Treatment includes immobilisation with avoidance of weight-bearing.Increasingly common because of snowboarding injuries.Displaced fractures usually require surgical fixation.Non-displaced fractures are treated with a non-weight-bearing short leg cast.It may be associated with subtalar dislocation.This is the most common type of talar fracture: Avascular necrosis and post-traumatic arthritis to the subtalar and tibiotalar joints are unfortunately frequent complications.Prolonged non-weight-bearing and immobilisation are needed.Displaced fractures require open reduction and internal fixation.CT scanning is extremely helpful in diagnosing and treating them. Talar injuries are not easily diagnosed and can create significant long-term disability when missed.Talar fracture is the second most common fracture of the tarsal bones.Falls on to the feet or violent dorsiflexion of the ankle (eg, against car pedals in a car accident) may cause fractures to the anterior body or articular dome of the talus.īone scans, CT scans, MRI and ultrasound may help to diagnose certain foot fractures that are not seen on plain X-rays. A separate review in 2003 suggested that the rules may have a lower sensitivity (93%) when applied to children, but with a reassuringly high negative predictive value of 95%.Inability to take four steps, both immediately after injury and when seen for assessment.Point tenderness over the navicular bone.Point tenderness over the base of the fifth metatarsal.The Ottawa rules suggest that X-rays are required if any of the following are present :.A BMJ review of sensitivity of the rules as a predictor suggested that the tool has an almost 100% sensitivity in adults and children. The Ottawa foot rules help to predict significant midfoot fractures.Other potential complications include non-union, avascular necrosis, compartment syndromes, vascular injuries, post-traumatic ankle deformities and tarsal tunnel syndrome. Any delay in providing adequate specific treatment increases the risk of post-traumatic osteoarthritis. Initial management includes ice, immobilisation and elevation. Stress fractures are common in athletes, and may occur in every bone of the foot and ankle, except the smaller toes. It has been thought that delayed soft-tissue coverage was associated with an adverse prognosis but this was not substantiated in one study. Outcomes are worse if treatment is not immediately initiated, if patients subsequently had neuritis or reflex sympathetic dystrophy, or if patients were involved in ongoing related litigation. Multiple fractures or dislocations of the feet are often initially overlooked in cases of multiple, severe trauma. Severe injuries to the foot can result in significant long-term pain and loss of function. The foot also contains sesamoid bones (bones embedded within a tendon).Forefoot: 5 metatarsals and 14 phalanges.Midfoot: the navicular, the cuboid and 3 cuneiforms.See also the separate articles Painful Foot and Heel Pain.Īpproximately 10% of all fractures occur in the bones of the foot.
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