Cavus Foot — MCQs
Which type of intra-articular fracture of the calcaneum is characterized by an increased Gissane's angle?
Which of the following conditions is least likely to be associated with rigid flat foot?
All are true regarding congenital talipes equinovarus (CTEV) except:
Windswept deformity is seen in which condition?
Combination of appearance in CTEV
Unilateral high stepping gait is seen in
A 65-year-old alcoholic suffering from diabetes has a flexion deformity of the right little finger over the metacarpophalangeal joint of around 15 degrees. The ideal management would be:
What splint is used in CTEV after correction?
Foot eversion is caused by
High stepping gait is due to
Cavus Foot Indian Medical PG Practice Questions and MCQs
Question 1: Which type of intra-articular fracture of the calcaneum is characterized by an increased Gissane's angle?
- A. Extra-articular fracture
- B. Joint depression-type fracture
- C. Avulsion fracture
- D. Tongue-type fracture (Correct Answer)
Explanation: ***Tongue-type fracture*** - This fracture pattern involves a **vertical fracture line** extending posteriorly through the body of the calcaneus, creating a "tongue"-shaped fragment that includes the posterior facet. - The superior portion of this fragment is **displaced superiorly**, leading to a characteristic increase in **Gissane's angle**. *Joint depression-type fracture* - This fracture involves the **depression of the articular surface** of the posterior facet into the body of the calcaneus. - In this type, the **Gissane's angle** is typically **decreased**, not increased, due to the collapse of the articular surface. *Extra-articular fracture* - An **extra-articular fracture** does not involve the articular surfaces of the calcaneus, meaning the **Gissane's angle** (which describes the relationship of the articular surfaces) is generally **preserved** or minimally affected. - These fractures occur outside the subtalar joint and are classified differently than intra-articular types. *Avulsion fracture* - An **avulsion fracture** typically occurs when a ligament or tendon pulls a piece of bone away from the main bone mass, often at muscle insertions like the Achilles tendon. - While it can occur in the calcaneus, it does not involve the characteristic displacement of the posterior facet that would lead to an **increased Gissane's angle** in the way a tongue-type fracture does.
Question 2: Which of the following conditions is least likely to be associated with rigid flat foot?
- A. Rheumatoid arthritis
- B. Athlete's foot (Correct Answer)
- C. Peroneal spasm
- D. Congenital tarsal coalition.
Explanation: ***Athlete's foot*** - **Athlete's foot** (tinea pedis) is a **fungal infection** of the skin of the foot, which typically causes itching, scaling, and redness. - It does not directly affect the bony or ligamentous structures of the foot to cause **rigid flat foot** deformation. *Rheumatoid arthritis* - **Rheumatoid arthritis** can cause **inflammatory arthropathy** affecting the joints of the foot, leading to joint destruction and subsequent collapse of the **medial longitudinal arch**, resulting in **rigid flat foot**. - Chronic inflammation and synovitis can alter pedal biomechanics and lead to a painful, **fixed deformity** of the foot. *Peroneal spasm* - **Peroneal spasm** is often associated with conditions like **tarsal coalition** or other painful foot pathologies. - The spasm of the peroneal muscles can pull the foot into **eversion** and **abduction**, contributing to a **rigid flat foot deformity** as the foot becomes fixed in this position. *Congenital tarsal coalition* - **Tarsal coalition** is an **abnormal connection** between two or more bones in the hindfoot or midfoot, which restricts normal motion and leads to a **rigid flat foot**. - It is a common cause of **peroneal spasm** as the body tries to immobilize the painful, rigid hindfoot motion.
Question 3: All are true regarding congenital talipes equinovarus (CTEV) except:
- A. Hindfoot varus
- B. Cavus
- C. Increased dorsiflexion (Correct Answer)
- D. Forefoot adduction
Explanation: ***Increased dorsiflexion*** - Congenital talipes equinovarus (CTEV), or **clubfoot**, is characterized by an **equinus deformity**, meaning the foot is pointing downwards, thus having significantly **reduced dorsiflexion**. - **Increased dorsiflexion** would imply the foot can be brought closer to the shin, which is directly opposite to the characteristic presentation of CTEV. *Hindfoot varus* - **Hindfoot varus** is a characteristic component of CTEV, where the heel is turned inward. - This inward turning of the heel contributes to the overall deformity and is one of the four main components of a clubfoot. *Cavus* - **Cavus** refers to a high arch in the foot, which is another defining feature of CTEV. - This exaggerated arch contributes to the rigidity and complex nature of the deformity. *Forefoot adduction* - **Forefoot adduction** means the front part of the foot is turned inward towards the body's midline, which is a key component of CTEV. - This inward deviation contributes to the 'club' shape of the foot and is often described as metatarsus adductus within the overall deformity.
