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Orthopedic Foot And Ank Review | Dr Hutaif Foot & Ankle -...

Updated: Feb 2026 44 Views
Orthopedic Foot And Ank Review | Dr Hutaif Foot & Ankle -...

Key Medical Takeaway

Looking for accurate information on ORTHOPEDIC MCQS ONLINE 015 FOOT AND ANKLE e? Lisfranc injuries are midfoot ligament disruptions, often missed initially. The Lisfranc ligament extends from the second metatarsal to the medial cuneiform; a “fleck sign” is an avulsion fracture at the second metatarsal base. Treatment for displaced injuries is typically open reduction and internal fixation (ORIF) with rigid screw/plate fixation. To review pubmed pmid view detailed evidence, consult relevant orthopedic literature.

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ORTHOPEDIC MCQS ONLINE 015 FOOT AND ANKLE e

QUESTION 1
of 100
This injury is best treated with
1
closed reduction and percutaneous pinning.
2
a short-leg cast with closed reduction.
3
open reduction and internal fixation (ORIF) with Kirschner wires.
4
ORIF with screw and/or plate fixation.
QUESTION 2
of 100
The Lisfranc ligament extends from the
1
medial cuneiform to the first metatarsal bone.
2
medial cuneiform to the second metatarsal bone.
3
first metatarsal base to the second metatarsal base.
4
first metatarsal base to the medial cuneiform.
QUESTION 3
of 100
In Lisfranc injuries, the "fleck sign," when present, represents
1
calcification of the interosseous ligament.
2
a stable Lisfranc injury.
3
a small avulsion fracture of the first metatarsal base.
4
a small avulsion fracture of the second metatarsal base.
QUESTION 4
of 100
In the evaluation of Lisfranc injuries, which radiographic studies should routinely be obtained?


1
MRI
2
Bilateral weight-bearing anteroposterior and lateral views of the foot with obliques
3
Stress radiographs under anesthesia
4
CT scan with 3-dimensional images
QUESTION 5
of 100
The second-toe deformity is most accurately described as
1
hammer toe.
2
claw toe.
3
curly toe.
4
crossover toe.
QUESTION 6
of 100
The patient's painful great-toe deformity is best treated with
1
proximal metatarsal bunionectomy.
2
simple bunionectomy.
3
cheilectomy.
4
resection of base of proximal phalanx.
QUESTION 7
of 100
Disruption of which anatomic structure is necessary for the second-toe pathology to occur?
1
Collateral ligaments
2
Intrinsic flexor tendons
3
Extrinsic extensor tendons
4
Plantar plate
QUESTION 8
of 100
On the morning of surgery the patient reports in the preop area that she has experienced skin breakdown over the second toe for 10 days. The extensor tendon is disrupted with an exposed proximal interphalangeal joint. She has been applying antibiotic ointment to the wound and denies fever or chills. What is the best plan of care?
1
Continue with plans for bunion and crossover toe correction.
2
Cancel the surgery and send the patient home with empiric oral medications.
3
Inform the patient that surgical joint debridement is necessary and the elective reconstructive surgery will be put on hold.
4
Swab the ulcer and admit the patient for peripherally inserted central catheter line placement and intravenous antibiotics.
QUESTION 9
of 100
Figure 9 is the radiograph of a 24-year-old amateur marathon runner who has ankle pain. She previously sustained a metatarsal stress fracture. In addition to asking about her training routine and the type of footwear she uses, the orthopaedic surgeon should inquire about this patient's history of nutrition and

