Foot and Ankle Surgery Practice Questions

Q: A 24-year-old woman experiences pain in the heel when walking uphill, which decreases when walking downhill. X-ray shows a bone spur. What is the diagnosis?

Calcaneal exostosis. ***Calcaneal exostosis*** - This condition involves a **bone spur** on the calcaneus, specifically at the insertion of the **Achilles tendon**. - The pain when walking uphill and improvement when walking downhill are classic signs because uphill walking increases **dorsiflexion** and tension on the Achilles tendon, irritating the spur. *Achilles tendinitis* - While Achilles tendinitis also causes **heel pain**, the primary issue is inflammation of the tendon itself, not necessarily an improvement with downhill walking. - The presence of a distinct bone spur on X-ray, as described, more directly points to mechanical irritation from an **exostosis**. *Plantar fasciitis* - This typically presents as **heel pain** that is worst with the first steps in the morning or after prolonged rest, and not specifically exacerbated by walking uphill or down. - The pain is usually located on the **underside of the heel**, not primarily described as an issue with Achilles tendon mechanics. *Osteomyelitis of calcaneum* - This is an **infection of the bone**, which would present with signs of systemic infection like fever, malaise, and severe, persistent pain that is not typically relieved by changing walking angles. - A bone spur on its own is not indicative of an **infection** without other signs and symptoms.

Q: Most common cause of insertional tendonitis of Achilles tendon is -

Overuse. ***Overuse*** - **Repetitive strain** on the Achilles tendon, often from activities like running or jumping, is the most common etiology for **insertional Achilles tendonitis**. - **Microtrauma** from excessive loading leads to inflammation and degeneration at the tendon's insertion point on the calcaneus. *Improper shoe wear* - While **inappropriate footwear** can contribute to Achilles tendonitis by altering foot mechanics or providing inadequate support, it is less frequently the primary cause compared to overwhelming **overuse**. - It often exacerbates existing issues or contributes to the development of tendonitis in conjunction with high-impact activities. *Infections from the ankle joint* - **Infections** of the ankle joint (septic arthritis) are a rare cause of localized Achilles tendonitis and would present with systemic signs of infection and severe joint involvement. - Tendonitis from infection is specifically known as **infectious tenosynovitis**, and usually involves adjacent structures, not typically causing isolated insertional tendonitis of the Achilles tendon directly. *Steroid injections* - **Steroid injections** near the Achilles tendon are generally *avoided* due to the risk of **tendon rupture**, not because they are a common cause of insertional tendonitis. - While they can have adverse effects, they are not typically a primary initiating factor for the condition itself.

Q: A ballet dancer presents with chronic anterolateral ankle pain. Most likely diagnosis?

Lateral Ankle Sprain. **Lateral Ankle Sprain** - **Chronic anterolateral ankle pain** in a ballet dancer is highly suggestive of a **lateral ankle sprain**, often due to repetitive strain and instability. - Sprains commonly involve the **anterior talofibular ligament (ATFL)** and **calcaneofibular ligament (CFL)**, leading to persistent discomfort and potential functional deficits. *Calcaneal Stress Fracture* - A **calcaneal stress fracture** typically presents with **heel pain** that is worse with weight-bearing activities, rather than primarily anterolateral pain. - While common in athletes, the pain location is less consistent with the description in the question. *Tibialis Posterior Tendinitis* - **Tibialis posterior tendinitis** causes pain and tenderness along the **medial arch** and posterior aspect of the ankle, often associated with a **flatfoot deformity**. - The pain location described (anterolateral) does not align with the typical presentation of this condition. *Anterior Ankle Impingement Syndrome* - **Anterior ankle impingement syndrome** results from compression of soft tissues or bony spurs at the **anterior ankle joint**, typically causing pain with **dorsiflexion**. - While possible in a dancer, the presentation as chronic anterolateral pain without specific mention of dorsiflexion-related pain makes a lateral ankle sprain a more probable initial diagnosis.

Q: Which of the following is true about hallux valgus?

