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| ==Hindfoot== | | ==Types== |
| ===Talus===
| | [[File:Foot_Bones.jpg|thumb|Bones of the foot.]] |
| ====Background====
| | {{Foot and toe fractures DDX}} |
| *Almost always associated with other injuries
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| ====Diagnosis==== | | ==See Also== |
| *CT often required for accurate diagnosis | | *[[Fractures (Main)]] |
| | | **[[Distal leg fractures]] |
| ====Management====
| | *[[Foot Diagnoses (Main)]] |
| *Major fracture (talar neck and head)
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| **Immediate ortho consultation required (high rate of avascular necrosis) | |
| *Minor fracture | |
| **Posterior splint, NWB, ortho referral
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| ===Calcaneus===
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| ====Background====
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| *Associated injuries are common
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| *Types
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| **Intra-articular (75%)
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| ***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====
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| *Imaging
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| **Decreased Boehler's angle (<25') may be only sign of fx (compare w/ opposite side)
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| ====Treatment====
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| *Intra-articular fracture
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| **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====
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| *(A) Normal Boehler's angle and (B) Abnormal Boehler's angle
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| [[File:Boehlers_Angle.jpg]]
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| ==Midfoot== | | ==References== |
| ===LisFranc Injury===
| | <references/> |
| *See [[Lisfranc Injury]]
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| ===Navicular/Cuboid/Cuneiform===
| | *Uptodate |
| *All are diagnosed/managed in similar way
| | *https://www.aliem.com/emrad-adult-ankle-foot-cant-miss/ |
| **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==
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| ===Fifth Metatarsal===
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| ====Background====
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| 3 types of fractures:
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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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| ##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
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| ##Ask about persistent pain prior to acute event to help distinguish stress fx from acute fx (sometimes sx of stress fx will worsen after acute stress and mislead you into thinking acute fx)
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| ====Diagnosis====
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| Plain radiographs are usually adequate
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| *Must distinguish Jones fx from diaphyseal stress freacture
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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, 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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| **Ortho referral
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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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| *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]] | |
