Foot and Ankle Surgery Practice Questions

Q: Frieberg's disease involves which of the following?

2nd metatarsal. **Explanation:** **Freiberg’s disease** is an **osteochondrosis** (avascular necrosis) affecting the head of the metatarsal. It most commonly involves the **2nd metatarsal head (Option C)** because it is the longest and most rigid metatarsal, making it susceptible to repetitive microtrauma and excessive loading during the toe-off phase of gait. It is typically seen in adolescent girls and presents with pain, swelling, and limited range of motion at the metatarsophalangeal joint. **Analysis of Incorrect Options:** * **Option A (Tibial tuberosity):** This is the site for **Osgood-Schlatter disease**, a traction apophysitis caused by repetitive strain from the patellar tendon. * **Option B (Calcaneal tuberosity):** This is the site for **Sever’s disease**, an apophysitis of the calcaneus common in active children. * **Option D (5th metatarsal):** The base of the 5th metatarsal is the site for **Iselin’s disease** (apophysitis). While the 5th metatarsal is also prone to Jones fractures, it is not the classic site for Freiberg’s. **High-Yield Clinical Pearls for NEET-PG:** * **Demographics:** Most common in adolescent females (ratio ~3:1). * **Radiology:** Early stages show flattening and sclerosis of the metatarsal head; late stages show joint space narrowing and secondary osteoarthritis. * **Hierarchy of Involvement:** 2nd Metatarsal (most common) > 3rd Metatarsal > 4th Metatarsal. * **Management:** Conservative (activity modification, orthotics) is first-line; surgery (debridement or osteotomy) is reserved for refractory cases.

Q: A 22-year-old football player presents with pain and swelling at the lateral aspect of the ankle, diagnosed as an inversion sprain. Which of the following ligaments is most likely affected?

Calcaneofibular ligament. **Explanation:** **1. Why the Correct Answer is Right:** Inversion sprains are the most common type of ankle injury, occurring when the foot is forcibly turned inward. The lateral collateral ligament complex of the ankle consists of three ligaments: the **Anterior Talofibular Ligament (ATFL)**, the **Calcaneofibular Ligament (CFL)**, and the **Posterior Talofibular Ligament (PTFL)**. * The **ATFL** is the weakest and most commonly injured ligament in plantarflexion-inversion. * The **CFL** is the second most commonly injured and is typically stressed when the ankle is in a neutral or dorsiflexed position during inversion. In clinical scenarios involving significant lateral ankle trauma, the CFL is a primary structure affected. **2. Why the Incorrect Options are Wrong:** * **A. Calcaneonavicular ligament (Spring ligament):** This is a medial structure that supports the head of the talus and maintains the medial longitudinal arch. It is not involved in lateral inversion sprains. * **C & D. Long and Short plantar ligaments:** These are located on the plantar (sole) aspect of the foot. They support the lateral longitudinal arch and are involved in conditions like pes planus or plantar fasciitis, rather than acute ankle sprains. **3. Clinical Pearls for NEET-PG:** * **Sequence of Injury:** In lateral sprains, the order of tearing is usually **ATFL > CFL > PTFL**. * **Anterior Drawer Test:** Used to assess the integrity of the ATFL. * **Talar Tilt Test:** Used to assess the integrity of the CFL. * **Deltoid Ligament:** The strong medial ligament of the ankle; it is rarely torn but can be involved in eversion injuries (Pott’s fracture).

Q: In which type of fracture, the tuber-joint angle is reduced to about half?