Great toe points laterally. ***Great toe points laterally*** - Hallux valgus is characterized by a **lateral deviation** of the great toe at the **first metatarsophalangeal (MTP) joint**. - This deviation causes the distal phalanx to point towards the other toes, often leading to a **bunion** over the medial aspect of the joint. *Great toe points medially* - This statement is incorrect as hallux valgus specifically describes the **lateral deviation** of the great toe, not medial. - A medial deviation of the great toe would be a rare and unrelated deformity. *Dorsal angulation of the 1st metatarsophalangeal joint* - **Dorsal angulation** at the first MTP joint is not a primary characteristic of hallux valgus; it describes a different type of toe deformity like **hallux rigidus** or **hammer toe**, where the toe becomes stiff or bent upwards. - Hallux valgus primarily involves angular deviation in the **transverse plane**, not the sagittal (dorsal/plantar) plane. *Lateral angulation of the 1st metatarsophalangeal joint* - While the great toe points laterally, it is actually the **metatarsal head** that deviates medially, leading to a lateral angulation of the **proximal phalanx** relative to the metatarsal, giving the appearance of the great toe pointing laterally. - This statement is imprecise because the primary angular deformity in hallux valgus involves the **phalanx** deviating laterally on a stable or medially deviated metatarsal, rather than the entire joint angulating laterally.

Q: Bunion is commonly seen at ?

Great toe MTP joint. ***Great toe MTP joint*** - A bunion, or **hallux valgus**, is a bump that forms on the outside of the **first metatarsophalangeal (MTP) joint** of the big toe. - This common foot deformity involves structural changes that result in the big toe pointing towards the smaller toes. *Medial malleolus* - The medial malleolus is the bony prominence on the **inside of the ankle**. - It is part of the tibia and forms the inner wall of the ankle joint, not typically where bunions occur. *Lateral Malleolus* - The lateral malleolus is the bony protrusion on the **outside of the ankle**. - It is part of the fibula and forms the outer wall of the ankle joint, unrelated to bunion formation. *Shin of tibia* - The shin refers to the **anterior crest of the tibia**, the large bone in the lower leg. - This area is prone to conditions like shin splints or fractures, but not bunions.

Q: In neglected cases of CTEV, which joints are fused?

Calcaneocuboid, talonavicular, and talocalcaneal joints. ***Calcaneocuboid, talonavicular, and talocalcaneal joints*** - In neglected cases of **clubfoot (CTEV)**, a **triple arthrodesis** is performed to correct the deformity. - This procedure involves the fusion of the **subtalar (talocalcaneal)**, **talonavicular**, and **calcaneocuboid joints** to provide a stable, plantigrade foot. *Tibiotalar, calcaneocuboid, and talonavicular joints* - The **tibiotalar joint (ankle joint)** is generally preserved in triple arthrodesis for CTEV to maintain ankle motion. - Fusing the tibiotalar joint would significantly **reduce ankle dorsiflexion and plantarflexion**, leading to a stiff ankle. *None of the above joints* - This option is incorrect because the fusion of specific joints is a recognized surgical treatment for severe, neglected CTEV. - **Triple arthrodesis** is a well-established procedure for correcting rigid foot deformities. *Ankle joint, calcaneocuboid, and talonavicular joints* - As mentioned, fusion of the **ankle joint (tibiotalar joint)** is generally avoided in triple arthrodesis for CTEV to preserve functional ankle motion. - The goal is to stabilize the foot while retaining as much articulation as possible in the ankle itself.

Q: Sudden dorsiflexion of the foot may lead to which of the following injuries?

