Multiple Choice Questions

Foot & Ankle

Test your knowledge , learn more and get ready for your orthopaedic exam

 61. A 59 year old man has a 3 year history of increased pain in his right foot with deformity. Examination reveals hindfoot fixed valgus of 15 degrees with midfoot abduction. He has tried nonsurgical treatment without relief. Which of the following would be the most appropriate surgical management?

A) Medial sliding os calcis osteotomy
B) Subtalar arthrodesis
C) Talonavicular arthrodesis
D) Subtalar arthrodesis with FDL transfer
E) Triple arthrodesis

Correct Answer : E

The most appropriate surgical treatment for stage III would triple arthrodesis.

Adult Acquired Flatfoot Deformity (AAFD) grading is by the Johnson and Strom classification system, which has classification grades of I to III. Myerson added a fourth grade in 1997. The classification system aids practitioners in identifying AAFD severity and also can guide treatment plans.

Stage I disease characteristically presents with posterior tibial tendon tenosynovitis with no arch collapse – Conservative with AFO +/- Tenosynovectomy
Stage II have flexible hindfoot, foot collapse and will be unable to perform a single-leg heel rise. This stage further subcategorizes into stage IIa and IIb. Stage IIa is foot collapse with valgus deformity of the hindfoot but no midfoot abduction, while in stage IIb midfoot abduction is present – Treatment with FDL transfer, calcaneal osteotomy, TAL, ± forefoot correction osteotomy ± spring ligament repair ± lateral column lengthening ± medial column arthrodesis ± PTT debridement
Stage III will have fixed deformity with hindfoot valgus and forefoot abduction.
Stage IV deformity will have ankle valgus secondary to deltoid ligament attenuation – triple arthrodesis and TAL + deltoid ligament reconstruction OR tibiotalocalcaneal arthrodesis (depending on flexibility of valgus ankle deformity)

Author : Firas Arnaout

 60. A 45-year-old manual worker presents with pain and resisted extension of the big toe. Plain radiograph shows a prominent dorsal osteophyte and early OA changes. Conservative management has failed.

What operative intervention would you suggest?

A) Cheilectomy
B) Chevron osteotomy
C) First MTPJ arthrodesis incorrect option
D) First MTPJ replacement
E) Lapidus

Correct Answer : A

Cheilectomy (first metatarsal osteotomy) for treatment of hallux rigidus will relieve dorsal impingement that is usually the source of pain in patients with this condition. Cheilectomy is recommended for mild to moderate deformity, that is, Grade1-2 and some 3s.

Arthrodesis is treatment of choice following failed cheilectomy or where advanced degenerative changes are present such as Grade 4 hallux rigidus and Grade 3 where <50% of the metatarsal head cartilage remains at the time of surgery.

Patients can also try non-operative options such as moulded shoe inserts or rocker bottom shoes.

Author : Firas Arnaout

 59. what is the mechanism of injury for ankle sprain:

A) plantarflexion and inversion
B) dorsiflexion and eversion
C) dorsiflexion
D) inversion
E) plantarflexion

Correct Answer : A

Lateral ligaments are commonly injured as compared to stronger deltoid ligament on medial side.

Author : Dr.Smita Patil

 58. Which of the following is FALSE regarding the following ankle injury, shown in the figure below:

A) This type of fracture is best treated by ORIF
B) This is usually caused by a Pronation-external rotation injury
C) This is a Spiral Fracture of the Lateral Malleolus and a transverse avulsion fracture of medial malleolus
D) The fracture shown is unstable
E) Migration of Talus bone is likely

Correct Answer : B

This is a supination-external rotation injury according to Hansen Classification. All other statements are true regarding this type of fracture. Lateral migration of Talus is likely

Author : Liam Borg

 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

 

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

 

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

 

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 

 

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 

 

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

 

48. Delayed unions and nonunions of base of fifth metatarsal fractures have been demonstrated to heal by:

A) Prolonged cast immobilization and non-weight bearing
B) Pulsed electromagnetic fields
C) Continued use of a fracture boot with protected weight-bearing
D) Injection of demineralized bone matrix
E) Rigid carbon fiber shoe inserts

 

