This document provides images and descriptions of various foot fractures, including: 1) Phalangeal, calcaneal, cuboid, Jones, navicular, and LisFranc fractures. Subtle fractures can be easily missed on imaging. 2) Fracture treatment depends on displacement and stability, ranging from non-weight bearing casts to surgery for displaced or unstable fractures to reduce risk of nonunion. 3) Certain fractures like navicular have a high risk of avascular necrosis and may require open reduction and internal fixation. 4) Multiple fractures in a child should prompt consideration of non-accidental trauma.

1. Image Bank: Foot FracturesImage and Answer

3. 1st and 2nd phalangeal fractures, note the lucency and cortical disruption

5. No fracture, this is a growth plate in a child, note the lack of cortication of the fragment and the multiple ossification centers, indicating this is a young foot.

7. Inverting the image sometimes reveals a subtle fracture, as seen at the base of the 5th metatarsal

10. +Calcaneal fracture, always track your cortical lines for disruptions

11. Dedicated calcaneus film, consider this in pt’s w/ falls or significant heel injuries concerning for a fracture. Mild hyperlucency noted (red arrow, likely calcific Achille’s tendon insertion) and hypolucency (blue arrow) concerning for a subtle fracture.

13. Cuboid fracture, very subtle, easily overlooked

15. Subtle cuboid fracture vsosnaviculare, consider possibility of an avulsion injury 2/2 rupture calcaneocuboid part of the bifurcated ligament should mechanism exist

17. Cuboid fracture, longitudinal plantar ligament avulsion fxTx: NWB splint w/ ortho f/u 2wks for wt-bearing XRays

18. Cuboid fracture, note the hypolucent irregularity (green arrows) with cortical distortion (red arrow)Tx: NWB short leg cast x4-6wks

19. Navicularpseudofracture…this is actually a normal Xray, the hypolucency is actually just as a result of prominent trabeculae, note the smooth cortical rim

21. Cuboid Fracture: Use the lateral films to interrogate the plantar aspect of the cuboid, you can easily miss obvious fractures!

23. Stress Fx/Jones Fx (distal to the insertion of the peroneus brevis and 4th MT groove) Tx: Strict NWB ortho shoe 4-6wks vs possible ORIF (high risk of non-union, usually only indicated for displaced fx)

25. Jones Fx (Zone II), no displacement, so likely no surgery

27. Subtle Stress Fx (Jones Zone iII): Use the lateral films to also interrogate the 5th MT to scan for subtle cortical disruptions (red arrow)

29. Disrupted Jones III Fx: This will need pinning, not today, but soon…call ortho but send home

31. Avulsion PseudoJones (Zone II) fracture of the 5th MTUnstable fracture, will require pinning, strict NWB status until f/u

33. LisFranc Fracture: Mechanism is twisting on a planted foot, falls, severe plantar flexion. Fracture through the proximal MTs or midfoot disruption causes classic “Terry Thomas” sign highlighted here. Isolated fracture type.

34. (left) Lis Franc w/ marked MT disruption and homolateral (all 5 MTs) shiftHomolateral fracture type highly associated with cuboid fractures(below) Isolated LisFranc w/ subtle cortical disruptions noted

36. Multiple new (blue arrows) and a healing (red arrow) distal MT fractures in a child…should consider DCFS call if the story is in question

38. Proximal phalangeal fracturesTx: Ice, elevation, NWB, f/u ortho for possible pinning given loose fragment

39. A/POblique

40. Navicular fracture (blue arrows) with cuneiform fracture (red arrows). Navicularfxs have high incidence of avascular necrosis! Need ORIF!!!