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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====
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| *CT often required for accurate diagnosis
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| ====Management====
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| *Major fracture (talar neck and head)
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| **Immediate ortho consultation required (high rate of avascular necrosis)
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| *Minor fracture
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| **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==
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| ===LisFranc Injury===
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| *See [[Lisfranc Injury]]
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| ===Navicular/Cuboid/Cuneiform===
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| *All are diagnosed/managed in similar way
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| **Imaging: (weight-bearing AP, lateral, oblique)
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| ***CT sometimes necessary
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| **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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| *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
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| *3 types of 5th metatarsal fx:
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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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| ##Second most common fx at base of 5th metatarsal
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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, usually in younger athletes
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| ##Important to identify given propensity for delayed union and nonunion
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| ##Usually present with h/o months of pain, which is more intense during exercise or weight-bearing
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| ###always ask about persistent pain prior to acute event to help distinguish worsening stress fx from 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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| **Acute fx will have narrow fx line that appears sharp, normal thin cortex adjacent to fx, and normal intramedullary canal
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| **Stress fx will demonstrate cortical thickening near fx line, older stress fx will demonstrate widened fx line and intramedullary sclerosis
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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, strict 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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| **Strict NWB short-leg cast, RICE
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| **Ortho referral for all stress fxs
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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== | | ==See Also== |
| *[[Fractures (Main)]] | | *[[Fractures (Main)]] |
| *[[Foot Bones]] | | **[[Distal leg fractures]] |
| *[[Ankle Fracture]] | | *[[Foot Diagnoses (Main)]] |
| *[[Ankle Sprain]] | | |
| *[[Ankle Fracture (Peds)]]
| | ==References== |
| *[[Lisfranc Injury]]
| | <references/> |
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| ==Source==
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| *Tintinalli
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| *Uptodate | | *Uptodate |
| *Ilustration by Dr. Frank Gaillard; CC SA NC BY licence | | *https://www.aliem.com/emrad-adult-ankle-foot-cant-miss/ |
| *http://radiopaedia.org/articles/jones_fracture
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| [[Category:Ortho]] | | [[Category:Orthopedics]] |