1
genetics.
2
rheumatology.
3
menstruation.
4
cardiovascular health.
QUESTION 10
of 100
A 28-year-old woman with bone-on-bone ankle arthritis, little deformity, and recalcitrant pain
1
Ankle replacement
2
Ankle fusion
3
Tibiotalocalcaneal fusion
4
Total contact cast
5
Intra-articular steroid injection
QUESTION 11
of 100
A 56-year-old woman with diabetes, neuropathy, and an unbraceable ankle and hindfoot deformity
1
Ankle replacement
2
Ankle fusion
3
Tibiotalocalcaneal fusion
4
Total contact cast
5
Intra-articular steroid injection
QUESTION 12
of 100
A 72-year-old man with a previous contralateral ankle fusion, rheumatoid arthritis, and 5 degrees of valgus; he has pursued nonsurgical treatment for 30 years and now has unrelenting pain
1
Ankle replacement
2
Ankle fusion
3
Tibiotalocalcaneal fusion
4
Total contact cast
5
Intra-articular steroid injection
QUESTION 13
of 100
A 72-year-old man with diabetic neuropathy and 5 degrees of valgus talar tilt; he has pursued nonsurgical treatment for 30 years and now has unrelenting pain
1
Ankle replacement
2
Ankle fusion
3
Tibiotalocalcaneal fusion
4
Total contact cast
5
Intra-articular steroid injection
QUESTION 14
of 100
Figure 14 is a sagittal-cut MR image from the hindfoot of a 54-year-old woman who has had plantar heel pain for 3 months. There is no history of trauma. Her pain is worse when she rises and at the end of the day. Upon examination she has localizable tenderness over the plantar medial tubercle of the calcaneus. The Achilles is intact and nontender, and subtalar joint motion is full and painless. A Tinel test result is negative. What is the most likely diagnosis?




1
Calcaneal stress fracture
2
Hindfoot coalition
3
Insertional Achilles tendonitis
4
Plantar fasciitis
QUESTION 15
of 100
Following surgical stabilization and fixation of the distal fibula, what is the most appropriate next step?
1
Place a transsyndesmotic screw.
2
Perform an open repair of the deltoid ligament.
3
Perform a stress examination of the syndesmosis.
4
Close the wound and apply a short-leg splint.
QUESTION 16
of 100
16A
B
C
Figures 16a through 16c are the postsurgical radiographs taken 3 months after surgical stabilization of the fracture and syndesmosis. The patient has no pain and symmetrical range of motion to the contralateral lower extremity. What is the most appropriate next step?



1
Removal of the transyndesmotic screw
2
Retention of hardware with progression of activity
3
Revision open reduction and internal fixation (ORIF) of the syndesmosis
4
Syndesmotic fusion
QUESTION 17
of 100
One year after surgical fixation of the ankle (Figure 17) the patient has persistent pain within the ankle and wants the hardware removed. He should be counseled that after hardware removal he should expect
1
significant resolution of his pain and discomfort.
2
high risk of postoperative fibular fracture.
3
improvement in the range of motion.
4
no significant change in his symptoms.
QUESTION 18
of 100
Which complication is most common after syndesmotic fixation?
1
Synostosis of the distal tibiofibular joint
2
Failure of fixation with subsequent loss of reduction
3
Malreduction of the distal tibiofibular joint
4
Posttraumatic ankle arthrosis
QUESTION 19
of 100
Figure 19 is the clinical photograph of a 54-year-old man who underwent a total ankle replacement (TAR). Three weeks after surgery he has increasing pain and a deep wound as seen in the photograph. What is the best next step?

1
Remove the total ankle and place an antibiotic spacer
2
Debride and exchange polyethylene
3
Perform a below-the-knee amputation
4
Convert to a fusion with an intercalary allograft
QUESTION 20
of 100
Figures 20a and 20b are the radiographs of a 56-year-old woman who runs a horse farm. She has a 2-year history of increasing ankle pain and swelling without previous treatment. Which treatment is most appropriate at this time?


1
/- Nonsteroidal anti-inflammatory drugs (NSAIDs) and bracing
2
/- Ankle fusion
3
/- Ankle arthroscopy and cheilectomy
4
/- Ankle distraction arthroplasty
QUESTION 21
of 100
Figure 21 is the intraoperative fluoroscopic image of a 40-year-old man who felt a pop during a twisting injury to his right ankle. He underwent open reduction and internal fixation (ORIF) of a bimalleolar ankle fracture. During the surgery the medial and lateral malleoli fractures were reduced and rigidly was internally fixed. Following fracture fixation, which additional test is recommended to ensure mortise stability?


