Foot Fracture

No Results

No Results

processing….

Approximately 10% of all fractures occur in the 26 bones of the foot. These bones comprise 2 bones in the hindfoot (calcaneus, talus), ^{[1, 2]} 5 bones in the midfoot (navicular, cuboid, 3 cuneiforms), and 19 bones in the forefoot (5 metatarsals, ^{[3, 4, 5]} 14 phalanges). In addition, the foot contains sesamoid bones, most commonly the os trigonum, os tibiale externum, os peroneum, and os vesalianum pedis. Their smooth sclerotic bony margins and relatively consistent locations help distinguish them from fractures. Hindfoot connects to the midfoot at the Chopart joint; forefoot connects to the midfoot at the Lisfranc joint. ^{[6, 7, 8]}

Foot fractures are among the most common foot injuries evaluated by primary care physicians, most often involving the metatarsals and toes. ^{[9, 10, 11]} Diagnosis requires radiographic evaluation, but ultrasonography has also proven to be highly accurate. If any of the following are present, a radiograph is required: point tenderness over the base of fifth metatarsal; point tenderness over the navicular bone;iInability to take 4 steps, both immediately after injury and in the ED. ^[12]

Management is determined by the location of the fracture and its effect on balance and weight bearing. ^[13]

Treatment approaches include the following ^[13] :

Below is an example of a common fracture.

For patient education resources including crutch walking instructions, see the Breaks, Fractures, and Dislocations Center, as well as Broken Foot.

In contrast to adults, children have relatively stronger ligaments than bone or cartilage. As a result, fractures are more common than sprains in children. However, a child’s forefoot is flexible and resilient to injury. When metatarsal or phalangeal fractures do occur, they may be difficult to recognize because of multiple growth centers. In such cases, comparison views of the uninjured foot often are helpful. Persistent foot pain in children should raise the physician’s concern for potentially important fractures, even in the absence of plain radiographic signs. ^[14]

In pediatric patients, foot tractures account for approximately 5-13% of all fractures. Toe fractures in children represent the most common foot fractures in the pediatric age group, accounting for as many as 18% of foot fractures. Phalangeal fractures represent 3-7% of all physeal fractures and are usually Salter-Harris type I or type II injuries.  Pediatric phalanx fractures are more common in boys than girls and are most commonly closed injuries. ^[15]

Robinson KP, Davies MB. Talus avulsion fractures: Are they accurately diagnosed?. Injury. 2015 Jul 7. [Medline].

Melenevsky Y, Mackey RA, Abrahams RB, Thomson NB 3rd. Talar Fractures and Dislocations: A Radiologist’s Guide to Timely Diagnosis and Classification. Radiographics. 2015 May-Jun. 35 (3):765-79. [Medline].

Fetzer GB, Wright RW. Metatarsal shaft fractures and fractures of the proximal fifth metatarsal. Clin Sports Med. 2006 Jan. 25(1):139-50, x. [Medline].

Zwitser EW, Breederveld RS. Fractures of the fifth metatarsal; diagnosis and treatment. Injury. 2010 Jun. 41(6):555-62. [Medline].

Schmoz S, Voelcker AL, Burchhardt H, Tezval M, Schleikis A, Stürmer KM, et al. [Conservative therapy for metatarsal 5 basis fractures – retrospective and prospective analysis]. Sportverletz Sportschaden. 2014 Dec. 28 (4):211-7. [Medline].

Saab M. Lisfranc fracture–dislocation: an easily overlooked injury in the emergency department. Eur J Emerg Med. 2005 Jun. 12(3):143-6. [Medline].

Libby B, Ersoy H, Pomeranz SJ. Imaging of the Lisfranc injury. J Surg Orthop Adv. 2015 Spring. 24 (1):79-82. [Medline].

Lau S, Bozin M, Thillainadesan T. Lisfranc fracture dislocation: a review of a commonly missed injury of the midfoot. Emerg Med J. 2017 Jan. 34 (1):52-56. [Medline].

Nagar M, Forrest N, Maceachern CF. Utility of follow-up radiographs in conservatively managed acute fifth metatarsal fractures. Foot (Edinb). 2014 Mar. 24 (1):17-20. [Medline].

Kataoka T, Kodera N, Takai S. The Ilizarov Mini-External Fixator for the Treatment of First Metatarsal Fracture: A Case Report. J Nippon Med Sch. 2017. 84 (3):144-147. [Medline].