Question 4: Windswept deformity is seen in which condition?
- A. Hyperparathyroidism
- B. Scurvy
- C. Rheumatoid Arthritis
- D. Rickets (Correct Answer)
Explanation: ***Rickets*** - **Windswept deformity** is characterized by bilateral knee deformities where one knee is in **valgus** and the other is in **varus**. - This condition is caused by a deficiency in **vitamin D**, **calcium**, or **phosphate**, leading to improper bone mineralization and subsequent bone deformities. *Rheumatoid Arthritis* - Rheumatoid arthritis is a **chronic autoimmune inflammatory disease** primarily affecting the synovial joints. - While it can cause joint deformities, they typically involve symmetric joint swelling, pain, and stiffness, with characteristic deformities like **ulnar deviation** or **swan-neck deformities**, rather than windswept deformity. *Hyperparathyroidism* - Hyperparathyroidism leads to excessive production of **parathyroid hormone**, which causes increased bone resorption and elevated blood calcium levels. - It can result in bone fragility, **osteitis fibrosa cystica**, and kidney stones, but it does not cause specific windswept deformity. *Scurvy* - Scurvy results from a severe deficiency of **vitamin C**, which is essential for collagen synthesis. - It presents with symptoms like bleeding gums, poor wound healing, and perifollicular hemorrhages, but it does not typically cause windswept deformity of the knees.
Question 5: Combination of appearance in CTEV
- A. Equinus, eversion, forefoot adduction, cavus
- B. Equinus, inversion, forefoot adduction, planus
- C. Equinus, inversion, forefoot adduction, cavus (Correct Answer)
- D. Equinus, eversion, forefoot abduction, cavus
Explanation: ***Equinus, inversion, forefoot adduction, cavus*** - The classic presentation of **clubfoot** (CTEV) involves a characteristic combination of deformities: **equinus** (fixed plantarflexion of the ankle), **inversion** (tilting of the heel inward), **forefoot adduction** (inward turning of the front of the foot), and **cavus** (an abnormally high arch). - These four components are essential for the diagnosis and classification of CTEV. *Equinus, eversion, forefoot adduction, cavus* - This option incorrectly lists **eversion** instead of inversion. Eversion involves the outward tilting of the heel and is not a feature of CTEV. - While equinus, forefoot adduction, and cavus are typical, the presence of eversion rules out classic CTEV. *Equinus, inversion, forefoot adduction, planus* - This option incorrectly lists **planus** (pes planus or flatfoot) instead of cavus. Cavus (high arch) is a defining characteristic of CTEV, not a flatfoot. - While equinus, inversion, and forefoot adduction are correct, the presence of planus makes this option incorrect. *Equinus, eversion, forefoot abduction, cavus* - This option incorrectly lists both **eversion** and **forefoot abduction**. Eversion is the outward tilting of the heel, and forefoot abduction is the outward turning of the front of the foot. - Both eversion and forefoot abduction are opposite to the deformities seen in classical CTEV.
Question 6: Unilateral high stepping gait is seen in
- A. Distal radiculopathy
- B. Cauda equina syndrome
- C. L5 radiculopathy (Correct Answer)
- D. None of the options
Explanation: ***L5 radiculopathy*** - Damage to the **L5 nerve root** can cause weakness in the **tibialis anterior muscle**, leading to **foot drop**. [1] - To compensate for the foot drop and prevent tripping, the patient develops a **high stepping gait** (steppage gait) on the affected side. [1] *Distal radiculopathy* - This term is too general; **radiculopathy** refers to nerve root compression but does not specify which root or its precise distal effects. - While a radiculopathy can cause weakness, "distal" does not specifically localize to L5 or unilateral foot drop. *Cauda equina syndrome* - This is a serious condition involving **compression of multiple nerve roots** below the conus medullaris. - It typically causes bilateral symptoms, including **saddle anesthesia**, bowel/bladder dysfunction, and often bilateral leg weakness, not isolated unilateral foot drop. *None of the options* - This option is incorrect because **L5 radiculopathy** directly explains unilateral high stepping gait due to foot drop.