1
Thompson
2
Cotton
3
Squeeze
4
Anterior drawer
QUESTION 22
of 100
What is the most appropriate diagnosis?
1
Osteomyelitis
2
Osseous tumor
3
Stress fracture
4
Charcot foot
QUESTION 23
of 100
What is the most appropriate treatment?
1
Bone biopsy
2
Total-contact casting
3
Double upright ankle foot orthosis
4
Empiric antibiotics
QUESTION 24
of 100
Glucose control assessment is best achieved by ordering which blood test?
1
Random glucose
2
Fasting glucose
3
Hemoglobin A1C
4
Prealbumin
QUESTION 25
of 100
The mechanism for the osseous destruction is attributable to
1
avascular necrosis.
2
tumor invasion.
3
hypervascularity.
4
infection.
QUESTION 26
of 100
Contracture of which structure causes hammertoe deformity?
1
Extensor digitorum longus tendon
2
Extensor digitorum brevis tendon
3
Flexor digitorum longus tendon
4
Flexor digitorum brevis tendon
QUESTION 27
of 100
A 10-year-old boy reports heel pain with sporting activities. An examination demonstrates gastrocnemius contracture and tenderness at the calcaneal apophysis. Radiographs are unremarkable. What is the best next step?
1
MRI
2
Surgical intervention
3
Activity modification
4
Cast immobilization
QUESTION 28
of 100
Figure 28 is the radiograph of a 25-year-old soccer player who twisted her left ankle 1 week ago. She has pain and swelling over the anterolateral ankle and there is ecchymosis over the lateral ankle. She has these muscle group findings: anterior tibial tendon-right 5/5, left 5/5; posterior tibial tendon-right
5/5, left 5/5; peroneals-right 5/5, left 4/5; Achilles-right 5/5, left 5/5. What is the best next diagnostic or treatment step?


1
Stress radiographs
2
Surgical resection of the fragment with lateral ligament reconstruction
3
Physical therapy for peroneal strengthening and proprioceptive training
4
Ankle arthroscopy for debridement
QUESTION 29
of 100
Which primary underlying pathologic finding is causing her symptoms?
1
Spring ligament tear
2
Gastrocnemius contracture
3
Tarsal coalition
4
Posterior tibial tendon dysfunction
QUESTION 30
of 100
Injury to which ligament is commonly seen in this condition?
1
Cervical
2
Calcaneonavicular (spring)
3
Deltoid
4
Interosseous
QUESTION 31
of 100
In addition to physical therapy, what is the best course of treatment at this time?
1
Steroid injection
2
Platelet-rich plasma injection
3
Ankle-foot orthosis
4
Foot orthosis with a lateral post
QUESTION 32
of 100
Which surgical procedure should be considered after 6 months of unsuccessful nonsurgical treatment?
1
Calcaneal osteotomy with bone graft and flexor digitorum longus tendon transfer
2
Subtalar fusion
3
Triple arthrodesis
4
Ankle arthrodesis
QUESTION 33
of 100
Figure 33 is the preoperative photograph of the patient's forefoot with the heel taken out of valgus. Which procedure will best address this forefoot deformity (which cannot be passively corrected by the examiner)?
33

1
First tarsometatarsal joint fusion
2
Gastrocnemius musculotendonous recession
3
Subtalar arthroereisis
4
Dorsal opening-wedge osteotomy of the medial cuneiform
QUESTION 34
of 100
Which stress fracture location is reported most frequently among ballet dancers?
1
Base of the second metatarsal
2
Base of the fifth metatarsal
3
Tibial sesamoid
4
Central third of the tarsal navicular
QUESTION 35
of 100
Figure 35 is the radiograph of a 37-year-old woman who began having right forefoot pain about 4 weeks ago after increasing her daily running mileage. She denies any specific injury. Upon examination she has tenderness over the medial forefoot with mild swelling. In addition to her activity level, what is the primary etiology of the radiograph finding?
1
Osteoporosis
2
Hallux valgus deformity
3
Hallux rigidus
4
A relatively long second metatarsal
QUESTION 36
of 100
Which radiographic abnormality most accurately serves as a predictor of ankle syndesmosis disruption?
1
Medial clear space equal to the superior clear space on the anteroposterior (AP) view
2
Tibiofibular overlap exceeding 6 mm on the AP view
3
Tibiofibular clear space exceeding 6 mm on AP view
4
Talocrural angle symmetric to the opposite side
QUESTION 37
of 100
What is the appropriate treatment at this time?
1
Begin a structured proprioceptive-based rehabilitation program and use a brace as needed.
2
Discontinue the brace and start aggressive range-of-motion physical therapy.
3
Use a short-leg weight-bearing cast for 4 weeks.
4
Maintain nonweight-bearing status on crutches for 4 weeks.
QUESTION 38
of 100
38A
B
Three months later this patient has continued swelling and giving-way episodes. Figures 38a and 38b are his stress radiographs. This study indicates laxity in which ligament?


