Foot and Ankle Surgery Practice Questions

Q: Which of the following is true about acute rupture of the tendo calcaneus (Achilles tendon)?

It usually occurs in middle-aged persons.. ### Explanation **1. Why Option D is Correct:** Acute rupture of the Achilles tendon (Tendo Calcaneus) typically occurs in **middle-aged individuals (30–50 years)**, often referred to as "weekend warriors." These are individuals who lead sedentary lifestyles but engage in sudden, strenuous physical activity. The rupture usually occurs 2–6 cm proximal to the calcaneal insertion (the "watershed area"), where the blood supply is poorest and age-related degenerative changes (tendinosis) are most prevalent. **2. Why Other Options are Incorrect:** * **Option A:** Rupture most commonly occurs due to **indirect injury**, such as sudden forced plantarflexion of the foot or unexpected dorsiflexion while the calf muscle is contracted. Direct trauma is a rare cause. * **Option B:** The diagnosis is primarily **clinical**. While ultrasound or MRI can be used for confirmation in ambiguous cases, a plain radiograph is generally unremarkable (except for the loss of Kager’s fat pad shadow) and cannot "confirm" a soft tissue rupture. * **Option C:** This describes a **negative Thompson Test**. In a complete rupture, compression of the calf muscles **fails** to produce plantarflexion. If plantarflexion occurs, the tendon is likely intact. **3. High-Yield Clinical Pearls for NEET-PG:** * **Simmonds/Thompson Test:** The gold standard clinical test. Squeezing the calf with the patient prone fails to produce plantarflexion. * **Matles Test:** With the patient prone and knees flexed to 90°, the affected foot will lie in more dorsiflexion compared to the normal side. * **Clinical Presentation:** Patients often report a sensation of being "kicked or shot in the heel" followed by a palpable gap (the "hatchet strike" defect). * **Management:** Non-operative (functional bracing) or operative repair depending on the patient's activity level and age.

Q: Which of the following is tarsometatarsal amputation?

Lisfranc's Amputation. **Explanation:** The correct answer is **Lisfranc’s Amputation**. This procedure involves disarticulation at the **tarsometatarsal joint**, which serves as the anatomical boundary between the midfoot and the forefoot. ### Why Lisfranc’s is Correct: Lisfranc’s amputation involves the separation of the five metatarsals from the cuneiforms and the cuboid. A significant clinical concern with this level of amputation is the development of an **equinovarus deformity**. This occurs because the insertion of the tibialis anterior and peroneus brevis is often lost or weakened, leading to the unopposed action of the gastrocnemius-soleus complex (Achilles tendon). ### Analysis of Incorrect Options: * **Sarmiento’s:** This is not an amputation but a specific type of **functional patellar tendon-bearing (PTB) cast/brace** used for the non-operative management of tibial fractures. * **Chopart’s Amputation:** This is a **mid-tarsal disarticulation** occurring at the talonavicular and calcaneocuboid joints. It preserves only the talus and calcaneus. Like Lisfranc’s, it is highly prone to equinus deformity. * **Syme’s Amputation:** This is a **disarticulation of the ankle joint**. It involves removing the entire foot and the malleoli, with the heel pad being preserved and migrated distally to allow for end-weight bearing. ### High-Yield Clinical Pearls for NEET-PG: * **Boyd’s Amputation:** A horizontal transection of the calcaneus with talocalcaneal arthrodesis (preserves the heel pad). * **Pirogoff’s Amputation:** Similar to Boyd’s, but the calcaneus is transected vertically and rotated 90 degrees. * **Most common complication** of midfoot amputations (Lisfranc/Chopart) is **Equinus deformity** due to muscle imbalance. * **Syme’s** is considered the most functional lower-limb amputation because it allows for direct end-weight bearing.

Q: What are the radiographic findings in Freiberg disease?