47. A Moberg procedure for hallux rigidus is:

A) An oblique first metatarsal shortening osteotomy
B) An ostectomy of the medial eminence of the metatarsal 
C) A medial closing wedge osteotomy of the proximal phalanx
D) A dorsal closing wedge osteotomy of the proximal phalanx 
E) A lateral closing wedge osteotomy of the proximal phalanx

 

46. Triple arthrodesis is associated with

A) Long-term clinical stability with respect to pain relief
B) High rates of nonunion 
C) Worse patient satisfaction when ankle arthritis is present
D) Development of ankle arthritis over time 
E) No increased risk for ankle arthritis

 

45. Patients sustaining a crushing injury to the foot with midfoot tenderness but without any radiographic signs of fracture or dislocation:

A) Should be managed with a postoperative shoe and early physical therapy until the tenderness resolves
B) Should be splinted and kept non-weight bearing until nontender
C) Should be protected in a cast boot with early weight bearing to tolerance
D) Requires open reduction internal fixation to prevent long-term arthritis
E) Can be discharged with no further follow-up

 

44. Range of motion following total ankle replacement is closely correlated with:

A) Amount of osteophytes resected during surgery
B) Meticulous ligament balancing
C) Level of tibial and talar saw cuts
D) Preoperative range of motion
E) Size of implant

 

43. Varus malunion following talar neck fracture is best corrected by:

A) Subtalar arthrodesis
B) Rotational calcaneal osteotomy with a bone block
C) Deltoid ligament release and lateral ligament reconstruction
D) Talar neck osteotomy with lengthening or by triple arthrodesis 
E) Lateral column lengthening

 

42. How many weeks following open reduction and internal fixation of a right ankle fracture can patients resume driving with normal braking times:

A) 6 weeks
B) 9 weeks
C) 12 weeks 
D) 16 weeks
E) 18 weeks

 

41. Posterior antiglide plating of AO type B lateral malleolar fractures may be associated with

A) Early loss of fixation
B) Greater wound healing complications 
C) Syndesmotic irritation
D) Peroneal tendonitis or peroneal tendon lesions
E) Greater risk for nonunion

 

40. The incidence of compartment syndrome following calcaneus fracture is:

A) 5%
B) 10%
C) 15%
D) 20%
E) 30%

 

39. According to Sanders’ computed tomography (CT) classification for calcaneus fractures, a Sanders III fracture has:

A) One fracture line in the posterior facet
B) Two fracture lines in the posterior facet 
C) Three fracture lines in the posterior facet
D) Four fracture lines in the posterior facet
E) Five fracture lines in the posterior facet

 

38. The most effective fixation technique that will ensure adequate visualization of avascular necrosis changes following talar neck fracture is:

A) Fixation with 0.062-inch K-wires
B) Closed reduction
C) Fixation with stainless steel mini-fragment screws
D) Fixation with titanium screws
E) Fixation with a stainless steel locking plate

 

37. Which of the following statements describes the results of extracorporeal shock wave therapy for chronic plantar fasciitis:

A) No improvement in pain scores occurred at 4 or 12 weeks. 
B) No improvement in pain scores occurred at 4 weeks, but significant improvement occurred at 12 weeks.
C) Pain scores significantly improved at 4 and 12 weeks. 
D) Pain scores improved, but function did not improve. 
E) Although pain scores improved, less than 50% of the patients were satisfied

 

36. Which of the following muscles raises the arch of the foot during dorsiflexion:

A) Posterior tibial tendon
B) Peroneus longus tendon 
C) Plantar aponeurosis 
D) Gastroc-soleus complex
E) Anterior tibial tendon

 

35. Which of the following groups of muscles are located in the first layer of the foot muscles

A) Abductor hallucis, flexor digitorum brevis, quadratus plantae 
B) Flexor hallucis brevis, adductor hallucis, flexor digiti, minimi
C) Abductor, hallucis, flexor digitorum brevis, abductor digiti minimi
D) Quadratus plantae, lumbricals
E) Abductor hallucis, quadratus plantae, lumbricals 

 

34. Which of the following compartments are most commonly involved (increased tissue pressure) in compartment syndrome of the foot:

A) Superficial 
B) Medial 
C) Calcaneal 
D) Adductor
E) First interosseus

 

33. A 26-year-old woman presents for treatment, and the motion in the subtalar joint is normal. 

Ankle arthritis is noted radiographically. 

