eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Fracture, Foot

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

Updated: Feb 6, 2009

Introduction

Background

Approximately 10% of all fractures occur in the 26 bones of the foot. These bones comprise 2 bones in the hindfoot (calcaneus, talus), 5 bones in the midfoot (navicular, cuboid, 3 cuneiforms), and 19 bones in the forefoot (5 metatarsals, 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.

Below is an example of a common fracture.

Fractures, foot. Proximal fifth metatarsal avulsion fracture (also termed pseudo-Jones, tennis, or dancer fracture).

Age

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.

Clinical

History

• Mechanism of injury
• Time between injury and presentation
• Prior injuries

Physical

• Inspect injured foot for swelling, bruises, deformity, and open wounds.
• Uncover uninjured foot for side-by-side comparison.
• Palpate for pulses, capillary refill, tenderness, instability, and crepitus.
• Test range of motion and joint function. Normal ranges of motion of the foot relative to the ankle are 45 degrees plantarflexion, 20 degrees dorsiflexion, 30 degrees inversion, 20 degrees eversion, 20 degrees internal rotation, and 10 degrees external rotation. Comparisons with the uninjured foot are helpful.
• Explore all open wounds.
• Conduct and document a careful neurologic exam of foot, including both motor and sensory functions.

Causes

Trauma - Direct, indirect, or overuse

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.

Treatment

Prehospital Care

Stabilize and elevate foot.

