Foot Trauma

Question 1

Calcaneal fracture

• common cause
• accompanying features
• imaging findings
• management

Answer 1

Fall from a height
-associated spinal/pelvic injury

Pain, bruising, swelling

Bohler’s angle - depressed

Depends on severity

• non surgical - PRICE and immobilisation, avoid weight bearing
• surgical fixation

Question 2

Metatarsal fracture

• most common site
• types
• management

Answer 2

Base of 5th metatarsal => symptomatic treatment

Jones
Pseudo-Jones
Lisfranc

Question 3

Jones fracture

• location
• mechanism of injury
• presentation
• importance of recognising this fracture
• management

Answer 3

Transverse fracture at metaphysis diaphysis junction at base of 4th, 5th metatarsal

Acute - rolling over ankle
Stress - repetitive high impact on lateral foot from overuse

Pain on lateral side at metatarsal
Swelling
Difficulty walking

Vascular watershed area => increased risk of nonunion

Management

• non surgical - cast, no weightbearing
• surgical - if pieces are displaced or not healing well

Question 4

Pseudo Jones fracture

• how does this differ from a Jones fracture
• mechanism of injury
• why is this less severe than a Jones fracture

Answer 4

Tuberosity avulsion fracture on 5th metatarsal

Landing awkwardly from a jump

Blood supply from multiple vessels => nonunion less likely

Question 5

Lisfranc fracture

• pathophysiology
• common cause
• presentation
• management

Answer 5

1+ metatarsals displaced from tarsus
-trip over pointed foot, fall on foot, twisting

Pain in midfoot
Swelling, bruising
Weight bearing may be hard

Non surgical - immobilisation
Surgical repair
Physical rehab therapy

Question 6

GENERAL ASSESSMENT FOR LIMB INJURIES

Answer 6

Mechanism of injury
Xray joint, above and below
Assess neurovasculature
Analgesia
Fluids especially in femoral fractures
WATCH OUT FOR COMPARTMENT SYNDROME
Refer to ortho if in doubt