable gap in the Achilles tendon

Correct Answer & Explanation

. Decreased subtalar motion with peroneal spasticity

Explanation

The 'C-sign' indicates a talocalcaneal coalition. Patients typically present with a rigid flatfoot, decreased subtalar motion, and secondary peroneal spasticity.

Question 156

Topic: 8. Foot and Ankle

A 7-year-old boy with spastic diplegic cerebral palsy presents with worsening crouch gait. He previously underwent isolated heel cord lengthening at age 4. Physical exam shows tight hamstrings and excessive ankle dorsiflexion. What is the most likely iatrogenic cause of his crouch gait?

. Over-lengthening of the Achilles tendon
. Under-lengthening of the hamstrings
. Excessive femoral anteversion
. Failure to address hip flexor contractures
. Over-lengthening of the psoas tendon

Correct Answer & Explanation

. Over-lengthening of the Achilles tendon

Explanation

Over-lengthening of the Achilles tendon in a child with CP removes the plantarflexion-knee extension couple, leading to excessive dorsiflexion and crouch gait. Concomitant unaddressed hamstring tightness exacerbates knee flexion.

Question 157

Topic: 8. Foot and Ankle

During the Ponseti method for clubfoot correction, the physician must sequentially correct the deformities. Which of the following describes the correct order of correction and the anatomical fulcrum used during manipulation?

. CAVE (Cavus, Adductus, Varus, Equinus); fulcrum at the calcaneocuboid joint
. CAVE; fulcrum at the lateral head of the talus
. EVAC (Equinus, Varus, Adductus, Cavus); fulcrum at the medial malleolus
. CAVE; fulcrum at the base of the 5th metatarsal
. VACE; fulcrum at the lateral head of the talus

Correct Answer & Explanation

. CAVE; fulcrum at the lateral head of the talus

Explanation

The Ponseti method corrects deformities in the CAVE sequence (Cavus, Adductus, Varus, Equinus). The manipulation involves supinating the forefoot to correct cavus, then abducting the foot using the lateral head of the talus as the fulcrum.

Question 158

Topic: 8. Foot and Ankle

A 4-year-old boy presents with calf pseudohypertrophy, a waddling gait, and uses his hands to push on his legs to stand up from the floor. Genetic testing reveals a mutation in the dystrophin gene. Which of the following is the most appropriate initial orthopedic consideration?

. Early prophylactic Achilles tendon lengthening
. Scoliosis screening by age 5
. Initiation of systemic corticosteroids
. Bilateral hip reconstructive surgery
. Immediate wheelchair prescription to preserve muscle strength

Correct Answer & Explanation

. Initiation of systemic corticosteroids

Explanation

The boy has Duchenne Muscular Dystrophy (DMD). Systemic corticosteroids are the mainstay of medical treatment to prolong ambulation and preserve pulmonary and cardiac function. Orthopedic interventions occur later as the disease progresses.

Question 159

Topic: 8. Foot and Ankle

A 14-year-old boy presents with frequent ankle sprains and rigid, painful flatfeet. Oblique radiographs of the foot reveal an "anteater nose" sign. What is the most appropriate initial surgical intervention if conservative management fails?

. Subtalar fusion
. Triple arthrodesis
. Excision of calcaneonavicular coalition with interposition
. Calcaneal lengthening osteotomy
. Excision of talocalcaneal coalition

Correct Answer & Explanation

. Excision of calcaneonavicular coalition with interposition

Explanation

The "anteater nose" sign is pathognomonic for a calcaneonavicular coalition. The standard surgical treatment after failed conservative care is resection of the coalition with interposition of fat or the extensor digitorum brevis muscle.

Question 160

Topic: Midfoot & Hindfoot

A mutation in the gene for peripheral myelin protein 22 causes which of the following disorders:

. Friedreich ataxia
. Charcot-Marie-Tooth disease
. Cerebral palsy
. Adrenoleukodystrophy
. Fragile X syndrome

Correct Answer & Explanation

. Charcot-Marie-Tooth disease

Explanation

Type I, or the hypertrophic demyelinating form, is the most common form of Charcot-Marie-Tooth disease. It is due to a mutation in the gene on chromosome 22, which encodes for peripheral myelin protein 22. Type I C harcot-Marie-Tooth disease has a prevalence of approximately 1 in 5,000 individuals.

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