1
Anterior talofibular
2
Calcaneal fibular
3
Posterior talofibular
4
Lateral talocalcaneal
QUESTION 39
of 100
39A
B
C
D
The continued pain and instability 4 months after injury are likely related to which finding on the presurgical MR images in Figures 39a through 39d?




1
Peroneal brevis tear
2
Osteochondral lesion of the talus
3
Loose body in the posterior ankle
4
Tear of the calcaneal-fibular ligament
QUESTION 40
of 100
40A
B
Figures 40a and 40b are this patient's intraoperative arthroscopic images. The abnormality seen here illustrates which of the patient's clinical findings?


1
Instability on unlevel ground
2
Ankle pain and swelling
3
Anterior laxity on lateral radiographs
4
Osteochondral lesion of the talus on MR imaging
QUESTION 41
of 100
Which nerve is not included in a standard popliteal nerve block?


1
Sural nerve
2
Saphenous nerve
3
Superficial peroneal nerve
4
Deep peroneal nerve
QUESTION 42
of 100
Which complication associated with subtalar arthroereisis devices for treatment of flexible flatfoot deformity is most common?
1
Fracture of the talus
2
Osteonecrosis of the calcaneus
3
Persistent pain in the sinus tarsi
4
Attritional rupture of the flexor digitorum longus (FDL) tendon
QUESTION 43
of 100
43A
B
Figures 43a and 43b are the postsurgical radiographs. Which tendon transfer is most appropriate for this patient's treatment?


1
Peroneus longus
2
Plantaris
3
Flexor hallucis longus
4
FDL
QUESTION 44
of 100
Os naviculare is present in which percentage of normal feet?
1
1% to 2%
2
10% to 14%
3
25% to 30%
4
40% to 50%
QUESTION 45
of 100
A
B C
D E
Figures 45a through 45c are the MR images of a 22-year-old woman who has had 6 months of ankle pain related to activities of daily living. She recently completed a course of cast immobilization and protected weight bearing without symptom resolution. Figures 45d and 45e are the intraoperative arthroscopy images after minimal probing. What is the most appropriate treatment?





1
Ankle fusion
2
Arthroscopic debridement and drilling
3
Retrograde drilling and bone grafting
4
Malleolar osteotomy and osteochondral grafting
QUESTION 46
of 100
A 32-year-old woman has had progressive left foot pain over the first metatarsophalangeal (MTP) joint. Footwear is becoming problematic. There is full range of motion of the first MTP with medial eminence pain. Her weightbearing radiograph reveals a hallux valgus angle (HVA) of 35 degrees and a 1-2 intermetatarsal angle (IMA) of 10 degrees. What is the best next step?
1
Distal metatarsal osteotomy
2
Distal soft-tissue reconstruction
3
Proximal metatarsal osteotomy
4
Lapidus bunionectomy
QUESTION 47
of 100
An 8-year-old boy with pes planus that reconstitutes with heel-rise; his mother brought him in for evaluation because he seems to be "tripping a lot".
1
Observation
2
Arizona brace
3
Medial arch support
4
Casting
5
Hindfoot fusion
QUESTION 48
of 100
A 37-year-old woman has had persistent right lateral ankle pain after sustaining a minor sprain 5 months ago. She has a sense of instability on
uneven ground. Physical therapy has not helped. She is tender along the peroneal tendons and in the sinus tarsi. She has a negative anterior drawer test result for the ankle and no tenderness over the anterior lateral malleolus. She also has bilateral pes planus that persists with heel rise.
1
Observation
2
Arizona brace
3
Medial arch support
4
Casting
5
Hindfoot fusion
QUESTION 49
of 100
A 15-year-old high school basketball player has pain over a medial midfoot prominence on his right foot. There has been no trauma and no specific treatment. He has bilateral flexible pes planus and pain with inversion against resistance on the right. His pain is disrupting or preventing his daily and sports activities.
1
Observation
2
Arizona brace
3
Medial arch support
4
Casting
5
Hindfoot fusion
QUESTION 50
of 100
A 69-year-old woman has rigid painful left pes planus that has become less symptomatic with casting. She has multiple comorbidities and is not a good surgical candidate. She has failed a trial of activity without any supports.




