my foot hurts…
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My foot hurts….
Heather Patterson PGY-2Emergency Medicine
May 31, 2007
Objectives • Review relevant foot boney anatomy• Brief discussion about 3 foot fractures• Practise!
Anatomy
Anatomy
Case • 35M working on roof, falls, lands like a
cat• c/o bilat heel pain and back pain
Case
Case
Calcaneus Fracture
Calcaneus fractures
apex ofanterior process apex of
posterior facet
Posteriortuberosity
Calcaneus Fracture • Mechanism:
– High energy axial load
• Intra or extraarticular
• Associations:– 7% bilateral– 10% spine compression #– 25% other LE injury
Calcaneus Fracture • Imaging:
– Standard AP/Lat foot and ankle views– Axial– +/- CT
• Important distinctions:– Involvement of subtalar joint– Depression of posterior facet
Calcaneus Fracture • Ortho:
– Treatment patterns vary– Intraarticular and comminuted fractures must
be seen
• Outcomes:– Poor outcomes– >50% have loss of ROM, chronic pain, and
functional disability
Case • 32M fell and landed with pointed toes
Case
Talar fractures• Anatomy:
– 7 articular surfaces (60% of surface)
– Regions:• Body • Neck • Head
Talar fractures• Minor talar
fractures:
– HEAD AND NECK:• Avulsion and chip
fractures of superior surface
– BODY:• Lateral, medial,
posterior body AND osteochondral of talar dome
• Require immobilization and referral to ortho for f/u
Talar fractures• Talar neck
fractures– 50% of major talar
injuries.
– Mechanism:• extreme
dorsiflexion
– Hawkins classification
– Often associated fractures
Talar fractures
• Type 1: nondisplaced• Type 2: subtalar subluxation• Type 3: dislocation of the talar body (50% open #’s)• Type 4: dislocation of the talar body & distraction
of the talonavicular joint.
Fracture type influences management & prognosis
Talar fractures• Talar body
fractures
– 23% of all talar fractures
• Ie posterior or lateral process fracture
– Major talar body fractures are uncommon
• usually axial loading
Talar fractures• Talar head
fractures– Uncommon (5-10%)
– Compression transmitted through the talonavicular joint applied on a plantarflexed foot
Talar fractures• Management:
– Major fractures require ortho consult
• Outcomes:– Risk of AVN, OA, and
chronic pain
Case • 18F playing soccer, tripped and twisted
foot• Not sure of how she twisted/landed
Case
Navicular Fracture • Classification:
– Dorsal avulsion• >50% of navicular #s • Eversion injury • Associated with deltoid
ligament injury• Minimal articular
involvement
– Tuberosity Fracture
• Eversion injury• Associated with
posterior tibialis tendon avulsion
Navicular Fracture • Classification:
– Body Fracture• Rare• Axial loading• Comminuted,
intraarticular
Navicular Fracture • Clinical
– Pain on palpation– +/- pain on passive
eversion or active inversion
• Imaging– Standard foot views– +/- bone scan
Navicular Fracture • Why do we care?
– Significant risk of AVN
• Management:– Outpatient Ortho:
• Dorsal avulsion and tuberosity # with minimal articular involvement
• Immobilize 4-6 wks– ED Ortho consult
• Body#, displaced #, >20% of articular surface involved
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