All are true.. **Explanation:** **Freiberg’s Disease** is a form of avascular necrosis (AVN) affecting the metatarsal head, most commonly the **second metatarsal** (80% of cases). It typically affects adolescent females due to repetitive microtrauma or vascular compromise. **Why Option D is correct:** The radiographic progression of Freiberg’s disease follows the **Smillie Classification**: * **Option A (Early to Late stages):** Initially, radiographs may be normal or show subtle **sclerosis** and **widening of the joint space** due to effusion. As the disease progresses, the metatarsal head flattens, leading to **complete collapse** and fragmentation (Stage IV). * **Option B (Imaging technique):** Standard AP views may miss early flattening. **Oblique views** are essential to visualize the dorsal aspect of the metatarsal head, where the collapse usually begins. * **Option C (Secondary changes):** In advanced stages (Stage V), the fragmented cartilage and bone can detach, leading to **osteochondral loose bodies** and secondary osteoarthritis of the metatarsophalangeal (MTP) joint. **Clinical Pearls for NEET-PG:** * **Demographics:** Most common in adolescent girls (puberty) who are physically active. * **Site:** 2nd Metatarsal > 3rd Metatarsal. * **Pathology:** It is a "crushing" type of osteochondritis. * **MRI:** The most sensitive modality for early diagnosis (shows bone marrow edema before X-ray changes). * **Treatment:** Initially conservative (activity modification, orthotics). Surgical options include debridement or dorsal closing wedge osteotomy (Gauthier procedure) to bring healthy cartilage into the weight-bearing zone.

Q: What is a fracture of the 5th metatarsal called?

Jones fracture. **Explanation:** The correct answer is **Jones fracture**. This refers to a transverse fracture at the **base of the 5th metatarsal**, specifically at the metaphyseal-diaphyseal junction (Zone 2). This area is clinically significant because it is a "watershed area" with a precarious blood supply, making these fractures prone to delayed union or non-union. **Analysis of Options:** * **Jones Fracture (Correct):** Occurs about 1.5 to 3 cm distal to the tuberosity. It must be distinguished from a **Pseudo-Jones fracture** (Avulsion fracture of the styloid process/tuberosity), which is more common and heals more easily. * **Malgaigne's Fracture:** A vertical shear injury of the pelvis involving double vertical fractures (fracture of the pubic rami anteriorly and disruption of the SI joint or ilium posteriorly). * **Cotton's Fracture:** A trimalleolar fracture of the ankle involving the medial malleolus, lateral malleolus, and the posterior malleolus (posterior lip of the tibia). * **Pott's Fracture:** A generic term for bimalleolar ankle fractures caused by eversion-external rotation injuries. **NEET-PG High-Yield Pearls:** 1. **Mechanism:** Jones fracture usually occurs due to a forceful adduction of the forefoot with the ankle in plantar flexion. 2. **Classification:** The **Lawrence and Botte classification** divides 5th metatarsal base fractures into three zones: Zone 1 (Pseudo-Jones), Zone 2 (Jones), and Zone 3 (Stress fracture of the proximal shaft). 3. **Management:** Jones fractures often require non-weight-bearing casts for 6–8 weeks or internal fixation (intramedullary screw) in athletes due to the high risk of non-union.

Q: A fracture of the talus without displacement is visualized on X-ray. What is the most likely complication?

