Foot and toe fractures: Difference between revisions

Latest revision as of 21:11, 22 March 2023

Background

Bones of the foot.

Talus and subtalar joint

Foot and Toe Fracture Types

Hindfoot

Midfoot

Forefoot

Clinical Features

History of trauma
Pain over fracture site

Differential Diagnosis

Foot diagnoses

Acute

Subacute/Chronic

Evaluation

Workup

XR foot and/or toe x 2 view
Consider need for more proximal or distal plain films
Consider non-contrast CT of the foot

Diagnosis

Management & Disposition

Foot and Toe Fractures Management Chart

Fracture	Splint	Disposition
Talus fracture	Posterior ankle splint
Calcaneus fracture	Posterior ankle splint
Lisfranc injury	Posterior ankle splint
Navicular fracture	Posterior ankle splint
Cuboid fracture	Posterior ankle splint
Cuneiform fracture	Posterior ankle splint
Fifth metatarsal fracture Jones	Posterior ankle splint	Ortho follow up 3-5D
Non-fifth metatarsal fracture	Posterior ankle splint	Ortho follow up 2-3 days
Toe Fracture	Posterior Ankle Splint

External Links

https://www.aliem.com/emrad-adult-ankle-foot-cant-miss/

References

Authors:

@@ Line 1: / Line 1: @@
-==Hindfoot==
+==Background==
-*[[Talus Fracture]]
+[[File:Foot_Bones.jpg|thumb|Bones of the foot.]]
-*[[Calcaneus Fracture]]
+[[File:Subtalar Joint.png|thumb|Talus and subtalar joint]]
+{{Foot and toe fractures DDX}}
-==Midfoot==
+==Clinical Features==
-*[[Lisfranc Injury]]
+*History of trauma
+*Pain over fracture site
-===Navicular/Cuboid/Cuneiform===
+==Differential Diagnosis==
-*All are diagnosed/managed in similar way
+{{Foot diagnoses}}
-**Imaging: (weight-bearing AP, lateral, oblique)
-***CT sometimes necessary
-**Treatment: Non-weightbearing short leg cast, ortho referral
-==Forefoot==
+==Evaluation==
-===[[Fifth Metatarsal Fracture]]===
+===Workup===
-====Background====
+*XR foot and/or toe x 2 view
-*'''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
+*Consider need for more proximal or distal plain films
-'''3 types of 5th metatarsal fx:'''
+*Consider non-contrast CT of the foot
-#'''Tuberosity (styloid) avulsion fracture:'''
-##Most common fx at base of 5th metatarsal
-##Sx often mild, pts usually present with sprained ankle complaint
-##Occurs due to forced inversion foot/ankle while in plantar flexion
-#'''Jones or metaphyseal-diaphyseal junction fracture:'''
-##Second most common fx at base of 5th metatarsal
-##Abrupt onset of lateral foot pain, with no prior h/o pain at that site, suggests acute injury and helps distinguish from stress injury
-##Occurs due to sudden change in direction w/ heel off the ground
-##Edema & ecchymosis usually present, may not be able to bear weight
-#'''Diaphyseal stress fracture:'''
-##Occurs through repetitive microtrauma, usually in younger athletes
-##Important to identify given propensity for delayed union and nonunion
-##Usually present with h/o months of pain, which is more intense during exercise or weight-bearing
-###always ask about persistent pain prior to acute event to help distinguish worsening stress fx from acute fx
-====Diagnosis====
+===Diagnosis===
-Plain radiographs are usually adequate
+<gallery mode="packed">
-*Must distinguish Jones fx from diaphyseal stress freacture:
+File:Boehlers_Angle.jpg|[[Calcaneus fracture]]
-**Acute fx will have narrow fx line that appears sharp, normal thin cortex adjacent to fx, and normal intramedullary canal
+File:CuboidAvulsionFracture.jpg|[[Cuboid fracture]]
-**Stress fx will demonstrate cortical thickening  near fx line, older stress fx will demonstrate widened fx line and intramedullary sclerosis
+File:A Medial cuneiform fracture.png|[[Cuneiform fracture]]
-[[File:Foot fx.png|center|frame|5th Metatarsal fx types]]
+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>
-====Management====
+==Management & Disposition==
-*Tuberosity (Styloid) Avulsion Fracture
+{{Foot and toe fractures}}
-**Refer to ortho if > 3mm displacement
-**Nondisplaced fx usually require only symptomatic tx, RICE
-**Walking boot (casting rarely necessary) and weight-bearing as tolerated, f/u in 1 week
-*Jones Fracture (non-displaced)
-**Posterior splinting, strict NWB, RICE, ortho f/u in 3-5 days
-**50% of Jones fx treated conservatively may result in nonunion or refracture
-**Conservative tx failure usually due to poor vascular supply of bone and premature return to weight-bearing
-*Diaphyseal Stress Fracture
-**Strict NWB short-leg cast, RICE
-**Ortho referral for all stress fxs
-===[[Metatarsal Fracture]]===
-====Background====
-*Must rule-out associated Lisfranc injury
-====Management====
-*Posterior splint, NWB, ortho referral in 2-3d
-===Phalange===
-*Management: buddy-taping, hard-soled shoe
 ==See Also==
 *[[Fractures (Main)]]
+**[[Distal leg fractures]]
 *[[Foot Diagnoses (Main)]]
+*[[Splinting]]
+==External Links==
+*https://www.aliem.com/emrad-adult-ankle-foot-cant-miss/
+==References==
+<references/>
-==Source==
+[[Category:Orthopedics]]
-*Tintinalli
-*Uptodate
-*Ilustration by Dr. Frank Gaillard; CC SA NC BY licence
-*http://radiopaedia.org/articles/jones_fracture
-[[Category:Ortho]]