1
Observation
2
Arizona brace
3
Medial arch support
4
Casting
5
Hindfoot fusion
QUESTION 51
of 100
What is the primary concern regarding resolution of this fracture?
1
Overload of the lateral foot column
2
Tendon pull on the fragments
3
Blood supply to this area
4
Patient activity level
QUESTION 52
of 100
Which treatment option will most reliably achieve long-term success?
1
Dwyer osteotomy
2
Surgical fixation with a solid screw
3
Surgical fixation with a cannulated screw
4
Iliac crest bone graft with plate fixation
QUESTION 53
of 100
Figure 53 is a coronal-cut CT scan of a 63-year-old woman who has a longstanding pes planus. She is seen for lateral ankle discomfort. Upon examination she is tender over the sinus tarsi and distal to the fibula. She has painless passive hindfoot eversion with 5/5 eversion strength. The most appropriate diagnosis is

1
subtalar arthritis.
2
middle-facet coalition.
3
lateral impaction syndrome.
4
calcaneonavicular coalition.
QUESTION 54
of 100
Figure 54 is the lateral radiograph of a 55-year-old man who is evaluated for a 2-year history of pain and stiffness of his right metatarsophalangeal (MTP) joint. Upon examination he has dorsal bossing, severe crepitation, and pain
with passive range of motion. There is pain with the "grind" test. Dorsiflexion is limited to 0 degrees. No sesamoid tenderness is present. What is the most appropriate surgical treatment?



1
Chevron bunionectomy
2
Cheilectomy and removal of loose body
3
MTP arthrodesis
4
Resection of proximal phalanx
QUESTION 55
of 100
What is the most likely diagnosis?
1
Fracture dislocation of the Lisfranc joint
2
Fracture dislocation of the Chopart joint
3
Fracture dislocation of the subtalar joint
4
Complex fracture dislocation of the midtarsal articulations
QUESTION 56
of 100
What is the most appropriate initial treatment?
1
Primary arthrodesis
2
Attempted closed reduction in the office
3
Attempted closed reduction under anesthesia with possible open reduction
4
Splinting to comfort level and progressive weight bearing as tolerated
QUESTION 57
of 100
If a closed reduction is attempted, which structure most likely will prevent a reduction?
1
Tibialis anterior tendon
2
Tibialis posterior tendon
3
Peroneus brevis tendon
4
Peroneus longus tendon
QUESTION 58
of 100
After full healing from this injury, which option most likely will help to optimize this patient's activities?
1
Extra-depth shoes
2
Rocker-bottom soles
3
Figure-of-8 soft-ankle brace
4
A patellar-tendon-bearing brace
QUESTION 59
of 100
Which lower extremity muscle is first weakened in Charcot-Marie-Tooth (CMT) disease?

1
Peroneus brevis
2
Peroneus longus
3
Foot intrinsics
4
Tibialis anterior
QUESTION 60
of 100
What are the most common locations of the pathology?
1
Calcaneocuboid and talocalcaneal joints
2
Talonavicular and calcaneocuboid joints
3
Talonavicular and calcaneonavicular joints
4
Talocalcaneal and calcaneonavicular joints
QUESTION 61
of 100
What is the origin of this patient's pathology?
1
Traumatic
2
Genetic
3
Arthritic
4
Attritional
QUESTION 62
of 100
After a review of the images, it appears the appropriate next diagnostic step should be
1
MRI.
2
CT scan.
3
bone scan.
4
ultrasound.
QUESTION 63
of 100
The patient undergoes further testing and it is discovered that the lesion encompasses 70% of the joint. What is the best next treatment option?
1
Arthroscopic debridement
2
Subtalar arthroereisis
3
Subtalar fusion
4
Lesion resection
QUESTION 64
of 100
A
B
C
Figures 64a through 64c are the MR images and radiograph of an active 30-year-old man who has been treated for pain in his subtalar joint for 6 months. He has had casting, physical therapy, and bracing but continues to have activity-limiting pain. An injection into the subtalar joint under fluoroscopic guidance temporarily relieved his pain. His best surgical option at this time is



