Foot and Ankle Surgery Practice Questions

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 ligaments is injured in an ankle inversion injury?

Anterior talofibular ligament. ***Anterior talofibular ligament*** - The **anterior talofibular ligament (ATFL)** is the most commonly injured ligament in an **ankle inversion sprain** due to its position and weaker structure. - It connects the **fibula** to the **talus** anteriorly, and when the foot inverts, this ligament is stretched and often torn first. *Calcaneofibular ligament* - The **calcaneofibular ligament (CFL)** is also an important lateral ankle ligament that can be injured in **severe inversion sprains**. - It is often damaged in conjunction with the ATFL, but typically only after the ATFL has already been compromised through an ankle inversion injury. *Posterior talofibular ligament* - The **posterior talofibular ligament (PTFL)** is the strongest of the **lateral collateral ligaments** and is rarely injured in isolation. - Injury to the PTFL usually occurs in cases of **severe, high-grade ankle dislocations** or very forceful inversion injuries, often involving other ligaments. *Deltoid ligament* - The **deltoid ligament** is a strong, fan-shaped ligament located on the **medial side of the ankle**. - It resists **eversion** of the ankle, meaning it is more commonly injured in **eversion sprains**, not inversion sprains.

Q: A patient with an ankle sprain has likely injured which ligament?

Anterior talofibular ligament. ***Anterior talofibular ligament*** - The **anterior talofibular ligament (ATFL)** is the most commonly injured ligament in an **ankle sprain**, especially during inversion injuries. - It is a key component of the **lateral collateral ligament complex** of the ankle and resists excessive inversion and plantarflexion. *Medial collateral ligament* - This refers to the **deltoid ligament** complex in the ankle, which is a very strong ligament on the medial side. - Injuries to the deltoid ligament are **less common** and usually occur with eversion forces, which are not typical for a standard ankle sprain. *Lateral collateral ligament* - While technically correct that the ATFL is part of the lateral collateral ligament complex, referring to the entire complex broadly is **less precise** than identifying the most frequently injured specific ligament within that complex. - A patient with an ankle sprain commonly injures a specific component of this complex, most often the ATFL. *Posterior talofibular ligament* - The **posterior talofibular ligament (PTFL)** is also part of the lateral collateral ligament complex but is injured **far less frequently** than the ATFL. - Injury to the PTFL typically occurs with **severe ankle sprains** or dislocations.

Q: Ankle sprain due to forced inversion of a plantar flexed foot is due to injury to

Anterior talofibular ligament. ***Anterior talofibular ligament*** - The **anterior talofibular ligament** is the most commonly injured ligament in **ankle sprains** caused by **forced inversion** of a **plantar-flexed foot**. - Its anatomical position makes it vulnerable as it is taut during plantarflexion and inversion. *Posterior talofibular ligament* - This ligament is usually injured in cases of **severe ankle sprains**, often involving - It provides significant stability against **posterior displacement** of the talus but is less frequently damaged in isolated inversion injuries. *Calcaneofibular ligament* - The **calcaneofibular ligament** is also commonly injured in **inversion sprains**, but typically after or in conjunction with the anterior talofibular ligament. - Its orientation makes it more resistant to injury during plantarflexion compared to the ATFL. *Posterior fibers of deltoid* - The **deltoid ligament** is located on the **medial side** of the ankle and resists **eversion** forces. - Injury to the deltoid ligament would occur with forced eversion, not inversion, making it an unlikely injury in this scenario.

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: Commonest ligament injured in ankle injury ?

Anterior talofibular ligament. ***Anterior talofibular ligament*** - The **anterior talofibular ligament (ATFL)** is the **most frequently injured ligament** in ankle sprains because it is the weakest and most commonly stretched during **inversion injuries**. - Its position makes it vulnerable during movements where the foot rolls inward, a common mechanism for ankle sprains. *Calcaneofibular ligament* - The **calcaneofibular ligament (CFL)** is stronger than the ATFL and is typically injured with more severe inversion forces, often in conjunction with ATFL rupture. - While it plays a crucial role in ankle stability, it is not the *most* commonly injured ligament. *Posterior talofibular ligament* - The **posterior talofibular ligament (PTFL)** is the strongest of the lateral ankle ligaments and is rarely injured in isolated ankle sprains. - Its injury usually signifies a **severe ankle sprain** with significant talar displacement or dislocation. *Spring ligament* - The **spring ligament**, also known as the **plantar calcaneonavicular ligament**, is located on the medial side of the foot and supports the medial longitudinal arch. - It is not directly involved in typical ankle sprains, which primarily affect the lateral collateral ligaments.

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: The rephrased question is:What is the most common complication of a fractured talus?

Avascular necrosis (AVN). ***Avascular necrosis (AVN)*** - The talus has a **precarious blood supply**, with arterial branches entering at multiple points but often centrally, making it vulnerable to **ischemia** after fracture. - Fractures, especially neck fractures, can disrupt these delicate vessels, leading to **osteonecrosis** and collapse of the bone. *Nonunion of the talus* - While possible, talar nonunion is **less common** than AVN due to the talus's dense cortical bone and limited muscle attachments. - Nonunion is more frequently seen with fractures of other bones, such as the **scaphoid**. *Osteoarthritis of the subtalar joint* - **Subtalar osteoarthritis** can occur post-talar fracture, often as a **secondary complication** of disrupted articular surfaces or AVN. - However, the **initial and most common direct complication** stemming from the blood supply disruption is AVN. *Osteoarthritis of the ankle joint* - **Ankle osteoarthritis** can also develop after certain talar fractures, particularly those involving the talar dome or leading to incongruity of the ankle joint. - Similar to subtalar arthritis, it is often a **later or secondary sequela**, rather than the immediate and most frequent direct complication like AVN.

Question 1

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 2

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 3

Which of the following ligaments is injured in an ankle inversion injury?

Accepted Answer

Anterior talofibular ligament

Answer

Calcaneofibular ligament

Answer

Posterior talofibular ligament

Answer

Deltoid ligament

Question 4

A patient with an ankle sprain has likely injured which ligament?

Accepted Answer

Anterior talofibular ligament

Answer

Medial collateral ligament

Answer

Lateral collateral ligament

Answer

Posterior talofibular ligament

Question 5

Ankle sprain due to forced inversion of a plantar flexed foot is due to injury to

Accepted Answer

Anterior talofibular ligament

Answer

Posterior talofibular ligament

Answer

Calcaneofibular ligament

Answer

Posterior fibres of deltoid

Question 6

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 7

Bunion is commonly seen at ?

Accepted Answer

Great toe MTP joint

Answer

Medial malleolus

Answer

Lateral Malleolus

Answer

Shin of tibia

Question 8

Commonest ligament injured in ankle injury ?

Accepted Answer

Anterior talofibular ligament

Answer

Calcaneofibular ligament

Answer

Posterior talofibular ligament

Answer

Spring ligament

Question 9

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 10

The rephrased question is:What is the most common complication of a fractured talus?

Accepted Answer

Avascular necrosis (AVN)

Answer

Osteoarthritis of the subtalar joint

Answer

Nonunion of the talus

Answer

Osteoarthritis of the ankle joint

Foot and Ankle Surgery — MCQs

Foot and Ankle Surgery — MCQs

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