Foot and toe fractures: Difference between revisions

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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
 
====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
[[File:Boehlers_Angle.jpg]]
 
==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====
*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===
====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==
==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/>


==Source==
*Tintinalli
*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
 
[[Category:Ortho]]
[[Category:Orthopedics]]

Revision as of 16:48, 5 March 2020