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

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

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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