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Self-Assessment Questions

Orthopaedic Surgery

Foot and Ankle Injuries: Review Questions

Francis H. Shen, MD, and Anjan P. Kaushik, BS

Dr. Shen is an assistant professor, Department of Orthopaedic Surgery, and Mr. Kaushik is a medical student; both are at the University of Virginia School of Medicine, Charlottesville, VA.

Choose the single best answer for each question.

1. A 47-year-old woman presents to an orthopaedic surgeon with a 3-month history of progressive edema in her right medial foot and ankle. There is no history of trauma, but the woman was a long-distance runner in college. The initial pain has subsided, but she now has difficulty walking because of an acquired progressive flatfoot. Which of the following findings would best support your diagnosis?
  1. Equal strength in both feet for the single heel raise test
  2. More toes seen lateral to the heel from a posterior view
  3. Decreased posterior tibiocalcaneal angle
  4. Swelling below the lateral malleolus
Click here to compare your answer.

2. A 22-year-old ballet dancer presents with pinpoint pain in her left forefoot in the third intermetatarsal space, which radiates to her toes when she walks. Manipulation of the third and fourth metatarsal heads elicits a slight click (positive Muldor sign), which confirms a diagnosis of Morton’s neuroma. All of the following are considered helpful therapies for this condition EXCEPT

  1. Customized foot orthotics and wide-toed athletic shoes to avoid compression
  2. Dorsal or plantar surgical neurectomy upon failure of conservative treatments
  3. Increased heel height to improve forefoot circulation and space redistribution
  4. Local anesthetics and corticosteroid injections to reduce pain and inflammation
  5. Metatarsal pad with ice treatment to reduce neural irritation
Click here to compare your answer.

3. A 28-year-old man in a motor vehicle accident sustains a hyperdorsiflexion injury to his foot. A radiograph reveals a Hawkins type II talar neck fracture with dislocation of the subtalar joint. Open reduction with internal fixation is performed, and the patient returns for follow-up radiographs 8 weeks later. A radiograph shows well-placed hardware and a radiolucent band in the dome of the talus (Hawkins sign). Based on these findings, which of the following is LEAST likely to occur in this patient?

  1. Ankle stiffness
  2. Avascular necrosis (AVN) of the talus
  3. Subtalar and talonavicular arthritis
  4. Talus nonunion or delayed union
  5. Varus malunion
Click here to compare your answer.

4. Which of the following statements regarding appropriate therapy for tarsal tunnel syndrome (TTS) is correct?
  1. There is no role for the use of local tarsal canal and anti-inflammatory agent injections in the symptomatic treatment of TTS
  2. If the bifurcation of the tibial nerve beneath the lacinate ligament is enlarged, surgically cutting the ligament provides space for nerve expansion
  3. It is important to preserve the fibrous tethers of tibial nerve branches to the fascia of the abductor hallucis muscle during surgical release of the tarsal tunnel
  4. Resection of the flexor retinaculum is associated with poor surgical outcome
  5. Wide-cushioned shoes and arch supports have not been shown to be effective for relieving compression
Click here to compare your answer.

5. A 63-year-old man lands awkwardly while skiing and hears a loud pop in his left ankle. He cannot bear weight on the ankle, and edema ensues soon after the injury. Which of the following fractures would be missed if only radiographs of the ankle are taken without knee examination or radiographs of the entire lower leg?

  1. Calcaneal fracture
  2. Maisonneuve fracture
  3. Pilon fracture
  4. Pott fracture
  5. Talar neck fracture
Click here to compare your answer.

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