Foot and toe fractures

Hindfoot

Talus

Background

• Almost always associated with other injuries

Diagnosis

• CT often required for accurate diagnosis

Management

• Major fracture (talar neck and head)
  • Immediate ortho consultation required (high rate of avascular necrosis)
• Minor fracture
  • Posterior splint, NWB, ortho referral

Calcaneus

Background

• Associated injuries are common
• Types
  • Intra-articular (75%)
    • Sclerotic line may be only evidence of impacted fracture
  • Extra-articular (25%)
    • Anterior process fx is most common

Diagnosis

• Imaging
  • Decreased Boehler's angle (<25') may be only sign of fx (compare w/ opposite side)

Treatment

• Intra-articular fracture
  • Immobilization w/ posterior splint
  • Non-weightbearing
  • Elevation (very important - fx has high rate of severe swelling)
  • Ortho consult
• Extra-articular fracture
  • Immobilization and close ortho f/u

Images

• (A) Normal Boehler's angle and (B) Abnormal Boehler's angle

Midfoot

LisFranc Injury

• See Lisfranc Injury

Navicular/Cuboid/Cuneiform

• All are diagnosed/managed in similar way
  • Imaging: (weight-bearing AP, lateral, oblique)
    • CT sometimes necessary
  • Treatment: Non-weightbearing short leg cast, ortho referral

Forefoot

Fifth Metatarsal

Background

• 3 types of fractures:
  • 1. 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
  • 2. Jones or metaphyseal-diaphyseal junction fracture
    • Occurs due to sudden change in direction w/ heel off the ground
  • 3. Diaphyseal stress fracture
    • Occurs through repetitive microtrauma

Diagnosis

• Plain radiographs are usually adequate

5th Metatarsal fx types

Management

• Tuberosity (Styloid) Avulsion Fracture
  • Refer to ortho if > 3mm displacement
  • Nondisplaced fx usually require only symptomatic tx
  • Walking boot (casting rarely necessary) and weightbearing as tolerated, f/u in 1 week
• Jones Fracture (non-displaced)
  • Posterior splinting, NWB, ortho referral
• Diaphyseal Stress Fracture
  • Ortho referral

Metatarsal

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)
• Foot Bones
• Ankle Fracture
• Ankle Sprain
• Ankle Fracture (Peds)
• Lisfranc Injury

Source

• Tintinalli
• Ilustration by Dr. Frank Gaillard; CC SA NC BY licence
• http://radiopaedia.org/articles/jones_fracture