ABFAS Practice Test Video Answers

1. B
Posterior tibial tendon dysfunction (PTTD) is the most common cause of adult acquired flatfoot. The clinical presentation of medial ankle pain, inability to perform single-limb heel rise, hindfoot valgus, forefoot abduction, and the “too many toes” sign are pathognomonic for this condition. The posterior tibial tendon is the primary dynamic stabilizer of the medial longitudinal arch.

2. B
In the Danis-Weber classification, Type B fractures occur at the level of the syndesmosis (transsyndesmotic). Type A fractures are below the syndesmosis (infrasyndesmotic), and Type C fractures are above the syndesmosis (suprasyndesmotic). This classification is based on the location of the fibular fracture relative to the syndesmosis.

3. B
The Chevron osteotomy (also known as Austin osteotomy) is a V-shaped cut made in the distal first metatarsal head. It is most appropriate for mild to moderate hallux valgus deformities. The Scarf osteotomy is a Z-shaped diaphyseal cut, the Lapidus is a first TMT fusion, and the Akin is performed on the proximal phalanx.

4. B
Stage I (Development/Fragmentation) of the Eichenholtz classification represents the acute phase characterized by bone fragmentation, joint destruction, and clinical signs of inflammation (warmth, erythema, swelling). Stage II (Coalescence) shows absorption of debris and early healing, while Stage III (Remodeling) demonstrates consolidation and remodeling.

5. B
In the Lauge-Hansen supination-external rotation (SER) pattern, the sequence of injuries is: Stage 1 – anterior inferior tibiofibular ligament (AITFL) injury; Stage 2 – spiral/oblique fracture of the fibula at the syndesmotic level; Stage 3 – posterior inferior tibiofibular ligament (PITFL) injury or posterior malleolus fracture; Stage 4 – medial malleolus fracture or deltoid ligament rupture.

6. B
The Lapidus procedure (first tarsometatarsal arthrodesis) is primarily indicated for hallux valgus with first TMT joint hypermobility or instability. It is also used for moderate to severe deformities and recurrent hallux valgus. The procedure addresses the apex of deformity at the first TMT joint.

7. B
Flexor digitorum longus (FDL) tendon transfer is the standard surgical treatment for Stage II posterior tibial tendon dysfunction. The FDL is transferred to the navicular bone to replace the function of the diseased posterior tibial tendon. FDL is chosen because it is synergistic with the posterior tibial tendon.

8. B
The Thompson test (also called the calf squeeze test) is the most sensitive clinical test for Achilles tendon rupture. A positive test occurs when squeezing the calf muscle does not produce passive plantar flexion of the foot, indicating discontinuity of the Achilles tendon.

9. B
The Lisfranc ligament connects the medial cuneiform (C1) to the base of the second metatarsal (M2) and is the critical structure for stability of the Lisfranc joint complex. Anatomic reduction of this ligament and the C1-M2 relationship is essential for successful surgical outcomes.

10. C
Arthritis of the first MTP joint requiring fusion (arthrodesis) is a contraindication for minimally invasive bunion surgery. MIS techniques are designed to preserve the joint, not fuse it. Severe first TMT joint instability and neuromuscular disorders requiring fusion are also contraindications.

11. B
During endoscopic plantar fasciotomy, releasing one-third to one-half (33-50%) of the medial band of the plantar fascia is recommended. Releasing more than this amount can lead to lateral column pain and instability due to loss of the windlass mechanism and arch support.

12. A
In the Myerson modification of the Hardcastle classification, Type A (Total incongruity) involves lateral displacement of all five metatarsals as a unit. Type B1 affects the medial column (first ray), Type B2 affects the lateral column, and Type C is a divergent pattern with medial and lateral displacement.

13. C
Weber C fractures occur above the level of the syndesmosis (suprasyndesmotic). These fractures typically involve disruption of the syndesmotic ligaments and may extend proximally to the fibular neck (Maisonneuve fracture). They correlate with pronation-external rotation injuries in the Lauge-Hansen system.

14. B
The midfoot, specifically the tarsometatarsal (Lisfranc) joints, is the most common location for Charcot neuroarthropathy in diabetic patients, accounting for approximately 60% of cases. The midfoot is followed by the hindfoot and then the ankle in frequency.

15. C
The Akin osteotomy is a medial closing wedge osteotomy performed on the proximal phalanx of the hallux. It is used to correct hallux valgus interphalangeus (deviation within the phalanx itself) and is often performed as an adjunct procedure to other hallux valgus corrections.

16. B
PIP joint arthroplasty (resection arthroplasty) involves excision of the head of the proximal phalanx to decompress the PIP joint and correct the hammertoe deformity. This shortens the digit and relieves tension on the flexor and extensor tendons, allowing the toe to straighten.