Clements JR, Schopf R. Advances in forefoot trauma. Clin Podiatr Med Surg. 2013 Jul. 30 (3):435-44. [Medline].

Perry JJ, Stiell IG. Impact of clinical decision rules on clinical care of traumatic injuries to the foot and ankle, knee, cervical spine, and head. Injury. 2006 Dec. 37(12):1157-65. [Medline].

Bica D, Sprouse RA, Armen J. Diagnosis and Management of Common Foot Fractures. Am Fam Physician. 2016 Feb 1. 93 (3):183-91. [Medline].

Sethuraman U, Grover SK, Kannikeswaran N. Tarsometatarsal injury in a child. Pediatr Emerg Care. 2009 Sep. 25(9):594-6. [Medline].

Foot Fractures – Phalanx. Pediatric Orthopaedic Society Of North America (POSNA). Available at https://posna.org/Physician-Education/Study-Guide/Foot-Fractures-Phalanx. Accessed: September 23, 2018.

David S, Gray K, Russell J, Starkey C. Validation of the Ottawa Ankle Rules for Acute Foot and Ankle Injuries. J Sport Rehabil. 2015 Aug 10. [Medline].

Pearse EO, Klass B, Bendall SP. The ‘ABC’ of examining foot radiographs. Ann R Coll Surg Engl. 2005 Nov. 87(6):449-51. [Medline].

Pires R, Pereira A, Abreu-E-Silva G, Labronici P, Figueiredo L, Godoy-Santos A, et al. Ottawa ankle rules and subjective surgeon perception to evaluate radiograph necessity following foot and ankle sprain. Ann Med Health Sci Res. 2014 May. 4(3):432-5. [Medline]. [Full Text].

Johnson PT, Fayad LM, Fishman EK. Sixteen-slice CT with volumetric analysis of foot fractures. Emerg Radiol. 2006 May. 12(4):171-6. [Medline].

Ting AY, Morrison WB, Kavanagh EC. MR imaging of midfoot injury. Magn Reson Imaging Clin N Am. 2008 Feb. 16(1):105-15, vi. [Medline].

Banal F, Etchepare F, Rouhier B. Ultrasound ability in early diagnosis of stress fracture of metatarsal bone. Ann Rheum Dis. 2006 Jul. 65(7):977-8. [Medline].

Canagasabey MD, Callaghan MJ, Carley S. The sonographic Ottawa Foot and Ankle Rules study (the SOFAR study). Emerg Med J. 2011 Oct. 28(10):838-40. [Medline].

Tollefson B, Nichols J, Fromang S, Summers RL. Validation of the Sonographic Ottawa Foot and Ankle Rules (SOFAR) Study in a Large Urban Trauma Center. J Miss State Med Assoc. 2016 Feb. 57 (2):35-8. [Medline].

Wedmore I, Young S, Franklin J. Emergency department evaluation and management of foot and ankle pain. Emerg Med Clin North Am. 2015 May. 33 (2):363-96. [Medline].

Schnaue-Constantouris EM, Birrer RB, Grisafi PJ. Digital foot trauma: emergency diagnosis and treatment. J Emerg Med. 2002 Feb. 22(2):163-70. [Medline].

Zenios M, Kim WY, Sampath J. Functional treatment of acute metatarsal fractures: a prospective randomised comparison of management in a cast versus elasticated support bandage. Injury. 2005 Jul. 36(7):832-5. [Medline].

Fleischer AE, Stack R, Klein EE, Baker JR, Weil L Jr, Weil LS Sr. Forefoot Adduction Is a Risk Factor for Jones Fracture. J Foot Ankle Surg. 2017 May 31. [Medline].

Bishop JA, Braun HJ, Hunt KJ. Operative Versus Nonoperative Treatment of Jones Fractures: A Decision Analysis Model. Am J Orthop (Belle Mead NJ). 2016 Mar-Apr. 45 (3):E69-76. [Medline].

Hunt KJ, Goeb Y, Esparza R, Malone M, Shultz R, Matheson G. Site-Specific Loading at the Fifth Metatarsal Base in Rehabilitative Devices: Implications for Jones Fracture Treatment. PM R. 2014 May 28. [Medline].

Lau S, Bozin M, Thillainadesan T. Lisfranc fracture dislocation: a review of a commonly missed injury of the midfoot. Emerg Med J. 2016 Mar 24. [Medline].