Tendo Achilles avulsion injury. ***Tendo Achilles avulsion injury*** - **Sudden dorsiflexion** of the foot, especially if forced or excessive, can cause extreme stretch on the **Achilles tendon**, potentially leading to its avulsion or rupture. - This mechanism often occurs during activities requiring a forceful push-off or landing with the foot in dorsiflexion, placing significant tensile stress on the tendon. *Anterior talofibular ligament injury* - This injury typically results from an **inversion sprain** of the ankle, where the foot is forcefully turned inward, causing damage to the lateral ankle ligaments. - **Dorsiflexion** alone is not the primary mechanism for injury to the **anterior talofibular ligament**. *Rupture of deltoid ligament* - The **deltoid ligament** is located on the medial side of the ankle and is most commonly injured with an **eversion sprain**, where the foot rolls outward. - While extreme dorsiflexion can put some strain on anterior fibers, it is not the primary mechanism, and a concomitant eversion force would likely be required for rupture. *Tarsal tunnel syndrome* - This condition involves **compression of the tibial nerve** as it passes through the tarsal tunnel, typically causing pain, numbness, and tingling in the sole of the foot. - It is often caused by chronic factors such as swelling, repetitive stress, or structural abnormalities, rather than an acute traumatic event like sudden dorsiflexion.

Q: In forceful inversion of the foot, fracture of the tuberosity of the 5th metatarsal is due to the pull exerted by which tendon?

Peroneus brevis. ***Peroneus brevis*** - The **peroneus brevis tendon** inserts onto the **tuberosity of the 5th metatarsal**. - During a **forceful inversion** injury, the foot is turned inward, stretching the lateral ankle structures and causing the peroneus brevis to strongly contract, leading to an **avulsion fracture** of its insertion point. *Peroneus longus* - The **peroneus longus tendon** inserts into the **medial cuneiform** and the **base of the first metatarsal**, not the 5th metatarsal tuberosity. - While it contributes to eversion, its pull is not directly responsible for avulsion fractures at the 5th metatarsal tuberosity. *Peroneus tertius* - The **peroneus tertius** is an extensor muscle that inserts on the **dorsal surface of the base of the 5th metatarsal**, not the tuberosity. - It assists with dorsiflexion and eversion, but its role in avulsion fractures of the tuberosity is minimal compared to the peroneus brevis. *Extensor digitorum (toe extension)* - The **extensor digitorum longus** tendonprimarily inserts onto the **phalanges of the lateral four toes** to extend them. - This tendon does not attach to the 5th metatarsal tuberosity and is not involved in this type of avulsion fracture.

Q: Avascular necrosis of which bone results in Kohler's disease?

Navicular Bone. ***Navicular Bone*** - **Kohler's disease** is an **avascular necrosis** condition specifically affecting the **navicular bone** in the foot, primarily observed in children. - It leads to focal pain, swelling, and tenderness over the **medial arch of the foot**. *Lunate bone* - Avascular necrosis of the **lunate bone** is known as **Kienbock's disease**, which affects the wrist. - This condition presents with chronic wrist pain and stiffness, distinct from **Kohler's disease** and its location. *Femoral neck* - Avascular necrosis of the **femoral neck** is a cause of **hip pain** and typically occurs in adults, often associated with trauma, steroid use, or alcohol abuse. - It is distinct from pediatric foot conditions like **Kohler's disease**. *Medial cuneiform bone* - While located in the foot, the **medial cuneiform bone** is not the primary site for **Kohler's disease**. - Avascular necrosis of the **medial cuneiform bone** is rare and does not have a specific eponymous designation like **Kohler's disease**.

Q: A 41-year-old man is admitted to the emergency department with a swollen and painful foot. Radiographic examination reveals that the head of the talus has become displaced inferiorly, thereby causing the medial longitudinal arch of the foot to fall. What is the most likely cause in this case?

