Foot and toe fractures: Difference between revisions
 
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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}}


====Diagnosis====
==Clinical Features==
*CT often required for accurate diagnosis
*History of trauma
*Pain over fracture site


====Management====
==Differential Diagnosis==
*Major fracture (talar neck and head)
{{Foot diagnoses}}
**Immediate ortho consultation required (high rate of avascular necrosis)
*Minor fracture
**Posterior splint, NWB, ortho referral


===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
**Extra-articular (25%)
***Anterior process fx is most common


====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>


====Treatment====
==Management & Disposition==
*Intra-articular fracture
{{Foot and toe fractures}}
**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====
==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===
*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==
==External Links==
===Fifth Metatarsal===
*https://www.aliem.com/emrad-adult-ankle-foot-cant-miss/
====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====
==References==
*Plain radiographs are usually adequate
<references/>
[[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
***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==
[[Category:Orthopedics]]
*Tintinalli
*Ilustration by Dr. Frank Gaillard; CC SA NC BY licence
*http://radiopaedia.org/articles/jones_fracture
[[Category:Ortho]]

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

See Also

External Links

References

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