Foot Fracture

Aka: Foot Fracture

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II. Exam

  1. See Ankle Exam
  2. Observe for signs of focal Trauma
    1. Swelling or Ecchymosis
    2. Deformity
    3. Open wounds
    4. Skin and nails
  3. Palpate bony landmarks (e.g. navicular, lis franc joint, fifth metarsal base, phalanges)
  4. Range of motion
    1. Perform active and passive range of motion
  5. Ambulate the patient
    1. Inability to walk is a red flag for Fracture
  6. Neurovascular exam
    1. Dorsalis pedis pulse, posterior tibial pulse, Capillary Refill
    2. Motor function and Sensation

III. Imaging

  1. Foot XRay
    1. Obtain 3 views (AP, lateral, oblique)
    2. Also obtain Ankle XRay when indicated
    3. Consider dedicated toe xrays as needed
    4. Consider repeat XRay in 5 to 10 days (non-diagnostic first xray)
  2. CT Foot
    1. Consider in non-diagnostic xray, but high suspicion for occult Fracture
  3. MRI Foot
    1. Consider in complicated injuries when ligament or Tendon Injury is suspected

IV. Causes: Common Fractures

  1. Hindfoot Fracture
    1. Calcaneus Stress Fracture
  2. Midfoot Fracture
    1. Lisfranc Fracture Dislocation
    2. Tarsal Navicular Fracture
    3. Tarsal Navicular Stress Fracture
  3. Forefoot Fracture
    1. Metatarsal Fracture (esp. Fifth Metatarsal Fracture)
    2. Metatarsal Stress Fracture
    3. Foot Phalanx Fracture
    4. Toe Fracture

V. Causes: Uncommon Fractures

  1. Hindfoot Fracture
    1. Calcaneus Fracture (high mechanism Fracture such as fall from height)
    2. Talus Fracture
  2. Midfoot Fracture
    1. Cuneiform Fracture (crush injury)
    2. Cuboid Fracture
      1. Crush injury from forced food abduction (nutcracker Fracture)
      2. Chip Fractures, on the other hand, are minor Fractures by comparison
  3. Forefoot Fracture
    1. Sesamoid Fracture

VI. Causes: Stress Fractures

  1. High Risk Foot Stress Fractures
    1. Talar Stress Fracture
    2. Tarsal Navicular Stress Fracture
    3. Fifth Metatarsal Stress Fracture
  2. Low Risk Foot Stress Fractures
    1. Calcaneus Stress Fracture
    2. Cuneiform Stress Fracture
    3. Cuboid Stress Fracture

VII. Management: Foot Fractures requiring urgent or emergent orthopedic Consultation

  1. Lisfranc Injury
  2. Tarsal Fractures (esp. displaced Fractures)
  3. Compartment Syndrome
    1. Seen especially with Calcaneal Fracture
    2. Lisfranc Injury
  4. Open Foot Fracture
  5. Neurovascular compromise

VIII. References

  1. Feden and Kiel (2017) Crit Dec Emerg Med 31(11): 3-10
  2. Orman and Ramadorai in Herbert (2016) EM:Rap 16(12): 8-9
  3. Silver (2024) Am Fam Physician 109(2): 119-29 [PubMed]

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