Tearing of the plantar calcaneonavicular (spring) ligament. ***Tearing of the plantar calcaneonavicular (spring) ligament*** - The **plantar calcaneonavicular ligament**, also known as the **spring ligament**, is crucial for supporting the head of the talus and maintaining the **medial longitudinal arch** of the foot. - Tearing of this ligament leads to the **inferior displacement of the talar head** and subsequent collapse of the arch, consistent with the symptoms described. *Fracture of the navicular bone* - A fracture of the **navicular bone** would typically cause localized pain and tenderness over the navicular, and while it could contribute to arch instability, it wouldn't primarily cause the **talar head** to *inferiorly displace* in this specific manner. - While a navicular fracture might lead to secondary arch collapse, the primary issue described is the displacement of the **talar head**, which is more directly related to spring ligament integrity. *Tearing of the deltoid ligament* - The **deltoid ligament** is located on the medial side of the ankle and primarily stabilizes the **talocrural joint**, preventing excessive eversion of the foot. - Its rupture would lead to ankle instability and pain, but it doesn't directly support the **medial longitudinal arch** in the same way the spring ligament does, nor would its tearing directly cause the talar head to displace inferiorly as described. *Sprain of the calcaneocuboid ligament* - The **calcaneocuboid ligament** is a component of the **lateral longitudinal arch** of the foot and connects the calcaneus to the cuboid bone. - A sprain of this ligament would primarily affect the *lateral* foot stability and lead to pain in that region, not the described collapse of the **medial longitudinal arch** or inferior displacement of the talar head.

Question 1

A 24-year-old woman experiences pain in the heel when walking uphill, which decreases when walking downhill. X-ray shows a bone spur. What is the diagnosis?

Accepted Answer

Calcaneal exostosis

Answer

Achilles tendinitis

Answer

Plantar fasciitis

Answer

Osteomyelitis of calcaneum

Question 2

Most common cause of insertional tendonitis of Achilles tendon is -

Accepted Answer

Overuse

Answer

Improper shoe wear

Answer

Infections from the ankle joint

Answer

Steroid injections

Question 3

A ballet dancer presents with chronic anterolateral ankle pain. Most likely diagnosis?

Accepted Answer

Lateral Ankle Sprain

Answer

Calcaneal Stress Fracture

Answer

Tibialis Posterior Tendinitis

Answer

Anterior Ankle Impingement Syndrome

Question 4

Which of the following is true about hallux valgus?

Accepted Answer

Great toe points laterally

Answer

Great toe points medially

Answer

Dorsal angulation of the 1st metatarsophalangeal joint

Answer

Lateral angulation of the 1st metatarsophalangeal joint

Question 5

Bunion is commonly seen at ?

Accepted Answer

Great toe MTP joint

Answer

Medial malleolus

Answer

Lateral Malleolus

Answer

Shin of tibia

Question 6

In neglected cases of CTEV, which joints are fused?

Accepted Answer

Calcaneocuboid, talonavicular, and talocalcaneal joints

Answer

Tibiotalar, calcaneocuboid, and talonavicular joints

Answer

None of the above joints

Answer

Ankle joint, calcaneocuboid, and talonavicular joints

Question 7

Sudden dorsiflexion of the foot may lead to which of the following injuries?

Accepted Answer

Tendo Achilles avulsion injury

Answer

Anterior talofibular ligament injury

Answer

Rupture of deltoid ligament

Answer

Tarsal tunnel syndrome

Question 8

In forceful inversion of the foot, fracture of the tuberosity of the 5th metatarsal is due to the pull exerted by which tendon?

Accepted Answer

Peroneus brevis

Answer

Peroneus longus

Answer

Peroneus tertius

Answer

Extensor digitorum (toe extension)

Question 9

Avascular necrosis of which bone results in Kohler's disease?

Accepted Answer

Navicular Bone

Answer

Lunate bone

Answer

Femoral neck

Answer

Medial cuneiform bone

Question 10

A 41-year-old man is admitted to the emergency department with a swollen and painful foot. Radiographic examination reveals that the head of the talus has become displaced inferiorly, thereby causing the medial longitudinal arch of the foot to fall. What is the most likely cause in this case?

Accepted Answer

Tearing of the plantar calcaneonavicular (spring) ligament

Answer

Fracture of the navicular bone

Answer

Tearing of the deltoid ligament

Answer

Sprain of the calcaneocuboid ligament

Foot and Ankle Surgery — MCQs

Foot and Ankle Surgery — MCQs

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