Foot Fracture Guidelines

Updated: Sep 23, 2018
  • Author: Robert Silbergleit, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Guidelines Summary

The American College of Radiology Appropriateness Criteria for acute trauma to the foot include the following [44] :

  • If a patient with acute foot trauma does not meet the inclusion criteria to be evaluated by the Ottawa Rules (such as a diabetic with peripheral neuropathy involving the foot), then imaging should be obtained. The first imaging study in this scenario should be a 3-view radiographic series of the foot.
  • If there is clinical concern for a midfoot injury (such as a Lisfranc injury), then imaging should be performed. The first imaging study in this situation is usually a 3-view radiographic series of the foot with weight bearing on at least the AP view, if possible. If there is continued clinical concern for a Lisfranc injury in the setting of a normal radiograph, then advanced imaging (MRI or CT) should be considered and performed on a case-by-case basis. Likewise, when there is clinical concern for an acute tendon rupture, further imaging with MRI or US would be confirmatory.
  • If there is clinical suspicion for plantar plate injury after MTP joint injury, radiography is the initial imaging modality. Weight-bearing AP, lateral, and sesamoid axial views may detect proximal migration of one or both hallux sesamoids with great toe injuries. US and MRI can directly evaluate the soft-tissue structures of the capsuloligamentous complex, specifically the plantar plate.
  • In the setting of penetrating trauma to the foot with a possible foreign body, radiography (if the foreign body is radiopaque) or US (with nonradiopaque foreign bodies) should be used to determine if a foreign body is indeed present.