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| ==Hindfoot== | | ==Background== |
| ===Talus===
| | [[File:Foot_Bones.jpg|thumb|Bones of the foot.]] |
| ====Background====
| | [[File:Subtalar Joint.png|thumb|Talus and subtalar joint]] |
| *Almost always associated with other injuries
| | {{Foot and toe fractures DDX}} |
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| ====Diagnosis==== | | ==Clinical Features== |
| *CT often required for accurate diagnosis | | *History of trauma |
| | *Pain over fracture site |
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| ====Management==== | | ==Differential Diagnosis== |
| *Major fracture (talar neck and head)
| | {{Foot diagnoses}} |
| **Immediate ortho consultation required (high rate of avascular necrosis)
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| *Minor fracture
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| **Posterior splint, NWB, ortho referral
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| ===Calcaneus=== | | ==Evaluation== |
| ====Background==== | | ===Workup=== |
| *Associated injuries are common | | *XR foot and/or toe x 2 view |
| *Types | | *Consider need for more proximal or distal plain films |
| **Intra-articular (75%) | | *Consider non-contrast CT of the foot |
| ***Sclerotic line may be only evidence of impacted fracture
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| **Extra-articular (25%)
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| ***Anterior process fx is most common
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| ====Diagnosis====
| | ===Diagnosis=== |
| *Imaging
| | <gallery mode="packed"> |
| **Decreased Boehler's angle (<25') may be only sign of fx (compare w/ opposite side)
| | File:Boehlers_Angle.jpg|[[Calcaneus fracture]] |
| | File:CuboidAvulsionFracture.jpg|[[Cuboid fracture]] |
| | File:A Medial cuneiform fracture.png|[[Cuneiform fracture]] |
| | File:PMC3497949 10.1177 1941738112459489-fig14.png|[[Fifth metatarsal fracture]] |
| | File:Lisfranc.jpg|[[Lisfranc injury]] |
| | File:NavicularFracMark.png|[[Navicular fracture]] |
| | File:PMC3411541 cmed-5-2012-039f3.png|[[Non-fifth metatarsal fracture]] |
| | File:Talus Fx.png|[[Talus fracture]] |
| | File:X-rays of foot phalanx.jpg|[[Toe fracture]] |
| | </gallery> |
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| ====Treatment==== | | ==Management & Disposition== |
| *Intra-articular fracture
| | {{Foot and toe fractures}} |
| **Immobilization w/ posterior splint
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| **Non-weightbearing
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| **Elevation (very important - fx has high rate of severe swelling)
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| **Ortho consult
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| *Extra-articular fracture
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| **Immobilization and close ortho f/u
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| ====Images==== | | ==See Also== |
| *(A) Normal Boehler's angle and (B) Abnormal Boehler's angle | | *[[Fractures (Main)]] |
| [[File:Boehlers_Angle.jpg]]
| | **[[Distal leg fractures]] |
| | | *[[Foot Diagnoses (Main)]] |
| ==Midfoot==
| | *[[Splinting]] |
| ===LisFranc Injury===
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| *See [[Lisfranc Injury]] | |
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| ===Navicular/Cuboid/Cuneiform===
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| *All are diagnosed/managed in similar way | |
| **Imaging: (weight-bearing AP, lateral, oblique)
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| ***CT sometimes necessary | |
| **Treatment: Non-weightbearing short leg cast, ortho referral
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| ==Forefoot== | | ==External Links== |
| ===Fifth Metatarsal===
| | *https://www.aliem.com/emrad-adult-ankle-foot-cant-miss/ |
| ====Background====
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| *Os peroneum is an accessory bone (ossicle) located at the lateral side of the tarsal cuboid, proximal to the base of 5th metatarsal, commonly mistaken for fx | |
| *3 types of 5th metatarsal fx:
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| '''#Tuberosity (styloid) avulsion fracture:'''
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| ##Most common fx at base of 5th metatarsal
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| ##Sx often mild, pts usually present with sprained ankle complaint
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| ##Occurs due to forced inversion foot/ankle while in plantar flexion
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| '''#Jones or metaphyseal-diaphyseal junction fracture:'''
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| ##Second most common fx at base of 5th metatarsal
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| ##Abrupt onset of lateral foot pain, with no prior h/o pain at that site, suggests acute injury and helps distinguish from stress injury
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| ##Occurs due to sudden change in direction w/ heel off the ground
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| ##Edema & ecchymosis usually present, may not be able to bear weight
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| '''#Diaphyseal stress fracture:'''
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| ##Occurs through repetitive microtrauma, usually in younger athletes
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| ##Important to identify given propensity for delayed union and nonunion
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| ##Usually present with h/o months of pain, which is more intense during exercise or weight-bearing
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| ###always ask about persistent pain prior to acute event to help distinguish worsening stress fx from acute fx
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| ====Diagnosis==== | | ==References== |
| Plain radiographs are usually adequate
| | <references/> |
| *Must distinguish Jones fx from diaphyseal stress freacture:
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| **Acute fx will have narrow fx line that appears sharp, normal thin cortex adjacent to fx, and normal intramedullary canal
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| **Stress fx will demonstrate cortical thickening near fx line, older stress fx will demonstrate widened fx line and intramedullary sclerosis
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| [[File:Foot fx.png|center|frame|5th Metatarsal fx types]]
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| ====Management====
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| *Tuberosity (Styloid) Avulsion Fracture
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| **Refer to ortho if > 3mm displacement
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| **Nondisplaced fx usually require only symptomatic tx, RICE
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| **Walking boot (casting rarely necessary) and weight-bearing as tolerated, f/u in 1 week
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| *Jones Fracture (non-displaced)
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| **Posterior splinting, strict NWB, RICE, ortho f/u in 3-5 days
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| **50% of Jones fx treated conservatively may result in nonunion or refracture
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| **Conservative tx failure usually due to poor vascular supply of bone and premature return to weight-bearing
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| *Diaphyseal Stress Fracture
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| **Strict NWB short-leg cast, RICE
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| **Ortho referral for all stress fxs
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| ===Metatarsal===
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| ====Background====
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| *Must rule-out associated Lisfranc injury
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| ====Management====
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| *Posterior splint, NWB, ortho referral in 2-3d
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| ===Phalange===
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| *Management: buddy-taping, hard-soled shoe
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| ==See Also==
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| *[[Fractures (Main)]]
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| *[[Foot Bones]]
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| *[[Ankle Fracture]]
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| *[[Ankle Sprain]]
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| *[[Ankle Fracture (Peds)]]
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| *[[Lisfranc Injury]]
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| ==Source==
| | [[Category:Orthopedics]] |
| *Tintinalli
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| *Uptodate
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| *Ilustration by Dr. Frank Gaillard; CC SA NC BY licence
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| *http://radiopaedia.org/articles/jones_fracture
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| [[Category:Ortho]] | |
