Multiple Choice Questions

Foot & Ankle

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Please use the comments section at the bottom of the page if you have any query or feedback about any of the questions.


57. A 27-year-old banker injures his foot and sustains a displaced divergent Lisfranc fracture-dislocation.
The optimal management would consist of:

A) Below knee plaster cast
B) Closed or open reduction and screw stabilization
C) Closed or open reduction and K-wire stabilization
D) A bridging external fixator
E) Closed or open reduction and combined screw and K-wire stabilization

Correct Answer : E

The tarsometatarsal joint is best thought of in three columns: a medial column (first tarsometatarsal joint), a middle column (second and third tarsometatarsal joints) and a lateral column (fourth and fifth tarsometatarsal joints).

Any dislocation or subluxation needs reduction. A cast or external fixator does not hold the reduction adequately.
Although there are many ways to stabilize the fracture-dislocation after reduction, it is generally accepted that the medial and middle columns should be treated with permanent fixation (for example screws) and the lateral column should have temporary fixation (for example K-wires removed after 6–12 weeks). This is due to the relatively greater mobility of the lateral column.

Author : Zihad Taher


56. The Achilles tendon reflex (ankle reflex) is transmitted through which of the following nerve roots

A) L4
B) L5
C) S1
D) S2
E) S3

Correct Answer : C

The Achilles tendon reflex is based upon the triceps muscle group (medial and lateral gastrocnemius muscles and soleus muscle) and is transmitted through the S1 nerve root.
Note the reflexes and the associated nerve roots:
Patellar tendon reflex – L4
Posterior tibial reflex – L5
Achilles tendon reflex – S1

Author : Rajesh Bahadur Lakhey


55. The extensor digitorum longus and brevis muscles are primarily innervated by which of the following nerve roots

A) L1
B) L2
C) L3
D) L4
E) L5

Correct Answer : E

The extensor digitorum and longus muscles are primarily innervated by the L5 nerve root.
Remember that the L5 nerve root innervates the following muscles:
– Extensor hallucis longus
Extensor digitorum longus and brevis
Gluteus medius

Author : Rajesh Bahadur Lakhey


54. A magnetic resonance image (MRI) of the right foot of a 16-year-old female cross-country runner is presented. 

The patient complains of progressive pain in her right foot. 

Recommended initial management should include:

A) Excisional biopsy
B) A period of non-weight bearing with further workup including nutritional and endocrine evaluation
C) Resumption of activities as tolerated
D) Open reduction internal fixation
E) Incisional biopsy

Correct Answer: B

The MRI demonstrates a stress fracture of the second metatarsal. 

Appropriate initial management includes a period of non-weight bearing, as well as assessment of risk factors for additional stress fractures such as poor nutrition and amenorrhea.

Author: Rajesh Bahadur Lakhey


53. 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:

A) Professional dancers
B) Recreational athletes
C) Non-athletes
D) Professional athletes
E) All groups can be expected to have similar success

Correct Answer: E

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.

Author: Rajesh Bahadur Lakhey


52. Isolated subtalar fusion:

A) Is not associated with development of ankle or transverse tarsal joint arthritis
B) Is associated only with development of transverse joint arthritis, but the ankle joint is spared
C) Is associated only with development of ankle arthritis, but the transverse tarsal joints are spared
D) Is associated with the development of both ankle and transverse tarsal joint arthritis
E) Is associated with knee joint degenerative arthritis

Correct Answer: D

In 48 subtalar fusions followed for 5 years, 36% of patients developed ankle arthritis and 41% of patients developed transverse tarsal joint arthritis.

Author: Rajesh Bahadur Lakhey


51. Take-down of ankle arthrodesis and conversion to total ankle replacement:

A) Is impossible if the fibula has been resected
B) Is a dependable procedure with a rate of complications similar to primary ankle replacement
C) Has a poor clinical success rate if there is no clear underlying cause of pain from the ankle fusion
D) Results in minimal gains in ankle range of motion
E) Requires custom made prosthetic implants 

Correct Answer: C

This article studied the success rates of revising previous ankle fusions to ankle replacement. The authors found that if the etiology of a patient’s pain was unclear, the patients did poorly. Patients with prior fibula resection could still be revised to ankle replacement with allograft bone to support the lateral side of the implant. Range of motion following revision to arthroplasty was comparable to primary replacement.

Author: Rajesh Bahadur Lakhey


50. Which of the following is the most reliable way to determine that a deltoid ligament injury is associated with a Weber B level lateral malleolus fracture:

A) The presence of medial tenderness on clinical examination 
B) The presence of medial ecchymosis on clinical examination 
C) The presence of significant medial swelling on clinical examination 
D) Evidence of medial clear space widening on stress radiographs
E) The presence of lateral malleolus tenderness 

Correct Answer: D 

Weber B supination, external rotation ankle fractures were evaluated to determine the reliability of medial tenderness, ecchymosis, and swelling in predicting deltoid incompetence. These clinical signs were poorly predictive, and stress radiographs were recommended for an accurate diagnosis of instability.

Author: Rajesh Bahadur Lakhey


49. The main blood supply to the talar body is from the:

A) Peroneal artery
B) Dorsalis pedis artery
C) Artery of the tarsal canal
D) Artery of the sinus tarsi
E) 1st dorsal metatarsal artery

Correct Answer: C

The main blood supply to the body of the talus is the artery of the tarsal canal, which is a branch off the posterior tibial artery. 

The dorsalis pedis and the artery of the sinus tarsi supply the talar head.