my foot hurts…

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

Practice….

Practice…

Practice…

Practice….

Practice….

Practice….

Practice….

Practice….

Practice….

Practice….

Practice….

Practice….

Practice….