Foot and toe fractures

Talus

• Neck
  • High risk of avscular necrosis
• Body
  • Delay in dx/tx can lead to non-union or subtalar osteoarthritis

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

Fifth Metatarsal

Jones Fracture

• <1.5 cm from proximal tip of 5th metatarsal
• transverse
• ORIF

Dancer's (Avulsion) Fracture

• proximal tip of 5th metatarsal (more proximal than Jones)
• avulsion (spiral) fracture, frequently displaced
• inversion injury (common in ballet dancers)
• Do not confuse unfused apophysis with a fracture!
• treatment
  • mildly displaced: heal w/ 6 to 8 weeks w/ short leg cast
  • displaced frxs (3-5 mm): may require ORIF

See Also

• Foot Bones
• Ankle Fracture
• Ankle Sprain
• Ankle Fracture (Peds)
• Lisfranc Injury