Emergency Department Care

• Ice, immobilize, and elevate foot and provide analgesia to all patients with significant foot fractures.
• Options for initial immobilization
  • Posterior or stirrup splints
  • Reinforced bulky dressing, also termed Jones splint, which consists of a web roll and an elastic compression bandage
  • Rigid, flat-bottom orthopedic shoe also termed postop or Reece shoe
  • Definitive immobilization often requires application of a cylindrical cast, applied during the acute phase (and often bivalved to accommodate further swelling) or after a few days when edema has begun to decrease.
• Toe fracture: Toe fractures are common and generally heal well with little or no therapy. Buddy tape broken toe to an adjacent, uninjured toe (with padding in between the toes to prevent skin maceration) and apply a rigid flat-bottom orthopedic shoe. While union of fracture segments occurs in 3-8 weeks, symptoms usually improve much earlier. Significantly displaced fractures, especially of the first toe, may be treated more aggressively with closed reduction and rigid immobilization. Irreducible fractures sometimes require open reduction and internal fixation.⁶
• First metatarsal fracture: This is the least commonly fractured metatarsal. The first metatarsal head bears twice the weight of other metatarsal heads. Treat minimally displaced or nondisplaced fractures with immobilization without weight bearing. Displaced fractures usually require open reduction and internal fixation (see Media file 7).
• Internal metatarsal fracture
  • Fractures of internal (second, third, fourth) metatarsals are very common. Nondisplaced and displaced fractures usually heal well, with weight bearing as tolerated, in a cast or rigid flat-bottom orthopedic shoe. In fact, recent data suggest that elastic support bandages are equivalent or superior to casts for such metatarsal fractures.⁷ Exclude disruptions of the Lisfranc (tarsometatarsal) joint by maintaining a high level of suspicion.
  • March fracture is a stress fracture of the second and/or third metatarsal that commonly occurs in joggers. Radiographs are often negative, and sometimes a bone scan helps determine this diagnosis. Treatment is cessation of aggravating activity for 4-6 weeks.
• Fifth metatarsal fracture: The proximal fifth metatarsal is the most common site of midfoot fractures.⁸ Fractures are of 2 general types, the Jones fracture and the pseudo-Jones or tennis fracture. Midshaft (see Media file 8) and distal fifth metatarsal fractures (see Media file 9) are less common.
  • Proximal avulsion fracture: Fractures at the proximal tuberosity are very common and termed pseudo-Jones or tennis fractures (see Media file 1). This avulsion injury usually is associated with a lateral ankle strain and occurs at the attachment of the peroneus brevis tendon. It heals well with a compression dressing and weight bearing as tolerated.
  • Jones fracture: This less common but more problematic fracture occurs transversely at the base of the fifth metatarsal, 1.5-3 cm distal to the proximal tuberosity (see Media file 2). Displacement of this fracture tends to increase with continued weight bearing. Patients with this fracture often (35-50%) develop persistent nonunions requiring bone grafting and internal fixation. Initial therapy must include immobilization without weight bearing.
• Fracture at Lisfranc (tarsometatarsal) joint
  • The Lisfranc joint is found at the base of second metatarsal and is formed by a 6-bone arch that includes the first, second, and third cuneiforms and first, second, and third metatarsals. Fracture-dislocations at this joint are rare, yet are still the most commonly misdiagnosed foot injuries (see Media file 3, Media file 6). They can result in posttraumatic arthritis and reflex sympathetic dystrophy. Displaced fractures are clinically and radiographically obvious, yet nondisplaced or minimally displaced fractures may be subtle.⁹
  • To facilitate diagnosis, grasp first and second metatarsals and move them alternately through plantarflexion and dorsiflexion.
  • Radiographic diagnosis is made by detecting widening (diastasis) of 2-5 mm between the bases of the first and second metatarsals or between the middle and medial cuneiforms. Fracture at the base of the second metatarsal strongly suggests the diagnosis. If standard radiographs appear normal despite clinical suspicion, radiographs of the injured foot bearing weight may reveal the fracture. These fractures require immediate orthopedic consultation for reduction and fixation. CT imaging is useful if clinical suspicion is high despite nondiagnostic plain radiography.¹⁰
• Talar fracture: Talar fracture is the second most common fracture of the tarsal bones. Blood supply is somewhat tenuous, resulting in a high incidence of avascular necrosis following displaced fractures.
  • Neck and body fracture: These are the most common talar fractures and may be associated with subtalar dislocation.¹¹ Displaced fractures usually require surgical fixation. Nondisplaced fractures are treated with non–weight-bearing short leg cast for 6-10 weeks.
  • Lateral process fracture: This type was previously rare, yet now is more common because of snowboarding injuries. Treatment should include immobilization with strict avoidance of weight bearing.
  • Posterior process (Shepherd) fracture: Caused by damage to the posterior process of the talus, this fracture's usual mechanism is sudden plantarflexion or repetitive motion, especially in athletes who dance or kick. Diagnosis usually is not confirmed in the ED, because clinical examination is typically nonspecific and plain film radiography normal. Suspicion warrants referral to an orthopedist. Treatment includes immobilization with either partial or full weight bearing. Note that this fracture often is confused with an accessory bone that occurs at this location, the os trigonum.
  • Transchondral/osteochondral talar dome fracture: This rare injury often presents as a nonhealing ankle sprain and is caused by small cartilaginous avulsions or body chips in tibial articulation. Tenderness of the talar dome can be appreciated with the foot in dorsiflexion. Radiographs may be normal, and injuries cannot be distinguished clinically from ankle sprains. Delayed presentation may show crepitus, joint locking, and laxity of lateral and anterior ankle ligaments. Suspicion warrants referral to an orthopedist for bone scan or other definitive imaging. Initial therapy for this injury is immobilization without weight bearing.
• Navicular fracture: Navicular fractures are rare and most often represent stress fractures in young athletes. They usually heal well with immobilization and weight bearing as tolerated.¹² Displaced fractures through the navicular body have a high incidence of avascular necrosis and require open reduction and internal fixation (see Media files 11-12).
• Calcaneal fracture
  • Calcaneal fractures usually occur in patients aged 30-50 years, with a peak incidence at 45 years. They occur in males 5 times more often than in females. They are most commonly caused by motor vehicle crashes or falls from a height.¹³
  • When caused by falls from a height, these fractures have a high rate of associated injuries. Identification of a calcaneal fracture should prompt a search for other related findings. Calcaneal fractures are part of the "lover's triad" (named for the constellation of injuries that may occur when jumping out of a second-story bedroom window), with lumbar compression fractures and forearm fractures. Ankle, femur, and elbow fractures are also common.¹⁴ A high index of suspicion for thoracic aortic rupture and renal vascular pedicle disruption must be maintained when calcaneal fractures are seen. The 2 main types of calcaneal fractures are as follows:
  • Intraarticular joint depression fracture: This is the most common form of calcaneal fracture. Lateral foot radiograph reveals a reduction in the Böehler's angle, the posterior angle formed by intersection of a line from the posterior to the middle facet and a line from the anterior to the middle facet (see Media files 7-8). Böehler's angle is normally between 20 and 40°. Angles less than 20°, or more than 5° smaller than that of uninjured side, indicate a fracture. Although often useful, the sensitivity of Böehler's angle has been shown to be less than that of physician gestalt in interpreting calcaneal films.¹⁵ Obtain an urgent orthopedic consultation for calcaneal fractures, since open reduction and internal fixation is usually necessary.
  • Extraarticular fracture: Treat these calcaneal fractures with a bulky compression dressing, rest, ice, and elevation. Arrange orthopedic follow-up care.