Haapamaki VV, Kiuru MJ, Koskinen SK. Ankle and foot injuries: analysis of MDCT findings. AJR Am J Roentgenol. 2004 Sep. 183(3):615-22. [Medline].

Dale JD, Ha AS, Chew FS. Update on talar fracture patterns: a large level I trauma center study. AJR Am J Roentgenol. 2013 Nov. 201(5):1087-92. [Medline].

Rammelt S, Zwipp H. Talar neck and body fractures. Injury. 2009 Feb. 40(2):120-35. [Medline].

DiGiovanni CW. Fractures of the navicular. Foot Ankle Clin. 2004 Mar. 9(1):25-63. [Medline].

Benson E, Conroy C, Hoyt DB, Eastman AB, Pacyna S, Smith J, et al. Calcaneal fractures in occupants involved in severe frontal motor vehicle crashes. Accid Anal Prev. 2007 Jul. 39(4):794-9. [Medline].

Davis D, Newton E. Fracture, Calcaneus. 2017 Jun. [Medline]. [Full Text].

Bohl DD, Ondeck NT, Samuel AM, Diaz-Collado PJ, Nelson SJ, Basques BA, et al. Demographics, Mechanisms of Injury, and Concurrent Injuries Associated With Calcaneus Fractures: A Study of 14 516 Patients in the American College of Surgeons National Trauma Data Bank. Foot Ankle Spec. 2016 Nov 28. [Medline].

Snoap T, Jaykel M, Williams C, Roberts J. Calcaneus Fractures: A Possible Musculoskeletal Emergency. J Emerg Med. 2017 Jan. 52 (1):28-33. [Medline].

Hahn MP, Richter D, Ostermann PA. [Injury pattern after fall from great height. An analysis of 101 cases]. Unfallchirurg. 1995 Dec. 98(12):609-13. [Medline].

Knight JR, Gross EA, Bradley GH, Bay C, LoVecchio F. Boehler’s angle and the critical angle of Gissane are of limited use in diagnosing calcaneus fractures in the ED. Am J Emerg Med. 2006 Jul. 24(4):423-7. [Medline].

Worsham JR, Elliott MR, Harris AM. Open Calcaneus Fractures and Associated Injuries. J Foot Ankle Surg. 2016 Jan-Feb. 55 (1):68-71. [Medline].

Prayson MJ, Chen JL, Hampers D. Baseline compartment pressure measurements in isolated lower extremity fractures without clinical compartment syndrome. J Trauma. 2006 May. 60(5):1037-40. [Medline].

Richter J, Schulze W, Klaas A, Clasbrummel B, Muhr G. Compartment syndrome of the foot: an experimental approach to pressure measurement and release. Arch Orthop Trauma Surg. 2008 Feb. 128(2):199-204. [Medline].

[Guideline] Bancroft LW, Kransdorf MJ, Adler R, et al. ACR Appropriateness Criteria acute trauma to the foot. National Guideline Clearinghouse. 2014; Accessed: June 1, 2016.

Dowling S, Spooner CH, Liang Y, Dryden DM, Friesen C, Klassen TP, et al. Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis. Acad Emerg Med. 2009 Apr. 16(4):277-87. [Medline].

Mounts J, Clingenpeel J, McGuire E, Byers E, Kireeva Y. Most frequently missed fractures in the emergency department. Clin Pediatr (Phila). 2011 Mar. 50(3):183-6. [Medline].

van Rijn J, Dorleijn DM, Boetes B, Wiersma-Tuinstra S, Moonen S. Missing the Lisfranc fracture: a case report and review of the literature. J Foot Ankle Surg. 2012 Mar-Apr. 51(2):270-4. [Medline].

Robert Silbergleit, MD Professor, Department of Emergency Medicine, University of Michigan Medical School

Robert Silbergleit, MD is a member of the following medical societies: American Association for the Advancement of Science, Alpha Omega Alpha, American Stroke Association, American Academy of Emergency Medicine, American Heart Association, National Association of EMS Physicians, Sigma Xi, Society for Academic Emergency Medicine, Society for Neuroscience

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francis Counselman, MD, FACEP Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School

Francis Counselman, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Norfolk Academy of Medicine, Association of Academic Chairs of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Tom Scaletta, MD President, Smart-ER (http://smart-er.net); Chair, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine

Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Foot Fracture

Research & References of Foot Fracture|A&C Accounting And Tax Services
Source

Share on Facebook

Tweet

Follow us