1
resection of the coalition bar.
2
subtalar fusion.
3
medial sliding calcaneal osteotomy.
4
Dwyer osteotomy.
QUESTION 65
of 100
What is a risk factor for interdigital neuroma?
1
Female gender
2
Increased mobility between the third and fourth rays
3
Achilles tendon contracture
4
Prolonged standing at work
QUESTION 66
of 100
Which Morton neuroma histology is most common?
1
Perineural fibrosis
2
Wallerian degeneration
3
Distal axonopathy
4
Segmental demyelination
QUESTION 67
of 100
A patient sustained a puncture wound to the plantar aspect of his foot. He was wearing shoes and socks at the time of the injury. Systemic antibiotic administration with specific coverage for which bacterial species (in addition to Staphylococcus aureus) should be instituted?
1
Escherichia coli
2
Mycobacterium marinum
3
Pseudomonas
4
Clostridium
QUESTION 68
of 100
Figure 68 is the radiograph of a 33-year-old runner who recently decided to begin running barefoot on trails. Since his transition to running without shoes 3 months ago, he has been having pain in the second metatarsophalangeal (MTP) joint. He feels like he is walking on a stone, notes edema in the ball of his foot, and has started to see a deviation of the second toe. What is the most likely etiology of these symptoms and findings?

1
Tear of the plantar plate
2
Second MTP joint synovitis
3
Second metatarsal stress fracture
4
Flexor tendonitis
QUESTION 69
of 100
Figure 69 is the radiograph of a 9-year-old who has posterior hindfoot pain while running. What is the most likely diagnosis?

1
Kohler disease
2
Thiemann disease
3
Freiberg infraction
4
Sever disease
QUESTION 70
of 100
A 62-year-old runner injured his right ankle 8 weeks ago. He has ongoing lateral ankle pain and swelling that did not improve with 4 weeks of immobilization and 4 weeks of physical therapy. MR images demonstrate a longitudinal tear of the peroneus brevis tendon. Treatment should involve
1
peroneus brevis tendon repair.
2
peroneus longus to peroneus brevis tenodesis.
3
6 weeks in short-leg cast.
4
platelet-rich plasma injection.
QUESTION 71
of 100
Figure 71 is the radiograph of a 67-year-old patient with rheumatoid arthritis who has experienced 6 months of increasing pain, swelling, and foot deformity. Anti-inflammatory medications, orthotics, and extra-depth shoes fail to provide sufficient relief.
71

1
Lapidus procedure
2
First metatarsophalangeal (MTP) joint arthrodesis and lesser metatarsal head resection
3
Proximal first metatarsal osteotomy
4
Distal first metatarsal chevron osteotomy
5
Biplanar distal first metatarsal osteotomy
QUESTION 72
of 100
72
Figure 72 is the radiograph of a 58-year-old active woman with progressive medial first MTP joint pain, particularly with shoe wear and increased activity. The patient has no hypermobility.

1
Lapidus procedure
2
First metatarsophalangeal (MTP) joint arthrodesis and lesser metatarsal head resection
3
Proximal first metatarsal osteotomy
4
Distal first metatarsal chevron osteotomy
5
Biplanar distal first metatarsal osteotomy
QUESTION 73
of 100
A 44-year-old patient who has had a proximal first metatarsal osteotomy has recurrent pain and difficulty wearing many types of shoes. Radiographs show a large 1-2 intermetatarsal angle (IMA).

1
Lapidus procedure
2
First metatarsophalangeal (MTP) joint arthrodesis and lesser metatarsal head resection
3
Proximal first metatarsal osteotomy
4
Distal first metatarsal chevron osteotomy
5
Biplanar distal first metatarsal osteotomy
QUESTION 74
of 100
74
Figure 74 is the radiograph of a 31-year-old woman with a painful bunion deformity that has failed nonsurgical treatment.
1
Lapidus procedure
2
First metatarsophalangeal (MTP) joint arthrodesis and lesser metatarsal head resection
3
Proximal first metatarsal osteotomy
4
Distal first metatarsal chevron osteotomy
5
Biplanar distal first metatarsal osteotomy
QUESTION 75
of 100