Consultations

Nonemergent referral or urgent consultation with an orthopedic surgeon (or podiatrist if appropriate) is often necessary; which is appropriate depends on the type of fracture.

Medication

Analgesics (narcotics, NSAIDs) are generally the only medications needed to treat foot fractures. Administer antibiotics and tetanus prophylaxis to patients with open fractures.

Nonsteroidal anti-inflammatory agents (NSAIDs)

These agents are used most commonly for relief of mild to moderately severe pain. Effects of NSAIDs in treatment of pain tend to be patient specific, yet ibuprofen is usually DOC for initial therapy. Other NSAIDS also may be used.

Ibuprofen (Ibuprin, Advil, Motrin)

Usually DOC for treatment of mild to moderately severe pain, if no contraindications. Inhibits inflammatory reactions and pain, probably by decreasing activity of enzyme cyclooxygenase, which inhibits prostaglandin synthesis.

Dosing

Adult

200-400 mg PO q4-6h prn; not to exceed 3.2 g/d

Pediatric

<6 months: Not established
6 months to 12 years: 20-40 mg/kg/d PO divided tid/qid
>12 years: Administer as in adults

Interactions

Aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity; may decrease effects of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT in patients taking anticoagulants—monitor PT closely and instruct patients to watch for signs of bleeding; may increase risk of methotrexate toxicity; may increase phenytoin levels

Contraindications

Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in coagulation abnormalities or during anticoagulant therapy

Narcotic combination analgesics

Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and aids physical therapy regimens. Many analgesics have sedating properties that benefit patients who have sustained fractures. Hydrocodone and oxycodone preparations are generally more effective and better tolerated than other narcotic-acetaminophen combinations such as those containing codeine.

Hydrocodone bitartrate and acetaminophen (Vicodin ES)

Drug combination indicated for relief of moderately severe to severe pain.

Dosing

Adult

1-2 tab/cap PO q4-6h prn

Pediatric

<12 years: 10-15 mg/kg acetaminophen PO q4-6h prn; not to exceed 2.6 g/d of acetaminophen
>12 years: 750 mg acetaminophen PO q4h; single dose not to exceed 10 mg of hydrocodone bitartrate; not to exceed 5 doses/d

Interactions

Phenothiazines may decrease analgesic effects; CNS depressants or tricyclic antidepressants increase toxicity

Contraindications

Documented hypersensitivity; high-altitude cerebral edema; elevated intracranial pressure

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Tablets contain metabisulfite, which may cause hypersensitivity; caution in patients dependent on opiates since this substitution may result in acute opiate-withdrawal symptoms; caution in severe renal or hepatic dysfunction

Antibiotics

Prophylaxis is given to patients with open fractures.

