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8. Foot and Ankle MCQs

Practice Set 9 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 161

Topic: 8. Foot and Ankle

The foot pictured in this clinical photograph (pic) represents:

. Calcaneovalgus foot
. Clubfoot
. Calcaneus foot
. Congenital vertical talus
. Skewfoot

Correct Answer & Explanation

. Congenital vertical talus

Explanation

The foot presented in the clinical photograph represents congenital vertical talus. Note the equinus of the hindfoot, calcaneus of the forefoot, and the crease in the sinus tarsi. In patients with a calcaneovalgus foot, the hindfoot is in calcaneus, not equinus.

Question 162

Topic: Midfoot & Hindfoot

Scapulothoracic fusion is most commonly indicated to help improve function in which of the following conditions:

. Duchenne muscular dystrophy
. Beckers muscular dystrophy
. Facioscapulohumeral dystrophy
. Charcot-Marie-Tooth disorder
. Congenital muscular dystrophy

Correct Answer & Explanation

. Facioscapulohumeral dystrophy

Explanation

Facioscapulohumeral dystrophy is a rare disorder inherited in an autosomal dominant fashion. Thirty percent of affected individuals have a new mutation. The genetic abnormality is found on chromosome 4, with a decreased number of D4Z4 tandem repeats, but this does not appear to code for a protein product. In this condition, selective weakness of the serratus anterior, trapezius, and rhomboid muscles is present. Therefore, the scapula is not effectively stabilized against the trunk during use. Although the deltoid is relatively spared, it cannot work well due to a hypermobile scapula. Fusion of the scapula to the thorax improves range of abduction in this condition.

Question 163

Topic: 8. Foot and Ankle

Which of the following physical examination findings is most indicative of an unrecognized sciatic nerve injury following a traumatic posterior hip dislocation in a 10-year-old child?

. Inability to actively extend the knee
. Inability to actively dorsiflex the ankle
. Loss of sensation over the medial thigh
. Weakness in hip adduction
. Inability to actively flex the hip

Correct Answer & Explanation

. Inability to actively dorsiflex the ankle

Explanation

The sciatic nerve, particularly its peroneal division, is at risk during posterior hip dislocations. Injury manifests as foot drop, characterized by weakness in ankle dorsiflexion and great toe extension.

Question 164

Topic: 8. Foot and Ankle

What is the characteristic mechanism of injury that produces a pediatric triplane fracture of the ankle?

. Supination-adduction
. External rotation applied to a supinated foot
. Pronation-abduction
. Direct axial loading
. Isolated internal rotation

Correct Answer & Explanation

. External rotation applied to a supinated foot

Explanation

Triplane fractures typically occur in older children and young adolescents nearing skeletal maturity. They are caused by an external rotation force applied to a supinated foot, creating fractures in the sagittal, coronal, and axial planes.

Question 165

Topic: 8. Foot and Ankle
An 11-year-old female patient with bilateral cavus feet presents with foot pain and callosities on the plantar surface of the foot. She is diagnosed with Charcot-Marie-Tooth disease and may require surgical intervention. During a standing Coleman's lateral block test, the patient's hindfoot varus corrects bilaterally when standing on a 1-inch wooden block. Which of the following surgical options is the most appropriate?
. Plantar fasciotomy
. Plantar-based opening wedge osteotomy of the medial cuneiform
. Osteotomy of the first metatarsal
. Lateral closing wedge osteotomy of the calcaneus
. Triple arthrodesis

Correct Answer & Explanation

. Plantar-based opening wedge osteotomy of the medial cuneiform

Explanation

This patient has a typical cavovarus foot. The key in evaluating the treatment options is the standing block test. Because her hindfoot varus is corrected during this test, her hindfoot is flexible and a calcaneal osteotomy is not necessary. Osteotomy of the base of the first metatarsal is also not preferred in such a case because the growth plate becomes at risk for arrest, the procedure requires internal fixation, the second metatarsal head becomes at risk for a stress transfer lesion, and is not located at the side of the deformity. In Charcot-Marie-Tooth disease, the deformity apex generally lies in the tarsometatarsal articulations and the medial cuneiform.

Question 166

Topic: 8. Foot and Ankle
Which of the following disorders is not a cause of cavus foot?
. Charcot-Marie-Tooth disease
. Friedreich's ataxia
. Myelomeningocele
. Poliomyelitis
. Tarsal coalition

Correct Answer & Explanation

. Tarsal coalition

Explanation

All of the disorders mentioned may cause cavus foot except for tarsal coalition.

Question 167

Topic: 8. Foot and Ankle

The mechanical axis of the lower extremity is defined as the angle formed by lines drawn from the center of the hip to the center of the knee to the center of the ankle. The resulting value should be:

. 15°
. 10°
. 7°
. 5°
. 0°

Correct Answer & Explanation

. 0°

Explanation

The mechanical axis should be 0°. Alignment following correctional osteotomies and arthroplasties must re-establish the mechanical axis.

