Foot Injuries

Question 1

Calcaneal fractures are usually associated with which type of situation?

Answer 1

Fall from height

Question 2

Calcaneal fractures can be extra-articular or involve which joint?

Answer 2

Subtalar joint

Question 3

If there is a calcaneal fracture, the heel tends to drift into which position?

Answer 3

Valgus

Question 4

Due to the valgus drift after a calcaneal fracture, which problems arise with the lateral ankle tendons?

Answer 4

Impingement

Question 5

What is the main treatment for calcaneal fractures and why is this controversial?

Answer 5

ORIF

May be difficult to achieve skin coverage, wound healing issues especially if a smoker, diabetes etc.

Question 6

Fractures of the talar neck usually occur in which scenarios?

Answer 6

Forced dorsiflexion of foot from rapid deceleration

Question 7

If a talar neck fracture is displaced, what does it involve?

Answer 7

Subluxation of the subtalar joint

(there may also be dislocation of the talar body from the ankle joint or the head of the talus from the talonavicular joint in high energy injuries)

Question 8

Where does the talus get its blood supply?

Answer 8

Anastomosis involving the peroneal, anterior tibial, and posterior tibial arteries

The artery of the tarsal canal is the most vital artery within the anastomosis

Question 9

Displacement, fracture, subluxation or dislocation of the talus all pose a serious risk of what?

Answer 9

AVN

Question 10

What is the treatment of displaced fractures of the talus?

Answer 10

Closed or open reduction and screw fixation

Question 11

What is a Lisfranc fracture-dislocation?

Answer 11

A fracture at the base of the 2^nd metatarsal is associated with dislocation of the base of the 2^nd metatarsal

(with or without dislocation of other metatarsals at the tarso-metatarsal joints)

Question 12

How will a patient typically present with a Lisfranc fracture-dislocation?

Answer 12

1. Grossly swollen foot
2. Bruised foot
3. Unable to weight bear
4. Normal x-ray (if so, get a CT)

Question 13

What is the treatment for a Lisfranc fracture-dislocation?

Answer 13

Open or closed reduction with fixation using screws

Question 14

Which metatarsal is most commonly fractured?

Answer 14

5^th

Question 15

What is a Jones fracture?

Answer 15

Fracture in the proximal diaphysis of the 5^th metatarsal

Question 16

Why is a Jones fracture more serious than a fracture at the base of the 5^th metatarsal?

Answer 16

1. There is relatively poor blood supply
2. Risk of non-union is higher

Question 17

What is the treatment for a Jones fracture?

Answer 17

1. Displaced - fixation, usually a single screw
2. Non-unions - bone grafting and fixation

Question 18

The 2nd metatarsal is a common site for a ______ fracture

Answer 18

The 2nd metatarsal is a common site for a stress fracture

Question 19

How may a fracture of the 2nd metatarsal typically come about?

Answer 19

1. Spontaneously
2. After a period of increased exercise

Question 20

Why is diagnosing a stress fracture of the 2nd metatarsal difficult?

Answer 20

Not visible on X-ray until healing/callus has started

(bone scan may aid in the diagnosis)

Question 21

Intra-articular toe fractures require which treatment?

Answer 21

Reduction and fixation if the fragments are sizeable

Open fractures can be stabilised with wires

Question 22

How can toe dislocations be treated?

Answer 22

Closed reduction and either neighbor strapping or wiring