Osteoarthritis of the ankle. **Explanation:** Fractures of the talus are notorious for their high complication rates due to the bone's unique anatomy—it is 60% covered by articular cartilage and has a precarious retrograde blood supply. **Why Option A is Correct:** While Avascular Necrosis (AVN) is a feared complication of talar neck fractures, **Osteoarthritis (OA)** of the ankle or subtalar joint is actually the **most common** overall complication, even in undisplaced fractures. This occurs because the talus is an intra-articular bone; any fracture, even without displacement, can cause chondral damage or subtle joint incongruity, leading to secondary degenerative changes over time. **Analysis of Incorrect Options:** * **B, C, and D (AVN):** AVN is a classic complication of talar neck fractures (Hawkins Classification). However, in **undisplaced** fractures (Hawkins Type I), the risk of AVN is relatively low (0–15%). When AVN does occur, it typically involves the **body** of the talus because the blood supply enters through the neck and flows retrogradely to the body. AVN of the "head" or "neck" specifically is anatomically incorrect in this clinical context. **NEET-PG High-Yield Pearls:** * **Hawkins Sign:** A subchondral radiolucent line in the talar dome seen on X-ray 6–8 weeks post-injury. Its presence indicates intact vascularity (excludes AVN). * **Blood Supply:** Primarily from the **Artery of the Tarsal Canal** (branch of the posterior tibial artery). * **Most common site of fracture:** Talar Neck. * **Aviator’s Astragalus:** Historical term for talar fractures caused by high-energy dorsiflexion.

Question 1

Which of the following is true about acute rupture of the tendo calcaneus (Achilles tendon)?

Accepted Answer

It usually occurs in middle-aged persons.

Answer

It occurs due to direct injury.

Answer

Radiograph will confirm the diagnosis.

Answer

Compression of calf muscles produces plantarflexion of the ankle.

Question 2

What is the change in Gissane's angle in an intra-articular fracture of the calcaneum?

Accepted Answer

Increased

Answer

Reduced

Answer

Not changed

Answer

Variable

Question 3

Which of the following statements is false with respect to Pes planus?

Accepted Answer

Rigid type on Jack's test often requires conservative intervention.

Answer

Obliterated/lost medial longitudinal arch leads to Pes planus.

Answer

If the heel goes into lateral deviation, it is called plano valgus.

Answer

The most common cause is idiopathic.

Question 4

Which of the following is the commonest cause for neuralgic pain in the foot?

Accepted Answer

Compression of the communication between the medial and lateral planter nerves

Answer

Injury to the deltoid ligament

Answer

Shortening of the plantar aponeurosis

Answer

Exaggeration of the longitudinal arches of the foot

Question 5

Which of the following is tarsometatarsal amputation?

Accepted Answer

Lisfranc's Amputation

Answer

Sarmiento's Amputation

Answer

Chopart's Amputation

Answer

Syme's Amputation

Question 6

What are the radiographic findings in Freiberg disease?

Accepted Answer

All are true.

Answer

Depending on the stage of the disease, radiographs may show only sclerosis and widening of the joint space (early), with complete collapse of the metatarsal head and fragmentation later.

Answer

Oblique views may be especially useful to fully appreciate subtle changes early in the disease.

Answer

Osteochondral loose bodies may be seen late in the disease.

Question 7

What is a Lisfranc fracture-dislocation?

Accepted Answer

Fracture-dislocation through the tarso-metatarsal joints.

Answer

Fracture-dislocation through the ankle joint.

Answer

Fracture-dislocation through the subtalar joints.

Answer

Fracture-dislocation through the mid-tarsal joints.

Question 8

All of the following are true regarding pes planus except:

Accepted Answer

One of the common types of tarsal coalition is calcaneonavicular and it is autosomal recessive.

Answer

There is collapse of the medial longitudinal arch.

Answer

The heel becomes valgus and the foot pronates at the subtalar-mid tarsal joint.

Answer

Jack's test differentiates between flexible and rigid deformity.

Question 9

What is a fracture of the 5th metatarsal called?

Accepted Answer

Jones fracture

Answer

Malgaigne's fracture

Answer

Cotton's fracture

Answer

Pott's fracture

Question 10

A fracture of the talus without displacement is visualized on X-ray. What is the most likely complication?

Accepted Answer

Osteoarthritis of the ankle

Answer

Osteonecrosis of the head of the talus

Answer

Avascular necrosis of the body of the talus

Answer

Avascular necrosis of the neck of the talus

Foot and Ankle Surgery — MCQs

Foot and Ankle Surgery — MCQs

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