Crush fracture of calcaneum. Explanation: The **Tuber-joint angle**, also known as **Bohler’s Angle**, is a critical radiological parameter used to assess the severity of calcaneal fractures [1]. It is formed by the intersection of two lines: one from the highest point of the anterior process to the highest point of the posterior facet, and another from the posterior facet to the highest point of the posterior tuberosity. 1. **Why Option A is correct:** In a **Crush (depressed) fracture of the calcaneum**, the posterior facet is driven downward into the body of the bone. This collapse flattens the calcaneal arch, leading to a significant reduction or even reversal of Bohler’s angle [1]. The normal range is **20° to 40°**; in crush fractures, this is typically reduced to half or less (often <10°). 2. **Why other options are wrong:** * **Fracture neck of humerus & Dislocation of shoulder:** These involve the upper limb and have no anatomical relationship with the tuber-joint angle. * **Split fracture of calcaneum:** While this involves the same bone, a simple split (extra-articular or non-depressed) does not necessarily cause the vertical collapse of the articular surface required to significantly alter Bohler’s angle. **High-Yield Clinical Pearls for NEET-PG:** * **Bohler’s Angle:** Normal = 20°–40°. A decrease indicates a calcaneal burst/crush fracture. * **Gissane’s Angle (Critical Angle):** Another important calcaneal angle; normal is **120°–145°**. It increases in intra-articular fractures. * **Mondor’s Sign:** Ecchymosis extending to the sole of the foot, pathognomonic for calcaneal fractures [1]. * **Associated Injuries:** Always rule out **compression fractures of the lumbar spine (L1)** and bilateral calcaneal fractures in patients who fall from a height (Don Juan Syndrome).

Q: In a child with a cavovarus foot deformity, the standing lateral block test assesses the flexibility of which structure?

Hindfoot. **Explanation:** The **Coleman Block Test** (standing lateral block test) is a clinical maneuver used to evaluate the flexibility of the **hindfoot (subtalar joint)** in patients with a cavovarus deformity. **1. Why Hindfoot is Correct:** In many cases of cavovarus foot (often seen in Charcot-Marie-Tooth disease), the primary deformity is a **plantar-flexed first ray (forefoot valgus)**. When the patient stands, this rigid forefoot forces the hindfoot into a compensatory varus position to maintain balance. By placing a block under the lateral aspect of the foot (unweighting the first ray), the clinician observes if the heel (hindfoot) corrects to a neutral or valgus position. * If the heel corrects: The hindfoot is **flexible**, and surgery should focus on the forefoot. * If the heel remains in varus: The hindfoot is **fixed/rigid**, and bony procedures (like a calcaneal osteotomy) are required. **2. Why Other Options are Incorrect:** * **Forefoot:** The test *uses* the forefoot's position to influence the hindfoot, but it specifically *assesses* the mobility of the subtalar joint (hindfoot). * **Ankle:** The ankle joint primarily allows dorsiflexion and plantarflexion; varus/valgus alignment is a function of the subtalar joint. * **Ankle and Hindfoot:** While the ankle is part of the foot complex, the block test is specific to the subtalar joint's ability to compensate for forefoot driven deformity. **Clinical Pearls for NEET-PG:** * **Primary Deformity:** In cavovarus, the "driver" is often the **Plantar-flexed 1st ray** (due to Peroneus Longus overactivity). * **Components of Cavovarus:** **C**avus (midfoot), **A**dduction (forefoot), **V**arus (hindfoot). * **Associated Condition:** Always screen for **Spinal Dysraphism** or **Charcot-Marie-Tooth (CMT)** in bilateral cases.

Question 1

Frieberg's disease involves which of the following?

Accepted Answer

2nd metatarsal

Answer

Tibial tuberosity

Answer

Calcaneal tuberosity

Answer

5th metatarsal

Question 2

A 22-year-old football player presents with pain and swelling at the lateral aspect of the ankle, diagnosed as an inversion sprain. Which of the following ligaments is most likely affected?

Accepted Answer

Calcaneofibular ligament

Answer

Calcaneonavicular ligament

Answer

Long plantar ligament

Answer

Short plantar ligament

Question 3

A 56-year-old Type II diabetic presents with complaints of swelling in the left ankle with effusion but only minimal pain. X-rays show severe osteopenia with bone destruction, extensive osteophytosis, and loose bodies. Which of the following is NOT a component of the management of this patient?

Accepted Answer

Total ankle replacement

Answer

Resting and splinting

Answer

Aspiration and compression bandage

Answer

Ankle arthrodesis

Question 4

In which type of fracture, the tuber-joint angle is reduced to about half?

Accepted Answer

Crush fracture of calcaneum

Answer

Fracture neck of humerus

Answer

Dislocation of shoulder

Answer

Spilt fracture of calcaneum

Question 5

In a child with a cavovarus foot deformity, the standing lateral block test assesses the flexibility of which structure?

Accepted Answer

Hindfoot

Answer

Ankle

Answer

Forefoot

Answer

Ankle and hindfoot

Foot and Ankle Surgery — MCQs

Foot and Ankle Surgery — MCQs

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