Penicillin G (Pfizerpen)

Interferes with synthesis of cell wall mucopeptide during active replication, resulting in bactericidal activity against susceptible microorganisms.

Dosing

Adult

2.4 million U IM single dose in 2 injection sites

Pediatric

50,000 U/kg IM to maximum of 2.4 million U

Interactions

Probenecid can increase effects; tetracyclines can decrease effects

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in impaired renal function

Clindamycin (Cleocin)

Lincosamide is useful as treatment against serious skin and soft-tissue infections caused by most staphylococcal strains. Also effective against aerobic and anaerobic streptococci, except enterococci. Clindamycin is used for prophylaxis in penicillin-allergic patients. Useful as treatment against streptococci and most staphylococcal strains.

Dosing

Adult

600 mg PO/IV q6-8h for 5-7d

Pediatric

20-40 mg/kg IM/IV tid/qid for 5-7 d

Interactions

Increases duration of neuromuscular blockade induced by tubocurarine and pancuronium; erythromycin may antagonize effects; antidiarrheals may delay absorption

Contraindications

Documented hypersensitivity; regional enteritis; ulcerative colitis; hepatic impairment; antibiotic-associated colitis

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in severe hepatic dysfunction; no adjustment necessary in renal insufficiency; associated with severe and possibly fatal colitis

Gentamicin (Gentacidin, Garamycin)

Aminoglycoside antibiotic used for gram-negative bacterial coverage. Commonly used in combination with both an agent against gram-positive organisms and one that covers anaerobes. Used in conjunction with ampicillin or vancomycin for prophylaxis in patients with open fractures.

Dosing

Adult

1.5 mg/kg/dose IV q8-24h; not to exceed 80 mg; dosing interval based on renal function

Pediatric

2 mg/kg/dose IV q8h; dosing interval based on renal function

Interactions

Other aminoglycosides, cephalosporins, penicillins, and amphotericin B may increase nephrotoxicity; enhances effects of neuromuscular blocking agents, thus prolonged respiratory depression may occur; loop diuretics may increase auditory toxicity of aminoglycosides—irreversible hearing loss of varying degrees may occur (monitor regularly)

Contraindications

Documented hypersensitivity; non–dialysis-dependent renal insufficiency

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Narrow therapeutic index (not intended for long-term therapy); caution in renal failure (not on dialysis), myasthenia gravis, hypocalcemia, and conditions that depress neuromuscular transmission; adjust dose in renal impairment

Tetanus toxoid

This agent is used for tetanus immunization. Booster injection is recommended in previously immunized individuals to prevent this potentially lethal syndrome.

Tetanus toxoid

Induces active immunity against tetanus in selected patients. Tetanus and diphtheria toxoids are the immunizing DOC for most adults and children older than 7 y. Necessary to administer booster doses to maintain tetanus immunity throughout life. Pregnant patients should receive only tetanus toxoid, not a diphtheria antigen-containing product. In children and adults, may administer into deltoid or midlateral thigh muscles. In infants, preferred site of administration is midthigh laterally.

Dosing

Adult

Primary immunization: 0.5 mL IM; give 2 injections 4-8 wk apart and a third dose 6-12 mo after second injection
Booster dose: 0.5 mL q10y

Pediatric

Administer as in adults

Interactions

Patients receiving immunosuppressants, including corticosteroids or radiation therapy, may remain susceptible despite immunization due to poor immune response; cimetidine may enhance or augment delayed-hypersensitivity responses to skin-test antigens; avoid concurrent use of chloramphenicol since it may impair amnestic response to tetanus toxoid; concurrent use of tetanus immune globulin may delay development of active immunity by several days (interaction is nevertheless clinically insignificant and does not preclude its concurrent use)

