Foot and Ankle Disorders (Hallux Valgus, Flatfoot, Diabetic Foot, Achilles) MCQs

Orthopedics · 47 free questions with answers & explanations.

1. A 52-year-old woman has symptomatic hallux valgus with an intermetatarsal angle (IMA) of 18° and hallux valgus angle (HVA) of 38°. Conservative treatment has failed. Based on the degree of deformity, the most appropriate surgical procedure is:
2. A 45-year-old obese woman presents with progressive flat foot deformity with inability to single heel rise on the left side, pain over medial hindfoot, and too-many-toes sign when viewed from behind. MRI shows longitudinal tearing of the posterior tibial tendon. This stage of posterior tibial tendon dysfunction (PTTD) is classified as:
3. A 60-year-old diabetic patient presents with a plantar foot ulcer under the first metatarsal head that probes to bone. X-ray shows periosteal reaction and cortical erosion of the metatarsal head. The most important investigation to confirm osteomyelitis underlying this ulcer is:
4. A 35-year-old recreational runner presents with acute onset heel pain during a sprint, feeling a 'pop,' with a palpable gap in the Achilles tendon 4 cm above the calcaneal insertion. The Thompson test is positive. What is the most appropriate management?
5. A patient with hallux valgus has an intermetatarsal angle of 16° and a hallux valgus angle of 32°. The distal metatarsal articular angle (DMAA) is normal. The most appropriate surgical procedure is:
6. An adult patient with stage IIB posterior tibial tendon dysfunction (PTTD) is best managed by:
7. A diabetic patient develops Charcot neuroarthropathy of the midfoot (rocker bottom deformity). The primary pathophysiological mechanism is:
8. The correct classification of an Achilles tendon rupture with a palpable gap, positive Thompson test, and inability to perform single-leg heel rise, presenting 6 weeks after injury, is:
9. A 55-year-old woman with a 10-year history of painful hallux valgus deformity is being evaluated for surgery. The intermetatarsal angle (IMA) is measured at 18° and the hallux valgus angle (HVA) is 42°. Which osteotomy is most appropriate for this degree of deformity?
10. A 40-year-old diabetic man presents with a painless plantar ulcer beneath the first metatarsal head, intact foot pulses, loss of protective sensation (10 g monofilament), and surrounding callus. According to the Wagner classification, this is Grade:
11. A 35-year-old long-distance runner presents with sudden severe posterior heel pain during a sprint, with a palpable gap above the calcaneum. Thompson's test is positive. What is the most accurate interpretation of a positive Thompson's test?
12. An adult flexible flatfoot patient fails conservative management. Which tendon is most commonly reconstructed/transferred in surgical correction of adult-acquired flatfoot deformity (AAFD) Stage II?
13. A 52-year-old woman with a 15-year history of type 2 diabetes develops a painless, warm, swollen foot with architectural collapse of the mid-foot. X-ray shows extensive joint destruction, fragmentation, and periarticular sclerosis with a 'bag of bones' appearance. The diagnosis is:
14. The intermetatarsal angle (IMA) in hallux valgus represents the angle between the first and second metatarsal shafts. A hallux valgus angle (HVA) of 30° and an IMA of 16° would be classified as:
15. A 40-year-old man presents with inability to stand on tiptoe on the right side, a palpable gap 4 cm above the posterior heel, and a positive Thompson (Simmonds) test. Ultrasound confirms complete Achilles tendon rupture. The most appropriate management for an active young adult is:
16. A 10-year-old child has painful flat foot that is rigid and does not correct on tiptoeing. X-ray of the ankle shows an oblique bony bar between the calcaneus and navicular. The diagnosis is:
17. A 38-year-old woman complains of burning pain under the heel, worst on first steps in the morning and after prolonged standing. X-ray shows a plantar calcaneal spur. The primary pathological process in plantar fasciitis is:
18. A 55-year-old woman with a 10-year history of diabetes mellitus presents with a painless plantar ulcer under the first metatarsal head. She cannot feel a 5.07 Semmes-Weinstein monofilament. The ulcer has no signs of infection and probing does not reach bone. According to the Wagner classification, this is:
19. A 42-year-old woman presents with medial foot pain and progressive flatfoot deformity. She cannot perform a single-leg heel rise on the affected side. MRI shows thickening and partial tear of a tendon with surrounding edema. Which tendon is involved?
20. A 35-year-old male recreational runner presents with acute onset heel pain while sprinting. He felt a 'pop' and has difficulty pushing off. Thompson's test is positive. MRI is performed. Which MRI sequence best demonstrates the Achilles tendon rupture, and what is the primary treatment in young active patients?
21. A 65-year-old woman with rheumatoid arthritis presents with severe forefoot pain and difficulty walking. Examination shows hallux valgus with dislocation of the 2nd, 3rd, 4th MTP joints and 'cock-up' toe deformities. The most appropriate surgical intervention for the forefoot is:
