MRCS Part B Revision · Anatomy
Foot and Ankle 2 — MRCS Part B Anatomy
By Dr Richard Miller, MBChB FRCS · Reviewed
Foot and Ankle 2 is a surgical anatomy station. Three of the seventeen examined stations in the MRCS Part B OSCE are surgical anatomy. The anatomy stations put a prosected specimen, a model or an image in front of you and ask you to identify structures and say what they do, what they relate to and what happens when they are injured.
What you need to know for the Foot and Ankle 2 station
The ankle seen from the sides and behind: the malleoli and what passes behind them, the ligaments, and the calcaneal tendon with the test that shows it has ruptured.
Siding the specimen
The lateral malleolus (fibula) sits lower and further back than the medial malleolus (tibia). With the sole down and the toes away from you, the side with the lower, more posterior malleolus is the lateral side.
The joint
A synovial hinge between the tibial plafond and the two malleoli above and the trochlea of the talus below. The talus is wider in front, so the joint is most stable in dorsiflexion, when the wide part is wedged between the malleoli, and least stable in plantarflexion, which is when inversion sprains happen. The distal tibiofibular syndesmosis, held by the anterior and posterior tibiofibular ligaments and the interosseous membrane, keeps the mortise tight.
Ligaments
Medially the deltoid ligament fans from the medial malleolus to the navicular, the spring ligament, the sustentaculum tali of the calcaneus and the talus. It is strong enough that a forced eversion usually breaks the malleolus rather than tearing it. Laterally there are three separate bands from the lateral malleolus: the anterior talofibular ligament to the talar neck, the calcaneofibular ligament to the side of the calcaneus, and the posterior talofibular ligament to the posterior process of the talus. The anterior talofibular ligament is the weakest and the one torn in the usual inversion sprain; the calcaneofibular follows in a worse injury.
The calcaneal (Achilles) tendon
The tendon of the superficial posterior compartment: gastrocnemius (two heads), soleus and, when present, plantaris join it, and it inserts on the middle of the posterior calcaneus over a bursa. It plantarflexes the foot for push-off. In Simmonds' test the patient kneels or lies prone with the feet over the end of the couch and the examiner squeezes the calf: an intact tendon plantarflexes the foot, a ruptured one does not. It is more reliable than asking the patient to point the toes, which the long flexors and peronei can still do.
Behind the medial malleolus
Under the flexor retinaculum, from front to back: tibialis posterior, flexor digitorum longus, the posterior tibial artery with its veins, the tibial nerve, and flexor hallucis longus — “Tom, Dick And a Very Nervous Harry”. The posterior tibial pulse is felt just behind the malleolus.
In front of the medial malleolus
The great saphenous vein, with the saphenous nerve beside it, which is why the vein is found there for a cut-down.
Behind the lateral malleolus
Peroneus (fibularis) longus and brevis under the superior peroneal retinaculum, brevis lying against the bone, with the sural nerve and small saphenous vein more superficially.
Images from this station
What are you asked at the Foot and Ankle 2 station?
The station runs to 15 questions over nine minutes. These are the questions as they are put to you; the model answers are in the question bank.
- Please side the above specimen
- Identify structures 1-3
- Identify structures 4 and 5
- Identify structures 6 and 7
- Identify structures 8 and 9
- Identify structure 10
- Which three muscles of the lower leg is structure 10 an extension of?
- What is Simmonds’ Test?
- Identify ligament 11
- Identify ligaments 12 and 13
- Identify ligaments 14 and 15
- Identify structure 16
And 3 more at this station.
How is the anatomy station marked in MRCS Part B?
An anatomy station is marked out of 20, and all 20 marks go to clinical knowledge and its application. No communication, technical-skill or professionalism marks are available in an anatomy bay, which is unusual: in most other stations more than half the marks sit outside your factual knowledge.
FAQ
What does the Foot and Ankle 2 station ask?
It opens with "Please side the above specimen" and runs to 15 questions over nine minutes. An anatomy station is marked out of 20, and all 20 marks go to clinical knowledge and its application. No communication, technical-skill or professionalism marks are available in an anatomy bay, which is unusual: in most other stations more than half the marks sit outside your factual knowledge.
How many anatomy stations are there in MRCS Part B?
Three of the seventeen examined stations are surgical anatomy, and two more are surgical pathology. Together they make up the five Anatomy and surgical pathology stations of the Applied Knowledge component.
How are the anatomy stations marked?
Each station is marked out of 20 and all 20 marks are awarded for clinical knowledge and its application. You also receive a separate global rating of pass, borderline or fail for the station.
Are the specimens real?
Yes. Anatomy bays use prosected cadaveric specimens, models and images. Candidates report being shown photographs of specimens as well as the specimens themselves, so practise on real dissection photography rather than diagrams alone.
What happens if I get an early question wrong?
The intercollegiate guidance says that if a wrong answer would affect your performance on later questions at the same station, the examiner gives you the correct answer before moving on. One mistake does not have to cost you the whole bay.
How many stations are in the MRCS Part B OSCE?
Seventeen examined stations of nine minutes each, with a minute to read the task before each one. Two preparation stations and at least one rest station bring the circuit to about twenty, and the exam takes about three and a half hours.
What is the pass mark for MRCS Part B?
There is no published pass mark. The cut score is set separately for Applied Knowledge and Applied Skills, for each circuit, by borderline regression. Published pass rates across the 2024/25 diets ranged from 51% to 66%.
Can I fail a station and still pass?
Yes. There is no rule about how many stations you may fail: the cut score applies to your total mark in each component, so a weak station costs the marks you lost on it and strong stations elsewhere can make them back. Applied Knowledge and Applied Skills are passed separately and must both be passed at the same sitting, so a strong anatomy performance cannot rescue a weak communication one.
Dr Richard Miller, MBChB FRCS
Station summaries are reviewed against the current intercollegiate MRCS syllabus and the published marking blueprint. Guidance changes between diets: check the royal colleges' own pages before relying on a date, a fee or a threshold.
Practise this station
The question bank carries the model answer to every question above, with the rest of the anatomy stations.
More anatomy stations