|
|
| Line 13: |
Line 13: |
|
| |
|
| ==Forefoot== | | ==Forefoot== |
| ===[[Fifth Metatarsal Fracture]]===
| | *[[Fifth Metatarsal Fracture]] |
| ====Background====
| |
| *'''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:'''
| |
| #'''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====
| |
| Plain radiographs are usually adequate
| |
| *Must distinguish Jones fx from diaphyseal stress freacture:
| |
| **Acute fx will have narrow fx line that appears sharp, normal thin cortex adjacent to fx, and normal intramedullary canal
| |
| **Stress fx will demonstrate cortical thickening near fx line, older stress fx will demonstrate widened fx line and intramedullary sclerosis
| |
| [[File:Foot fx.png|center|frame|5th Metatarsal fx types]]
| |
| | |
| ====Management====
| |
| *Tuberosity (Styloid) Avulsion Fracture
| |
| **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]]=== | | ===[[Metatarsal Fracture]]=== |
| Line 59: |
Line 22: |
| *Posterior splint, NWB, ortho referral in 2-3d | | *Posterior splint, NWB, ortho referral in 2-3d |
|
| |
|
| ===Phalange=== | | ===[[Foot Phalange (Toe) Fracture]]=== |
| *Management: buddy-taping, hard-soled shoe | | *Management: buddy-taping, hard-soled shoe |
|
| |
|