17. C
Stage III PTTD is characterized by a rigid (fixed) flatfoot deformity without ankle involvement. The hindfoot cannot be passively corrected to neutral. Stage IV involves ankle valgus tilt and tibiotalar arthritis in addition to the rigid flatfoot deformity.

18. B
Following open Achilles tendon repair, the standard protocol involves non-weight bearing with the ankle positioned in plantar flexion (equinus position) to protect the repair and reduce tension on the tendon. This is typically maintained for 3-6 weeks before gradual progression to weight bearing.

19. B
The spring ligament (plantar calcaneonavicular ligament) is the primary static stabilizer of the medial longitudinal arch. Failure of this ligament is thought to be one of the initiating factors in progressive collapsing foot deformity (PCFD), leading to increased stress on the posterior tibial tendon.

20. A
The intermetatarsal angle (IMA) is measured between the longitudinal axes of the first and second metatarsal shafts. Normal IMA is typically less than 9 degrees. An increased IMA is one of the key radiographic parameters used to assess the severity of hallux valgus deformity.

21. B
The Scarf osteotomy involves a Z-shaped diaphyseal cut through the first metatarsal shaft. This osteotomy allows for lateral translation, rotation, and some shortening or lengthening of the metatarsal. It is particularly useful for moderate to severe hallux valgus deformities.

22. B
A positive Thompson test indicates Achilles tendon rupture and is demonstrated by the absence of passive plantar flexion of the foot when the calf is squeezed. In an intact tendon, squeezing the calf causes plantar flexion of the ankle.

23. B
The Lisfranc ligament is a three-component structure (dorsal, interosseous, and plantar bands) connecting the medial cuneiform (C1) to the base of the second metatarsal (M2). The interosseous component is the strongest and most important for stability.

24. B
The Evans osteotomy (lateral column lengthening) is performed through the anterior process of the calcaneus. A bone graft is inserted to lengthen the lateral column, which helps correct forefoot abduction and restore the medial longitudinal arch in flatfoot reconstruction.

25. B
The medializing (sliding) calcaneal osteotomy shifts the calcaneal tuberosity medially to correct hindfoot valgus alignment. This procedure changes the mechanical axis of the Achilles tendon from a valgus to a more neutral position, reducing the deforming force on the arch.

26. C
Lateral column pain and instability is the most common complication following endoscopic plantar fasciotomy, particularly if more than one-third to one-half of the fascia is released. This results from disruption of the windlass mechanism and loss of arch support.

27. B
The “fleck sign” refers to a small avulsion fracture at the base of the second metatarsal, representing an avulsion of the Lisfranc ligament insertion. This finding is pathognomonic for a Lisfranc injury and indicates ligamentous disruption of the tarsometatarsal joint complex.

28. B
Triple arthrodesis involves fusion of three hindfoot joints: the subtalar (talocalcaneal), talonavicular, and calcaneocuboid joints. This procedure is indicated for Stage III PTTD with rigid flatfoot deformity and provides correction and stabilization of the hindfoot.

29. B
The flexor hallucis longus (FHL) tendon is the most commonly used tendon for augmentation in chronic Achilles tendon reconstruction with large gaps. The FHL is harvested through a posterior approach and has adequate strength and excursion to supplement Achilles function.

30. B
Plantar fasciitis involves inflammation at the origin of the plantar fascia on the medial calcaneal tuberosity. The hallmark symptom is “first-step” pain in the morning or after periods of rest, caused by re-tearing of the fascia that partially healed during rest.

31. C
In the Lauge-Hansen pronation-external rotation (PER) pattern, the fibular fracture occurs above the syndesmosis (suprasyndesmotic), often at a high level. This can include a Maisonneuve fracture with a proximal fibula fracture. The syndesmotic ligaments are typically disrupted.

32. C
The single limb heel rise test primarily assesses posterior tibial tendon function. Patients with PTTD are unable to perform this test or have significant difficulty and pain. The test requires the posterior tibial tendon to invert the heel as the patient rises onto their toes.

33. B
Surgical repair of acute Achilles tendon rupture is typically performed within 1-2 weeks of injury for optimal outcomes. Earlier repair allows for easier identification of tendon ends and primary repair without the need for augmentation or grafting.

34. C
Claw toe deformity involves hyperextension at the MTP joint, flexion at the PIP joint, and flexion at the DIP joint. This distinguishes it from hammertoe (MTP extended/neutral, PIP flexed, DIP extended) and mallet toe (isolated DIP flexion).

35. B
The Cotton osteotomy is an opening wedge osteotomy of the medial cuneiform. It is used to correct forefoot supination (varus) that may persist after hindfoot correction in flatfoot reconstruction. A bone graft is inserted to maintain the correction.

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