In a preoperative discussion, she states the desire to have as mobile a foot as possible, wear high heel shoes, and participate in realistic exercise activities. 

What is the ideal position for ankle arthrodesis:

A) 10° of dorsiflexion, 5° of valgus, and neutral rotation
B) Neutral dorsiflexion, 15° of valgus, and neutral rotation 
C) 10° of plantarflexion, 10° of valgus, and neutral rotation
D) 10° of plantarflexion, neutral valgus, and 10° of external rotation
E) Neutral dorsiflexion, 5° of valgus, and neutral rotation

32. A patient underwent an arthrodesis of the hallux metatarsophalangeal joint for correction of painful arthritis . She remains symptomatic and cannot walk without pain.

The most likely cause for her pain is:

A) Fusion of the hallux in too much plantarflexion
B) Fusion of the hallux in too much dorsiflexion
C) Fusion of the hallux in too much varus
D) Removal of too much bone in the metatarsophalangeal joint during fusion, leading to claw hallux
E) Removal of too much bone in the metatarsophalangeal joint during fusion, leading to lesser toe metatarsalgia

31. A 76-year-old man has experienced aching in the anterior aspect of his ankle for 6 months. He felt a sudden onset of soreness 6 months ago. Since then, he has noted weakness of the foot. 

He walks with a limp, and the foot hits the ground during the heel contact phase of gait. On examination there is a mobile subcutaneous mass in the anterior ankle. 

The patient’s magnetic resonance image (MRI) is presented .

Which of the following is the most accurate diagnosis:

A) A ganglion of the anterior ankle
B) Synovial sarcoma 
C) Pigmented villonodular synovitis
D) A rupture of the anterior tibial tendon
E) An accessory extensor hallucis longus

30. A 33-year-old recreational athlete presents for treatment of chronic ankle pain. He recalls multiple ankle sprains that occurred 10 years ago. He has not undergone any surgical treatment. 

On examination, his ankle is stable, there is no crepitus on range of motion, and pain is present to palpation of the posterior ankle. 

A computerized axial tomography is presented . 

The surgical procedure most consistent with a rapid recovery and predictable outcome is:

A) Ankle arthrodesis
B) Arthroscopy of the ankle with drilling of the osteochondral defect
C) Osteoarticular autograft procedure
D) Cartilage cell harvest with staged debridement of the talus and cartilage cell implantation
E) Osteoarticular allograft procedure

 

29. A 57-year-old woman presents for treatment of a painful flatfoot deformity. She says that her foot has been painful for 4 years, but she does not recall any injury to the foot. The opposite foot is not bothersome. 

Upon examination, she has pain in the midfoot and hindfoot. Resisted inversion is painful. She is able to perform a single and repetitive heel rise test. 

The most likely diagnosis is:

A) An unrecognized Lisfranc injury
B) Posterior tibial tendon rupture
C) Rupture of the spring ligament
D) Idiopathic tarsometatarsal arthritis
E) Calcaneonavicular tarsal coalition

 

28. Which of the following structures is disrupted in patients with an acute medial subtalar dislocation:

A) Lisfranc ligament
B) Long plantar ligament 
D) Calcaneonavicular ligament
C) Talocalcaneal ligament                                                                                                                                                                                                                      E) Anterior talofibular ligament

 

27. A foot is maximally dorsiflexed during this point of the gait cycle:

A) Midswing
B) Midstance
C) Toe off
D) Heelstrike
E) First one-third of stance

 

26. A patient sustains a fracture of the anterior process of the calcaneus. 

What ligament is responsible for avulsion of this bone:

A) Short plantar 
B) Long plantar 
C) Anterior talofibular
D) Calcaneofibular 
E) Bifurcate

 

25. A 65-year-old woman presents for treatment of a painful flatfoot condition. 

On examination, the hindfoot is in marked valgus and a rupture of the posterior tibial tendon is noted. 

The recommended treatment is a transfer of the flexor digitorum longus tendon and a medial translational osteotomy of the calcaneus. 