1
25-year-old man has had a painful bunion deformity since childhood. Nonsurgical treatment has failed. Weight-bearing radiographs reveal a congruent hallux valgus (HV) with a large distal metatarsal articular angle (DMAA) and a normal 1-2 IMA. There is no arthritis or first tarsometatarsal joint or hypermobility.
2
Lapidus procedure
3
First metatarsophalangeal (MTP) joint arthrodesis and lesser metatarsal head resection
4
Proximal first metatarsal osteotomy
5
Distal first metatarsal chevron osteotomy
QUESTION 76
of 100
What is the most common underlying etiology for this condition in this clinical setting?
1
Microvascular disease
2
Poorly controlled blood glucose
3
Sensory neuropathy
4
Chronic renal failure
QUESTION 77
of 100
If nonsurgical treatment of this wound fails, the most likely cause for failure is
1
poor tolerance to casting.
2
poorly controlled blood glucose.
3
inappropriate choice of antibiotics.
4
underlying osteomyelitis.
QUESTION 78
of 100
If surgery is necessary, what is the most appropriate procedure?
1
Below-knee amputation
2
Debridement of all infected tissue with primary closure
3
Debridement of all infected tissue with free-flap closure
4
Debridement of all infected tissue and a negative-pressure dressing for the resulting wound
QUESTION 79
of 100
After the patient's wound has healed, which intervention is critical to prevent future ulceration?
1
A well-fitted prosthesis on the left
2
Making sure he wears large shoes to decrease pressure on his feet
3
A bilateral ankle-foot orthoses fitting
4
Custom-molded soft shoe inserts
QUESTION 80
of 100
Which repair technique for an osteochondral lesion of the medial talus shoulder produces hyaline cartilage that is similar to native cartilage and will not degrade over time?
1
Autologous osteochondral transplantation
2
Arthroscopic bone marrow stimulation
3
Chondroplasty
4
Osteochondral allograft transplantation
QUESTION 81
of 100
What is the most common turf toe mechanism of injury?
1
Hyperdorsiflexion of the first metatarsophalangeal (MTP) joint and axial load with the foot fixed in equinus
2
Hyperdorsiflexion of the first MTP joint with valgus thrust
3
Hyperplantarflexion of the first MTP joint axial load with the foot fixed in equinus
4
Hyperplantarflexion of the first MTP joint with valgus thrust
QUESTION 82
of 100
A
B
Figures 82a and 82b are the clinical photograph and radiograph of a 60-year-old man with a 30-year history of diabetes complicated by borderline chronic
renal failure, heart failure controlled by medication, and bilateral lower extremity neuropathy. He is currently wheelchair bound because of his cardiopulmonary limitations, but uses his legs for transfers. He has had a progressive left ankle deformity that has progressed to the point at which he cannot use his leg for pivot transfers. He is adamant that something should be done to improve his living situation. Which surgical option can best achieve his goal of using the leg for transfers?




1
Local debridement of the ankle with long-term bracing
2
Attempted fusion using a multiplanar external fixation
3
Attempted fusion using an intramedullary rod
4
Attempted fusion using screw fixation
QUESTION 83
of 100
Pain and tenderness at location 2 on Figures 83a and 83b is most consistent with which diagnosis?
1
Baxter's nerve entrapment.
2
Plantar fasciitis.
3
Tarsal tunnel syndrome.
4
Fat pad atrophy.
QUESTION 84
of 100
What is the most appropriate initial diagnostic test for plantar heel pain?
1
MRI
2
Ultrasound
3
Weight-bearing plain radiographs
4
Inflammatory arthritis serology
QUESTION 85
of 100
What is the strongest risk factor for plantar fasciitis?
1
Female gender
2
African American ancestry
3
BMI higher than 30
4
Weight lifting and body building
QUESTION 86
of 100
What is the most reliable nonsurgical treatment for plantar fasciitis?
1
High-impact loading exercise
2
Corticosteroid injection
3
Platelet-rich plasma (PRP) injection
4
Plantar fascia stretching
QUESTION 87
of 100
Which surgical procedure should be considered for treatment of chronic plantar fasciitis?
1
Endoscopic or open plantar fasciotomy
2
Heel spur excision
3
Achilles tendon lengthening
4
Extensile approach, medial and plantar, to include release of tarsal tunnel and complete plantar fasciotomy
QUESTION 88
of 100
A 45-year-old woman with grade II adult-acquired flatfoot deformity has pain on the lateral side of her foot just distal to the tip of the fibula. Which component of a comprehensive flatfoot reconstruction most likely will address the deformity responsible for this pain?
1
Spring ligament reconstruction
2
Lateral column lengthening
3
Medial-displacing calcaneal osteotomy
4
Medial cuneiform opening-wedge osteotomy
QUESTION 89
of 100
A
B
C
Figures 89a through 89c are the radiographs of a 35-year-old woman who has had 7 years of progressive ankle pain. She experiences stiffness and pain despite the use of an ankle-foot orthosis. Examination reveals pain along the anterior tibiotalar joint without tenderness to the subtalar or talonavicular joints. What is the most appropriate surgical intervention?