Contraindications

Documented hypersensitivity; history of any type of neurological symptoms or signs following administration of this product
FDA recommends that elective tetanus immunization be deferred during any outbreak of poliomyelitis because tetanus toxoid injections are an important cause of provocative poliomyelitis

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Do not use to treat actual tetanus infections, or for immediate prophylaxis of unimmunized individuals (use instead tetanus antitoxin, preferably human tetanus immune globulin); diminished antibody response to active immunization may be seen in patients receiving immunosuppressive therapy; better to defer primary diphtheria immunization until immunosuppressive therapy discontinued; routine immunization of symptomatic and asymptomatic HIV-infected persons is recommended

Follow-up

Complications

• Compartment syndrome is the most dangerous acute complication of foot fractures. This syndrome is associated primarily with midfoot fractures sustained as the result of a crush mechanism. Clinical signs include marked swelling (early) and neurovascular compromise (late). Recent data emphasize that compartment syndrome is a subjective clinical diagnosis. Measurement of compartment pressures may provide useful supplemental information, but pressure thresholds defining compartment syndrome in lower extremity fractures are elusive¹⁶ and the osseofascial spaces of the foot are not distinct or isloated.¹⁷ Suspicion of compartment syndrome warrants emergent orthopedic consultation; treatment is fasciotomy when the diagnosis is confirmed.
• Long-term complications of foot fracture
  • Arthritis
  • Infection
  • Nonunion or instability
  • Gait disturbances

Prognosis

• Prognosis of foot fracture is generally excellent with appropriate treatment.

Patient Education

• Proper instruction in crutch-walking is required for those unable to bear weight.
• For excellent patient education resources including crutch walking instructions, visit eMedicine's Breaks, Fractures, and Dislocations Center. Also, see eMedicine's patient education article Broken Foot.

Miscellaneous

Medicolegal Pitfalls

• Failure to note fractures because radiographs not obtained or misread
• Failure to consult or refer to an orthopedic surgeon when necessary

Multimedia

Media file 1: Fractures, foot. Proximal fifth metatarsal avulsion fracture (also termed pseudo-Jones, tennis, or dancer fracture).

Media file 2: Fractures, foot. Jones fracture of the fifth metatarsal.

Media file 3: Fractures, foot. Lisfranc fracture-dislocation.

Media file 4: Fractures, foot. Calcaneal fracture with intraarticular involvement and joint depression.

Media file 5: Fractures, foot. Calcaneal fracture with intraarticular involvement and joint depression with Böehler angle imposed. Reduced angle of 16 degrees is pathologic.

Media file 6: Fractures, foot. Subtle fracture of the first cuneiform at the Lisfranc joint. Another fracture at the base of the first metatarsal is not seen here but was found on subsequent computed tomography.

Media file 7: Fractures, foot. CT scan showing fracture of first cuneiform and proximal first metatarsal.

Media file 8: Fractures, foot. Spiral fracture of the shaft of the fifth metatarsal. This fracture was treated conservatively with immobilization.

Media file 9: Fractures, foot. Minimally displaced fracture of the distal fifth metatarsal. This fracture was treated conservatively with immobilization in a rigid flat bottom shoe.

Media file 10: Fractures, foot. Two fractures of the proximal phalanx of the great toe. The fracture at the base is obvious, but the fracture at the head is more subtle. Make certain to examine every bone on the radiograph to avoid being distracted by obvious finding.

Media file 11: Comminuted navicular fracture in a young drunk driver involved in a motor vehicle crash. The patient sustained no other injuries and was discharged in a plaster splint with strict nonweightbearing. The patient subsequently had a computerized tomography (CT) scan and underwent open reduction and internal fixation 9 days after the injury. A standard anteroposterior (AP) view is shown here.

Media file 12: An added oblique view of this same patient with a navicular fracture was performed in the ED to help verify the absence of other significant fractures. Obtaining views that are not part of the routine foot series can be helpful and should be added when needed.

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].

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

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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