Foot and toe fractures

Talus

• Neck
  • High risk of avscular necrosis
• Body
  • Delay in dx/tx can lead to non-union or subtalar osteoarthritis

Calcaneus

• If suspect fx order an axial view
• Types
  • Intra-articular (75%)
    • Sclerotic line may be only e/o impacted fracture
    • May only be apparent based on decreased Bohler's angle (<30degrees)
    • Draw line from highest posterior to highest point of calcaneus
    • Draw line from highest anterior to highest point of calcaneus
  • Extra-articular (25%)
    • Anterior process fx is most common (lateral radiograph)

5th Metatarsal

• Avulsion fracture of the tuberosity
  • Due to inversion injury
  • Occurs at insertion of peroneus brevis tendon
  • Do not confuse unfused apophysis with a fracture!
• Jones' Fracture
  • 5th MT fx that occurs within 1.5cm of the tuberosity
    • Lies distal to both the tarso-metatarsal joint and joint between 4th and 5th MTs
  • Often confused with a fracture of the tuberosity
  • Non-union is common; tx with NWB cast

Diagnosis

• x-ray
  • AP, lateral and oblique

Fifth Metatarsal

Jones Fracture

• >1.5 cm from proximal tip pf 5th metatarsal
• transverse
• insertion point of peroneus tertius
• ORIF

Dancer's (Avulsion) Fracture

• <1.5 cm from proximal tip pf 5th metatarsal
• spiral frx
• common in ballet dancers
• mechanism: inversion
• frequently displaced
• treatment
  • mildly displaced frx: heal w/ 6 to 8 weeks w/ short leg cast
  • displaced frxs (3-5 mm) may require ORIF