1
Total ankle arthroplasty (TAA)
2
Ankle arthrodesis
3
Tibiotalocalcaneal arthrodesis
4
Anterior tibial exostectomy with Achilles lengthening
QUESTION 90
of 100
Which structure is the primary stabilizer of the lesser metatarsophalangeal (MTP) joint?



1
Flexor digitorum brevis
2
Flexor digitorum longus
3
Plantar plate
4
Collateral ligament
QUESTION 91
of 100
The cause of this patient's symptoms most likely is
1
pigmented villonodular synovitis (PVNS).
2
lipoma.
3
ganglion.
4
interdigital neuroma.
QUESTION 92
of 100
The most appropriate pedorthic management of symptomatic interdigital neuroma involves
1
a metatarsal pad.
2
a dancer's pad.
3
a custom foot orthosis.
4
a medial heel wedge.
QUESTION 93
of 100
Open or endoscopic decompression of interdigital neuroma is predicated on the hypothesis that interdigital neuromas represent a compression neuropathy from which anatomic structure?
1
Lumbrical tendon
2
Interosseous muscle
3
Intermetatarsal ligament
4
Plantar plate
QUESTION 94
of 100
The primary advantage of the plantar approach for resection of interdigital neuromas is
1
a less painful scar.
2
a lower infection rate.
3
better access to the neuroma.
4
earlier weight bearing.
QUESTION 95
of 100
The most common complication associated with corticosteroid injection for the treatment of interdigital neuroma is

1
Infection
2
Chronic regional pain syndrome (CRPS)
3
Hammertoe deformity
4
Hives
QUESTION 96
of 100
The most appropriate urgent orthopaedic intervention involves
1
splinting in situ with serial compartment checks.
2
urgent closed reduction and splinting with serial compartment checks.
3
closed reduction and percutaneous fixation when the operating room is available.
4
emergency foot fasciotomy.
QUESTION 97
of 100
Six months after surgical repair, the patient reports that when tapping over her central midfoot incision, paresthesias to the third and fourth toes occur. What is the most likely diagnosis?
1
Complex regional pain syndrome (CRPS)
2
Laceration of the deep peroneal nerve
3
Neuritis of the superficial peroneal nerve
4
Scar hypersensitivity
QUESTION 98
of 100
The patient returns 1 year later to report curling of her toes and numbness on the plantar surface of her foot. What is the most likely cause of this condition?
1
CRPS
2
Plantar fasciitis
3
Plantar fibromatosis
4
Subclinical compartment syndrome
QUESTION 99
of 100
Figure 99 is the radiograph of an 18-year-old National Collegiate Athletic Association Division I basketball player who jumped for a basket. After
landing, he was unable to put weight on his left great toe. He developed pain, swelling, and ecchymosis maximally around the sesamoids. When assessing stability of the first metatarsophalangeal joint, he appears to have more laxity on the left. What is the best next step?

1
Standing radiographs of the right foot
2
MRI of the foot
3
Carbon fiber insole with a Morton extension
4
Surgery for reconstruction
QUESTION 100
of 100
Video 100 is the presurgical lateral ankle examination of a 45-year-old woman who has had pain and discomfort for 2 years along the posterolateral ankle following a sudden dorsiflexion injury. She notes occasional clicking and popping, and she has not experienced resolution of her symptoms despite immobilization and physical therapy. Examination reveals a stable ankle-to-anterior drawer and inversion stress testing. No strength deficit is noted, but
she has apprehension with resisted eversion. MR images do not reveal evidence of tendonosis or tear. The most appropriate surgical intervention is



1
imbrication of the lateral collateral ligaments with reinforcement with the extensor retinaculum (modified Brostrom procedure).
2
peroneal tendon synovectomy and tubularization of the peroneus brevis.
3
groove deepening of the fibula with imbrication of the peroneal retinaculum.
4
excision of the peroneus brevis with tenodesis of the proximal stump to the peroneus longus.
Dr. Mohammed Hutaif
Written & Medically Reviewed by
Dr. Mohammed Hutaif
Consultant Orthopedic & Spine Surgeon
Keywords
Prof. Mohammed Hutaif Orthopedic Surgeon Yemen pubmed pmid view pmid view abstract abstract at pubmed foot ankle int
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