The rationale for the osteotomy includes all of the following except:

A) To increase the ground reaction forces medially
B) ) To make the Achilles tendon vector lateral to the axis of the subtalar joint 
C) To improve the weight bearing tripod effect of the foot
D) To augment the flexor transfer medially
E) To decrease the valgus force of the gastrocnemius on the hindfoot

24. A 49-year-old woman has had swelling in the posterior aspect of the ankle for 5 years . The pain is focal and does not radiate. She notes that pain is worse with activity, exercise, and shoe wear. 

Which of the following is not an acceptable treatment for this patient:

A) Short leg cast immobilization
B) High heel shoe with no heel counter
C) Debridement of the insertion of the Achilles tendon
D) Osteotomy of the calcaneus
E) Achilles stretching exercises and physical therapy modalities including corticosteroid application

 

23. A 22-year-old basketball player presents for treatment of a stress fracture of the base of the fifth metatarsal at the junction of the metaphysis and diaphysis. The fracture was treated operatively, and the patient returned to playing basketball. 

Three months later, it was apparent that a repeat fracture was present. The fracture was treated with screw removal and a repeat screw fixation. 

Four months later, he sustained a repeat stress fracture of the metatarsal. On examination, he has a mild cavovarus foot configuration with normal ankle range of motion. Inversion is 15° and eversion is 5°. The base of the fifth metatarsal is prominent.

The most likely cause for the repeat fracture is

A) Abnormal ankle biomechanics
B) Chronic unrecognized ankle instability 
C) A varus heel 
D) Bone sclerosis of the fifth metatarsal base
E) Chronic avascularity of the fifth metatarsal base 

 

22. A 23-year-old man sustains an injury to his foot when falling off a ladder. The foot is grossly twisted inward, and the talonavicular joint is dislocated with the talar head penetrating through the extensor brevis muscle. 

The dislocation is reduced. 

The likelihood of this resulting in avascular necrosis of the talus is:

A) Rare
B) 20% 
C) 40%
D) 70% 
E) 100%

 21. A 43-year-old construction worker sustained a work-related injury to his foot 7 months ago. 

He was initially treated with cast immobilization and limited weight bearing. 

He has lateral foot pain and inability to walk comfortably. He has limited walking endurance. 

Upon examination, pain is present laterally along the course of the peroneal tendons, and no motion of the subtalar joint is present.

The recommendation is:

A) Physical therapy followed by job modification 
B) Shoe modification and orthotic support 
C) Nonsteroidal medication, and ankle foot orthoses
D) Injection of the peroneal tendons with cortisone 
E) Subtalar arthrodesis

 

20. You are commencing a repair of an acute rupture of the Achilles tendon that occurred 8 days previously in a 32- year-old recreational tennis player. Fibrillation of the tendon ends is noted. 

The following is most important to maximize the ultimate outcome of the repair:

A) Resection of the frayed tendon end, and end-to-end apposition
B) Incorporation of the plantaris tendon in the repair 
C) Repair of the tendon with the foot in slight equinus
D) Augmentation of the repair with a facial turn down flap
E) Repair with the tendon ends at normal resting tension

 

19. The nerve most likely to be at risk during surgical exposure when performing a triple arthrodesis is the:

A) Sural 
B) Lateral cutaneous branch superficial peroneal
C) Intermediate cutaneous branch superficial peroneal 
D) Lateral plantar 
E) Dorsalis pedis

18. The radiograph of a 22-year-old woman with ankle pain and instability is presented. She has noted this problem for 10 years, and it appears to be worsening. The opposite ankle is not symptomatic. She has not had any previous treatment for foot or ankle problems.

The cause of this ankle deformity is most likely to be associated with which of the following conditions:

A) Recurrent ankle instability
B) Congenital bimalleolar dysplasia 
C) Subtalar fusion
D) Talar growth arrest
E) Fibular hemimelic syndrome

17. A 14-year-old boy presents for treatment of a painful foot, which has been present for 2 years. He has limited his athletic activities. He has similar symptoms in the opposite foot, although not as severe. 

On clinical examination, the alignment and appearance of the foot are normal; motion of the foot and ankle is good; and some discomfort is present in the sinus tarsi. 

Standard radiographs, of which the lateral view is presented, include anteroposterior, lateral, and oblique views. Because the diagnosis is unclear, more imaging studies are required. 

