- Author: Robert Silbergleit, MD; Chief Editor: Trevor John Mills, MD, MPH more...
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]
Foot fractures are among the most common foot injuries evaluated by primary care physicians, most often involving the metatarsals and toes. Diagnosis requires radiographic evaluation, but ultrasonography has also proven to be highly accurate. Management is determined by the location of the fracture and its effect on balance and weight bearing.
Treatment approaches include the following :
- Metatarsal shaft fractures are initially treated with a posterior splint and avoidance of weight-bearing activities; subsequent treatment consists of a short leg walking cast or boot for 4-6 weeks.
- Proximal fifth metatarsal fractures have different treatments depending on the location of the fracture. A fifth metatarsal tuberosity avulsion fracture can be treated acutely with a compressive dressing, then the patient can be transitioned to a short leg walking boot for 2 weeks, with progressive mobility as tolerated after initial immobilization.
- A Jones fracture has a higher risk of nonunion and requires at least 6-8 weeks in a short leg non-weight-bearing cast; healing time can be as long as 10 to 12 weeks.
- Great toe fractures are treated with a short leg walking boot or cast with toe plate for 2-3 weeks, then a rigid-sole shoe for an additional 3-4 weeks. Lesser toe fractures can be treated with buddy taping and a rigid-sole shoe for 4-6 weeks.
- Lisfranc injuries can be categorized as stable or unstable. Stable Lisfranc injuries can be immobilized in the ED and patients discharged home, but unstable injuries require an orthopedic referral for consideration of surgical fixation.
Below is an example of a common fracture.
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.
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