22. The 'too many toes' sign is specifically seen in which condition?
23. A 50-year-old man with poorly controlled gout develops acute pain and swelling of the first MTP joint. X-ray shows joint space narrowing, periarticular erosions with overhanging edges, and soft tissue tophi. He is on allopurinol 300 mg. Target serum urate level for gouty arthropathy with tophi, per current guidelines, is:
24. A 45-year-old woman with a 10-year history of pes planus presents with progressive medial ankle pain, inability to perform single-heel-rise on the affected side, and collapse of the medial longitudinal arch. On observation, the 'too many toes' sign is present. The most likely diagnosis and the structure primarily responsible is:
25. A 62-year-old diabetic presents with a Wagner Grade 3 foot ulcer: a deep ulcer penetrating to tendon and joint capsule over the first metatarsal head with no systemic sepsis. The recommended management step (after appropriate debridement) is:
26. A 38-year-old recreational runner develops acute posterior heel pain with an audible 'pop' while sprinting. Examination shows a palpable gap 2–6 cm above the calcaneal insertion and a positive Simmond's (Thompson) test. Ultrasonography confirms complete Achilles tendon rupture. For a young active patient, the preferred management is:
27. Hallux valgus deformity is radiographically quantified by two angles. The normal intermetatarsal angle (IMA) between the first and second metatarsals is <9°. A 30-year-old woman has an IMA of 18° and a hallux valgus angle of 38°. This magnitude of deformity is best corrected surgically by:
28. A 55-year-old diabetic man undergoes debridement for a neuropathic plantar ulcer over the first metatarsal head. The most important initial investigation before deciding on vascular reconstruction is:
29. An adult with painful flexible flatfoot fails 6 months of conservative treatment. MRI reveals a Grade III tear of the tibialis posterior tendon with peritendinous fluid and complete loss of longitudinal arch. The most appropriate surgical option is:
30. In hallux valgus deformity, the intermetatarsal angle (IMA) is 16° and the hallux valgus angle (HVA) is 35°. No degenerative change is present. The most appropriate surgical correction is:
31. A 40-year-old runner presents with acute onset severe pain in the Achilles tendon while playing badminton, with an audible 'pop'. Simmonds-Thompson squeeze test is positive. Ultrasound confirms complete Achilles tendon rupture 4 cm above the insertion. The management that offers the lowest re-rupture rate with acceptable complication risk is:
32. A 52-year-old woman presents with pain at the medial first metatarsophalangeal joint and forefoot crowding. Radiograph shows a hallux valgus angle (HVA) of 42° and an intermetatarsal angle (IMA) of 18°. The most appropriate surgical correction is:
33. A 60-year-old diabetic presents with a painless plantar ulcer under the first metatarsal head (grade 2 by Wagner classification) with no osteomyelitis. The mechanism of ulceration in diabetic neuropathic foot is primarily:
34. A 40-year-old runner presents with acute onset severe pain and a 'pop' sensation in the calf. Examination reveals a palpable gap 4 cm above the calcaneal insertion and Thompson's test is positive. The most appropriate initial management for a complete Achilles tendon rupture in this active patient is:
35. The medial longitudinal arch is maintained by the plantar fascia, intrinsic foot muscles, and the spring (calcaneonavicular) ligament. In adult-acquired flatfoot deformity (AAFD) stage II, the primary tendon insufficiency driving progressive valgus hindfoot and forefoot abduction is:
36. A 55-year-old woman with hallux valgus has a hallux valgus angle (HVA) of 38° and an intermetatarsal angle (IMA) between the first and second metatarsals of 18°. The most appropriate surgical procedure is:
37. A diabetic patient presents with a painless plantar foot ulcer under the second metatarsal head classified as Wagner grade 2. The most critical initial intervention to promote healing is:
38. A 40-year-old male runner presents with acute-onset posterior heel pain during a sprint; he felt a 'pop' and now has significant weakness of plantarflexion. The Thompson test is positive. The most reliable clinical sign distinguishing complete Achilles tendon rupture from partial tear is:
39. In a child with symptomatic flexible flatfoot (pes planovalgus), the initial conservative management includes arch support orthotics. When surgical intervention becomes necessary in a skeletally immature patient, the preferred procedure is:
40. A 50-year-old woman with hallux valgus has a hallux valgus angle (HVA) of 38° and an intermetatarsal angle (IMA) of 18° on weight-bearing AP radiograph. The DISTAL metatarsal articular angle (DMAA) is normal. The most appropriate corrective osteotomy is:
41. A 48-year-old obese woman presents with insidious onset of right medial ankle pain, swelling, and progressive flatfoot deformity. She can stand on tiptoe on the left but is unable to perform a single heel rise on the right. MRI shows diffuse thickening and partial tear of the posterior tibial tendon. The stage of posterior tibial tendon dysfunction (PTTD) is:
42. A 65-year-old diabetic man presents with a painless ulcer under the 1st metatarsal head (plantar surface) with surrounding callus. Probe to bone test is positive. Foot radiograph shows bony destruction of the 1st metatarsal head with preserved skin integrity proximally. According to the Wagner classification, this ulcer is:
43. A 38-year-old recreational runner develops acute onset sharp pain in the posterior heel during a sprint race and notices a palpable gap above the calcaneum. Thompson's test is positive (no plantar flexion on calf squeeze). The Thompson test assesses the integrity of which anatomical structure?
44. A 55-year-old diabetic patient presents with a painless plantar ulcer under the first metatarsal head with surrounding callus, palpable foot pulses, and intact ankle reflexes but absent vibration sense distally. The Wagner grade of this ulcer (depth to subcutaneous tissue but not to tendon or capsule) is:
45. A 45-year-old woman with rheumatoid arthritis presents with painful planovalgus (flatfoot) deformity that is flexible on single-heel-rise test. MRI reveals complete rupture of the tibialis posterior tendon. The most appropriate surgical option is:
46. Interdigital neuroma (Morton's neuroma) most commonly occurs between which metatarsal spaces, and what is the histological finding?
47. Acute Achilles tendon rupture in a 38-year-old recreational athlete is confirmed by a positive Thompson test. Conservative management with functional bracing results in a re-rupture rate compared to operative repair of approximately: