eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Fracture, Foot: Differential Diagnoses & Workup

Author: Robert Silbergleit, MD, Associate Professor, Department of Emergency Medicine, University of Michigan Medical School
Contributor Information and Disclosures

Updated: Feb 6, 2009

Differential Diagnoses

Ankle Injury, Soft Tissue
Compartment Syndrome, Extremity
Dislocations, Foot

Workup

Imaging Studies

  • Plain-film radiography
    • Ottawa foot rules are a tool that predicts significant midfoot fractures. They are guidelines used to determine whether radiographs are necessary.1
    • 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
      • Inability to take 4 steps, both immediately after injury and in the ED
    • When performed, a systematic approach to reading foot radiographs is important and reduces the risk of missing important injuries.2
  • Other imaging modalities: Bone scanning, CT scanning, MRI, and ultrasonography may help diagnose certain foot fractures that are occult on plain film radiography.3,4 Although recent anecdotal reports suggest that ultrasonography may someday have a role in routine assessment of acute foot fractures,5 second-line imaging studies generally do not need to be performed while the patient is in the ED and are usually ordered only after consultation with a foot surgeon.

More on Fracture, Foot

Overview: Fracture, Foot
Differential Diagnoses & Workup: Fracture, Foot
Treatment & Medication: Fracture, Foot
Follow-up: Fracture, Foot
Multimedia: Fracture, Foot
References
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References

  1. 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. Dec 2006;37(12):1157-65. [Medline].

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

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

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

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

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

  7. 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. Jul 2005;36(7):832-5. [Medline].

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

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

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

  11. Rammelt S, Zwipp H. Talar neck and body fractures. Injury. Apr 23 2008;[Medline].

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

  13. 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. Jul 2007;39(4):794-9. [Medline].

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

  15. 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. Jul 2006;24(4):423-7. [Medline].

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

  17. 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. Feb 2008;128(2):199-204. [Medline].

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Further Reading

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Keywords

broken foot, toe fracture, broken toe, first metatarsal fracture, internal metatarsal fracture, fifth metatarsal fracture, proximal avulsion fracture, Jones fracture, Jones' fracture, fracture at Lisfranc joint, fracture at tarsometatarsal joint, talar fracture, navicular fractures, calcaneal fractures, March fracture, pseudo-Jones fracture, tennis fracture, posterior process fracture, Shepherd fracture, transchondral talar dome fracture, osteochondral talar dome fracture, intraarticular joint depression fracture, compartment syndrome

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Contributor Information and Disclosures

Author

Robert Silbergleit, MD, Associate Professor, Department of Emergency Medicine, University of Michigan Medical School
Robert Silbergleit, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American Association for the Advancement of Science, American Heart Association, American Stroke Association, National Association of EMS Physicians, Sigma Xi, Society for Academic Emergency Medicine, and Society for Neuroscience
Disclosure: Nothing to disclose.

Medical Editor

Francis Counselman, MD, Program Director, Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School
Francis Counselman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Norfolk Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Tom Scaletta, MD, President, Emergency Excellence (EmEx) (www.emergencyexcellence.com); Assistant Professor of Emergency Medicine, Rush Medical College, Cook County Hospital; Chairperson, 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 and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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