Question 168

Topic: 8. Foot and Ankle

A 2-year-old boy presents with intoeing. An examination shows that his feet form an angle of 20° inward with the direction he is walking. Which of the following parameters describes his condition:

. Thigh-foot angle
. Tibial torsion angle
. Angle of femoral anteversion
. Foot progression angle
. Transmalleolar axis

Correct Answer & Explanation

. Foot progression angle

Explanation

The 20° inward angle formed with the direction the patient is walking is a foot progression angle. This angle encompasses all factors influencing position and progression of the lower extremity during gait.

Question 169

Topic: 8. Foot and Ankle

A 2-year-old patient presents with bowed legs. The metaphyseal diaphyseal angle is 17°, and the mechanical axis shows 15° of varus bilaterally. The varus appears to be in the proximal tibia. No evidence of metabolic disease or dysplasia is present. Recommended treatment inlcudes:

. Observation
. Knee-ankle-foot orthosis
. High tibial osteotomy
. Medial staple hemiepiphysiodesis
. Percutaneous hemiepiphysiodesis with drill

Correct Answer & Explanation

. Knee-ankle-foot orthosis

Explanation

This patient has infantile Blount disease. Brace treatment is appropriate to try, although it is not always successful. The best treatment is for the patient to wear a knee-ankle-foot brace full-time. High tibial osteotomy, medial staple hemiepiphysiodesis, and percutaneous hemiepiphysiodesis are inappropriate treatments for this patient at 2 years old. If the varus does not improve by the time the patient is 3.5 years old to 4 years old, then high tibial osteotomy should be performed.

Question 170

Topic: 8. Foot and Ankle

Which of the following methods of measuring limb length inequality includes the greatest number of factors leading to pelvic height difference:

. Scanogram
. Orthoroentgenogram
. Tape method
. Block method
. Teleroentgenogram

Correct Answer & Explanation

. Block method

Explanation

The block method consists of adding height to the short limb in blocks until the pelvis is level. The block method measures differences in foot height and pelvic size as well as inequalities of the long bones. Because the teleroentgenogram shows the whole limb in one exposure, the exposure is susceptible to be parallax and distorted at the ends. The orthoroentgenogram and scanogram measure limb length inequality similarly, but the scanogram captures only the joints and eliminates the diaphyses.

Question 171

Topic: 8. Foot and Ankle
A patient with myelomeningocele is a community ambulator. She has a minimal Trendelenburg's sign but has a calcaneus gait. Her motor level is:
. L2
. L3
. L4
. L5
. S1

Correct Answer & Explanation

. L5

Explanation

A calcaneus gait describes heel strike with no pushoff. This patient has active anterior tibialis with no gastrocsoleus. The Trendelenburg's test shows that her gluteals are minimal at less than L4. The patient's motor level is L5.

Question 172

Topic: 8. Foot and Ankle
A 1-year-old patient with L4 myelomeningocele presents with a foot complication. Radiographs are shown in neutral plantarflexion (Slide 1) and in maximal plantarflexion (Slide 2). Recommended treatment includes:
. Ponseti's cast treatment
. Orthotic treatment
. Complete subtalar release
. Open reduction of congenital talonavicular dislocation
. Excision of midtarsal bone

Correct Answer & Explanation

. Open reduction of congenital talonavicular dislocation

Explanation

This patient has a congenital vertical talus, also known as a congenital dorsolateral dislocation of the talonavicular joint. Because the navicular is not yet ossified, the dorsal position of the first metatarsal line illustrates evidence of the patient's congenital vertical talus when compared to the position of the talus. The congenital vertical talus is fixed because it does not become reduced upon maximum plantarflexion. The best treatment for congenital vertical talus is open reduction of the congenital talonavicular dislocation, with tendon lengthening.

Question 173

Topic: 8. Foot and Ankle

An infant with a severe clubfoot is undergoing serial casting using the Ponseti method. After four casts, the midfoot rotation is corrected, the heel is in valgus, and the talonavicular joint is reduced, but the foot remains in 15 degrees of equinus. What is the most appropriate next step in management?

. Percutaneous Achilles tenotomy
. Tibialis anterior tendon transfer
. Posterior release surgery
. Application of another cast pushing into forceful dorsiflexion
. Switch to a Denis Browne bar immediately

Correct Answer & Explanation

. Percutaneous Achilles tenotomy

Explanation

Once the cavus, adductus, and varus deformities are corrected and the talonavicular joint is reduced, residual equinus is treated with a percutaneous Achilles tenotomy followed by a final cast in dorsiflexion.

Question 174

Topic: 8. Foot and Ankle

A 14-year-old athlete presents with recurrent ankle sprains and a rigid, painful flatfoot. Lateral radiographs of the foot demonstrate a continuous bony bridge between the talus and calcaneus appearing as a "C-sign". Which tarsal coalition is most likely present?