Question 7: A 65-year-old alcoholic suffering from diabetes has a flexion deformity of the right little finger over the metacarpophalangeal joint of around 15 degrees. The ideal management would be:
- A. Complete fasciectomy
- B. Partial (selective) fasciectomy
- C. Percutaneous fasciotomy
- D. Observation (Correct Answer)
Explanation: ***Observation*** - A 15-degree flexion deformity of the **metacarpophalangeal (MCP) joint** is considered mild and does not significantly impair hand function, making observation the appropriate initial management. - The goal of intervention in **Dupuytren's contracture** is to improve hand function, and surgical or medical treatment is typically reserved for deformities of **30 degrees or more** at the MCP joint or any **proximal interphalangeal (PIP) joint contracture**. *Complete fasciectomy* - This procedure involves the **excision of all diseased palmar fascia**, including tissue not directly involved in the contracture. - Due to its **aggressiveness** and higher rates of complications and recurrence, complete fasciectomy is generally **not recommended** for Dupuytren's contracture. *Partial (selective) fasciectomy* - This involves the **excision of only the diseased and contracted fascia**, aiming to release the finger contracture. - While an effective treatment for advanced Dupuytren's contracture, it is **overtreatment** for a mild, 15-degree MCP joint deformity, which typically does not require surgical intervention. *Percutaneous fasciotomy* - This minimally invasive procedure involves **dividing the contracted cords** using a needle, typically performed in an outpatient setting. - It's mainly suitable for **isolated cord contractures** at the MCP joint without extensive fascial involvement and for patients who prefer less invasive options, but similar to fasciectomy, it is reserved for more significant contractures to improve function.
Question 8: What splint is used in CTEV after correction?
- A. Bohler-Brown splint
- B. Thomas splint
- C. Dennis Brown splint (Correct Answer)
- D. None of the options
Explanation: ***Dennis Brown splint*** - The **Dennis Brown splint** is specifically designed for maintaining the correction of **clubfoot (CTEV)** in infants to prevent recurrence. - It consists of a bar connecting two shoes that hold the feet in an **external rotation** and **abduction** position. *Bohler-Brown splint* - The **Bohler-Brown splint** is primarily used for the management of **tibial shaft fractures**. - It is a **traction splint** designed to maintain alignment and length of the fractured bone. *Thomas splint* - The **Thomas splint** is typically used for **femoral shaft fractures** to provide traction and reduce muscle spasm. - It is not indicated for the long-term management of clubfoot. *None of the options* - This option is incorrect as the **Dennis Brown splint** is a well-established and a primary splint used for CTEV after correction.
Question 9: Foot eversion is caused by
- A. Tibialis anterior
- B. Tibialis posterior
- C. Peroneus longus (Correct Answer)
- D. Extensor digitorum
Explanation: ***Peroneus longus*** - The **peroneus longus** muscle (fibularis longus) is a primary evertor of the foot. - It originates from the head and upper lateral surface of the fibula, inserts into the medial cuneiform and first metatarsal, and its contraction pulls the foot outwards and downwards. *Tibialis anterior* - The **tibialis anterior** is the primary dorsiflexor and invertor of the foot. - It pulls the foot upwards and inwards, which is the opposite action of eversion. *Tibialis posterior* - The **tibialis posterior** is a strong invertor and plantar flexor of the foot. - It contributes to maintaining the arch of the foot and does not cause eversion. *Extensor digitorum* - The **extensor digitorum longus** primarily extends the toes and assists in dorsiflexion of the ankle. - While it may have a slight eversion component, it is not the primary muscle responsible for foot eversion.
Question 10: High stepping gait is due to
- A. Gluteus maximum paralysis
- B. CDH
- C. Quadriceps paralysis
- D. Foot drop (Correct Answer)
Explanation: ***Foot drop*** - **Foot drop** causes the patient to lift the leg higher during walking to prevent the toes from dragging on the ground, resulting in a **high stepping gait**. - This condition is often due to weakness or paralysis of the **dorsiflexor muscles** of the foot, typically from **peroneal nerve injury** or **L4/L5 radiculopathy**. *Gluteus maximum paralysis* - **Gluteus maximus paralysis** causes difficulty with hip extension and is often compensated by a **backward lurch** of the trunk during gait. - It results in a **Trendelenburg gait** (if the gluteus medius is also affected) or instability during standing, but not typically a high stepping gait. *CDH* - **Congenital hip dysplasia (CDH)** involves abnormal development of the hip joint. - It usually leads to a **waddling gait** due to instability and pain, or limb length discrepancy, not a high stepping gait. *Quadriceps paralysis* - **Quadriceps paralysis** results in weakness or inability to extend the knee. - Patients typically compensate by hyperextending the knee or leaning forward over the affected leg during gait, which is not a high stepping gait.
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