The next study to obtain is:

A) External oblique views of the foot
B) Axial views of the subtalar joint (Harris)
C) Oblique views of the subtalar joint (Broden) 
D) Internal oblique views of the midfoot 
E) Inclined views of the talonavicular joint (Canale)

 

16. A 52-year-old man presents for evaluation and treatment of a painful flatfoot deformity. While playing tennis 2 years ago, he felt a tearing sensation in his foot and ankle. Since that time, he notes that the arch of his foot has become progressively flatter. 

Upon examination, he has a flatfoot and  inability to perform a single heel rise and weak inversion strength. 

He desires to have this deformity corrected. At surgery, the posterior tibial tendon is grossly normal in appearance. 

The most likely source of his deformity is:

A) Rupture of the Achilles tendon
B) Rupture of the peroneus longus tendon 
C) Rupture of the plantar fascia
D) Rupture of the spring ligament
E) Rupture of the inferolateral long plantar ligament

 

15. The most common complication of arthrodesis of the proximal interphalangeal (PIP) joint of lesser toes is:

A) Claw toe deformity
B) Mallet toe deformity 
C) Hammer toe deformity
D) Curly toe deformity
E) Instability of metatarsophalangeal (MP) joint

 

14. A patient presents for treatment in your emergency department following an injury that he sustained 4 hours earlier. His foot was run over by a piece of heavy industrial equipment. 

On examination, he has pain in the foot, a displaced fracture of the second metatarsal, a 3-cm area of severe contusion over the forefoot, and numbness of the dorsal surface of the foot. 

The next examination that you recommend is:

A) Measurement of compartment pressures in the foot
B) Magnetic resonance imaging of the tarsometatarsal joint
C) Computerized axial tomography of the midfoot
D) Doppler evaluation of the foot pulses
E) Laser Doppler flowmetry 

 

13. The nerve commonly associated with painful heel syndrome is the:

A) Medial plantar nerve
B) Lateral plantar nerve
C) First branch of the lateral plantar nerve 
D) Calcaneal nerve
E) Deep peroneal nerve

 

12. A 37-year-old construction worker presents for evaluation and treatment of a painful stiff foot. He has noticed the stiffness for approximately 12 years, and particularly feels the stiffness when he is working on uneven ground surfaces. Upon clinical and radiographic examination, he is noted to have a calcaneonavicular coalition without any peritalar arthritis. 

Your recommended treatment is:

A) Triple arthrodesis
B) Subtalar arthrodesis
C) Resection of the coalition
D) Calcaneal osteotomy 
E) Calcaneocuboid and talonavicular arthrodesis

 

11.  A 13-year-old girl is seen in clinic for bunion. She is asymptomatic but has a hallux valgus angle of 29°, an intermetatarsal angle of 15°, and a medial prominence over the first metatarsal head. 

The family asks whether anything can be done to prevent future problems with the foot. 

You recommend:

A) Osteotomy of the first metatarsal base
B) Hemiepiphyseodesis of the medial physis of the first metatarsal 
C) Double osteotomy of the first metatarsal
D) Mitchell osteotomy
E) Shoe modifications if symptoms develop 

 

10. Which of the following conditions is not associated with an increased risk of congenital vertical talus ?

A) Cerebral palsy
B) Myelomeningocele
C) Arthrogryposis
D) Nail patella syndrome
E) Larsen syndrome 

 

9. Which of the following conditions is not associated with an increased risk of congenital vertical talus?

A) Sacral agenesis
B) Cerebral palsy
C) Myelomeningocele
D) ArthrogryposisV
E) Nail patella syndrome

 

8. A 15-year-old basketball player has mild scoliosis, pes planus, pectus carinatum, and long slender fingers. 

In order to determine if he has Marfan syndrome and should be allowed to continue playing basketball. It is most useful to order a:

A) Cardiac echo 
B) Magnetic resonance image of the lumbosacral spine 
C) Slit lamp examination
D) Chest radiograph
E) Dermal fibroblast assay 

 

7. Which ancillary test is not helpful in the diagnosis of Charcot-Marie-Tooth disease (CMT):

A) Electromyography (EMG)
B) Nerve conduction velocity (NCV)
C) Nerve biopsy
D) Muscle biopsy
E) Muscle enzymes

 

6. A 7-year-old boy presents with bilateral high arches. His parents report that they are having difficulty finding shoes that comfortably fit him. The patient denies any foot pain. The father had similar problems with his feet and was diagnosed with a “mild” neurologic condition. 