. Calcaneonavicular coalition
. Talonavicular coalition
. Talocalcaneal coalition
. Calcaneocuboid coalition
. Naviculocuneiform coalition

Correct Answer & Explanation

. Talocalcaneal coalition

Explanation

The radiographic "C-sign" on a lateral view of the ankle/foot is highly specific for a talocalcaneal (subtalar) coalition. Calcaneonavicular coalitions typically show the "anteater nose" sign on an oblique view.

Question 175

Topic: 8. Foot and Ankle



A newborn presents with a rigid, rocker-bottom foot deformity. Radiographs demonstrate the navicular articulating with the dorsal aspect of the talar neck. This dislocation does not reduce on a maximum plantarflexion lateral radiograph. What is the diagnosis?

. Congenital vertical talus
. Oblique talus
. Severe equinovarus (clubfoot)
. Calcaneovalgus foot
. Metatarsus adductus

Correct Answer & Explanation

. Congenital vertical talus

Explanation

A rigid dorsal dislocation of the navicular on the talus that fails to reduce with forced plantarflexion is the pathognomonic radiographic finding of congenital vertical talus (CVT). An oblique talus would reduce on plantarflexion.

Question 176

Topic: 8. Foot and Ankle

A 14-year-old boy presents with frequent ankle sprains and rigid flatfeet. A CT scan confirms a calcaneonavicular coalition covering less than 50% of the joint surface, with no arthritic changes. Initial conservative management has failed. What is the recommended surgical intervention?

. Subtalar arthrodesis
. Triple arthrodesis
. Resection of the coalition with interposition of the EDB muscle belly
. Calcaneal lengthening osteotomy
. Medial displacement calcaneal osteotomy

Correct Answer & Explanation

. Resection of the coalition with interposition of the EDB muscle belly

Explanation

For a symptomatic calcaneonavicular coalition covering less than 50% of the joint without degenerative changes, resection of the coalition with interposition of the extensor digitorum brevis (EDB) or fat is the treatment of choice.

Question 177

Topic: 8. Foot and Ankle

A 3-year-old boy initially treated successfully with the Ponseti method for idiopathic clubfoot presents with dynamic supination of the foot during the swing phase of gait. Passive range of motion is normal. What is the treatment of choice?

. Repeat serial casting
. Anterior tibial tendon transfer to the lateral cuneiform
. Split posterior tibial tendon transfer
. Achilles tendon lengthening
. Triple arthrodesis

Correct Answer & Explanation

. Anterior tibial tendon transfer to the lateral cuneiform

Explanation

Dynamic supination in a previously corrected clubfoot is a classic sign of relapse. Since the foot is passively correctable, anterior tibial tendon (ATT) transfer to the lateral cuneiform is the standard procedure to balance the foot dynamically.

Question 178

Topic: 8. Foot and Ankle

During clinical gait analysis of a child with spastic diplegic cerebral palsy, a "crouch gait" is identified. Which combination of joint deformities best defines this gait pattern?

. Hip extension, knee extension, and ankle plantarflexion
. Hip flexion, knee flexion, and ankle dorsiflexion
. Hip flexion, knee extension, and ankle plantarflexion
. Hip extension, knee flexion, and ankle dorsiflexion
. Hip flexion, knee flexion, and ankle plantarflexion

Correct Answer & Explanation

. Hip flexion, knee flexion, and ankle dorsiflexion

Explanation

Crouch gait in cerebral palsy is characterized by excessive hip and knee flexion combined with excessive ankle dorsiflexion (calcaneus) during the stance phase. It often results from over-lengthened Achilles tendons.

Question 179

Topic: 8. Foot and Ankle

A 13-year-old male presents with recurrent ankle sprains and a rigid flatfoot. Radiographs show a "C-sign" on the lateral view.

Which of the following physical exam findings is most characteristic of this condition?

. Inability to heel walk
. Decreased subtalar joint motion
. Weakness of the tibialis anterior
. Positive Silfverskiold test
. Hyperlaxity of the first ray

Correct Answer & Explanation

. Decreased subtalar joint motion

Explanation

The "C-sign" on a lateral radiograph indicates a talocalcaneal coalition. The hallmark physical exam finding for a tarsal coalition is decreased or absent subtalar motion and a rigid, unyielding flatfoot deformity.

Question 180

Topic: 8. Foot and Ankle
Which of the following descriptions reflects all transverse-plane factors affecting the position of the patient's foot during gait:
. Thigh-foot angle
. Transmalleolar axis
. Foot progression angle
. Heel bisector
. Femoral anteversion

Correct Answer & Explanation

. Foot progression angle

Explanation

The foot-progression angle is a reflection of all transverse-plane factors affecting the position of the patient's foot during gait.

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