Foot Fracture

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Basics

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

Pediatric Considerations
  • 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

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Basics

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

Pediatric Considerations
  • 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

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