On exam, the child has bilateral pes cavus with a supple hindfoot. 

Treatment of the feet at this time should consist of:

A) Soft tissue procedures alone
B) Soft tissue procedures and calcaneal osteotomy
C) Triple arthrodesis 
D) Bracing 
E) Observation

 

5. The most common cause of an indirect injury to the Lisfranc joint occurs through which mechanism:

A) Compression
B) Hyperdorsiflexion
C) Axial load of a plantarflexed foot
D) Supination and external rotation
E) Pronation and adduction

 

4. Initial management of a symptomatic Haglund’s deformity in a runner consists of:

A) Intratendinous steroid injection 
B) Debridement of the tendon 
C) Excision of the posterosuperior calcaneal prominence 
D) Heel lift and soft shoe counter 
E) A firm heel counter and medial heel wedge 

 

3. A 46y old man fell 20 feet and sustained the injury shown in the figure attached. The injury is closed; however, the soft tissues are swollen and ecchymotic with blisters. 

The most appropriate initial management should consist of 

A) long leg cast
B) a short leg cast
C) immediate open reduction and internal fixation
D) a temporizing spanning external fixator
E) primary ankle fusion

 

 

2. 36y woman sustained a tarsometatarsal joint fracture-dislocation in a motor vehicle accident. The patient is treated with ORIF. 

What is the most common complication?

A) Posttraumatic arthritis
B) Infection
C) Fixation failure
D) Malunion
E) Nonunion

 

1. A 50-year-old patient presents with a 2 month history of midfoot pain after a twisting injury to their foot, which has now been diagnosed as a chronic Lisfranc injury. 

Lisfranc injury - Wikipedia

Which of the following is TRUE about tarsometatarsal arthrodesis in this situation?

A) It is best performed across all tarso-metatarsal joints
B) It is a good option in late diagnosis of this injury
C) It will allow this patient to mobilise fully weight bearing from day one post-surgery
D) It is best performed through a lateral approach
E) It is part of the ‘Triple arthrodesis’ procedure

 

5. A 50-year-old patient presents with a 2 month history of midfoot pain after a twisting injury to their foot, which has now been diagnosed as a chronic Lisfranc injury. 

Lisfranc injury - Wikipedia

Which of the following is TRUE about tarsometatarsal arthrodesis in this situation?

A) It is best performed across all tarso-metatarsal joints
B) It is a good option in late diagnosis of this injury
C) It will allow this patient to mobilise fully weight bearing from day one post-surgery
D) It is best performed through a lateral approach
E) It is part of the ‘Triple arthrodesis’ procedure

 

4. 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

 

3. A patient underwent an arthrodesis of the hallux metatarsophalangeal joint for correction of painful arthritis . She remains symptomatic and cannot walk without pain.

The most likely cause for her pain is:

A) Fusion of the hallux in too much plantarflexion
B) Fusion of the hallux in too much dorsiflexion
C) Fusion of the hallux in too much varus
D) Removal of too much bone in the metatarsophalangeal joint during fusion, leading to claw hallux
E) Removal of too much bone in the metatarsophalangeal joint during fusion, leading to lesser toe metatarsalgia

 

2. A 76-year-old man has experienced aching in the anterior aspect of his ankle for 6 months. He felt a sudden onset of soreness 6 months ago. Since then, he has noted weakness of the foot. 

He walks with a limp, and the foot hits the ground during the heel contact phase of gait. On examination there is a mobile subcutaneous mass in the anterior ankle. 

The patient’s magnetic resonance image (MRI) is presented .

Which of the following is the most accurate diagnosis:

A) A ganglion of the anterior ankle
B) Synovial sarcoma 
C) Pigmented villonodular synovitis
D) A rupture of the anterior tibial tendon
E) An accessory extensor hallucis longus

 

1. A 46y old man fell 20 feet and sustained the injury shown in the figure attached. The injury is closed; however, the soft tissues are swollen and ecchymotic with blisters. 

The most appropriate initial management should consist of 

A) long leg cast
B) a short leg cast
C) immediate open reduction and internal fixation
D) a temporizing spanning external fixator
E) primary ankle fusion

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