Foot Fracture

Description

Injury to tarsal bones or metatarsals including calcaneus, talus, navicular, cuboid, cuneiform, and metatarsals

Etiology

• Most common foot injuries are of the metatarsals and phalanges
• The calcaneus is the most commonly fractured of the tarsal bones
• Calcaneus fractures: Compression injury from sudden high-velocity impact to heel:
  • 75% are intra-articular; 50% have associated injuries:
    • 10% spine fractures
    • 25% with associated lower extremity trauma
    • 9% bilateral, 5% open
• Metatarsal fractures: Divided into stress fractures, twisting injuries, or direct trauma:
  • First metatarsal: Direct applied force
  • Second and third metatarsals are most often involved in stress fractures and twisting injuries
  • Fifth metatarsal: Avulsion fracture (dancer's fracture) of proximal apophysis is the most common injury
  • Jones fracture: Transverse fracture of the metaphyseal–diaphyseal junction of fifth metatarsal; results from twisting while foot inverted. At risk for nonunion given blood supply only from nutrient arteries
• Talus: Caused by dorsiflexion with axial load, lateral process fx is a common snowboarder's injury
• Navicular: Results from axial compression or stress fractures
• Cuboid and cuneiform fractures are rare and occur in conjunction with other injuries, often with tarsal–metatarsal injuries
• “Nutcracker” compression of cuboid, often related to horseback riding
• Tarsal–metatarsal injuries (Lisfranc injuries) are high-energy injuries:
  • Axial load on plantarflexed foot, or hindfoot fixed with forced foot eversion
  • Unstable forefoot on hindfoot
  • 20% go undiagnosed on initial visit
  • 3 types: Convergent, divergent, and incongruent

• Metatarsal fractures account for 90% of foot fractures in children, usually from direct trauma:
  • Lesser metatarsal fractures (2–4) most common, followed by base of fifth, then base of first metatarsal
  • Physeal injury may occur with proximal first metatarsal fractures
• Other common injuries include phalangeal fractures (17%) and navicular fractures (5%)
• Fractures of talus or calcaneus occur with distal tibia or fibula fractures (8%)
• Calcaneus fractures are less likely intra-articular. Less common to have associated spine fractures