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Foot injuryAnatomy2468880-2615565Talus: articulates with navicular and calcaneus; no muscular attachmentsMedial column: 1st MT + med cunefiormMiddle column: 2-3rd MT + middle + lat cuneiformsLateral column: 4-5th MT + cuboid Hindfoot: talus + calcaneusChopart jt: hindfoot/midfootMidfoot: med/mid/lat cuneiforms, navicular, cuboidLisfranc: jt between tarsal and metatarsal bones (between midfoot and forefoot)Forefoot: metatarsals and phalanxesTarsus: hindfoot + midfoot00Talus: articulates with navicular and calcaneus; no muscular attachmentsMedial column: 1st MT + med cunefiormMiddle column: 2-3rd MT + middle + lat cuneiformsLateral column: 4-5th MT + cuboid Hindfoot: talus + calcaneusChopart jt: hindfoot/midfootMidfoot: med/mid/lat cuneiforms, navicular, cuboidLisfranc: jt between tarsal and metatarsal bones (between midfoot and forefoot)Forefoot: metatarsals and phalanxesTarsus: hindfoot + midfootOttawa Foot RulesPain in mid-foot + inability to WB (4 steps) immediately and in ED Tender base 5th metatarsal / navicular100% sens, 79% spec for clinically significant midfoot fracturesXR3954780107950AP: Med border 2nd MT lines with medial border middle cuneiformOblique: Med + lat border 3rd MT lines with med + lat border lat cuneiformMed border 4th MT lines with med border of cuboidLateral:MT should never be more dorsal than respective tarsal boneAP: Med border 2nd MT lines with medial border middle cuneiformOblique: Med + lat border 3rd MT lines with med + lat border lat cuneiformMed border 4th MT lines with med border of cuboidLateral:MT should never be more dorsal than respective tarsal boneTalar #2468880147320Neck and body #: neck most common (ie. 50%); due to forced dorsiflexion; assoc with subtalar dislocations, AVN; neck and head # require OT ASAPHawkin’s classification: I non-displaced; no incongruity of subtalar joint; AVN in 10%II displaced; ankle jt OK (may be subluxation of subtalar jt – distal talus and rest of foot while prox talus stays OK); 30- 50% risk of AVNIII displaced; dislocation of talus from ankle and subtalar jt (head goes ant, body goes post-medially, tibia goes between); AVN in 90%; reduce ASAPNeck and body #: neck most common (ie. 50%); due to forced dorsiflexion; assoc with subtalar dislocations, AVN; neck and head # require OT ASAPHawkin’s classification: I non-displaced; no incongruity of subtalar joint; AVN in 10%II displaced; ankle jt OK (may be subluxation of subtalar jt – distal talus and rest of foot while prox talus stays OK); 30- 50% risk of AVNIII displaced; dislocation of talus from ankle and subtalar jt (head goes ant, body goes post-medially, tibia goes between); AVN in 90%; reduce ASAPTalar dome (ie. Plateau) #: difficult to detect; consider in non-healing sprain; OT if displacedLateral process #: OTPost process #: Shepherd’s #, dancers and kickersPicon #: due to talus being forced into tibial metaphysis (eg. Fall from height); OTSubtalar dislocationMay be mistaken for ankle dislocation; foot inverted and internally rotated; often assoc with talar #; difficult to reduceCalcaneal #212598097155Most common #’ed tarsal bone; assoc with other leg inj in 25%, vertebral # in 10%, also with pelvic; 75% intra-articular; bilateral in 7%; risk of compartment syndrome; can also get avulsion #’s off ant process and lat calcaneum; 50% get chronic painMOI: fall from heightBohler’s salient angle: post tuberosity to highest midpoint / ant tuberosity to midpoint; normal = 20-40deg; # if <20degMng: conservative if non-displaced and extra-articular; all need admissionMost common #’ed tarsal bone; assoc with other leg inj in 25%, vertebral # in 10%, also with pelvic; 75% intra-articular; bilateral in 7%; risk of compartment syndrome; can also get avulsion #’s off ant process and lat calcaneum; 50% get chronic painMOI: fall from heightBohler’s salient angle: post tuberosity to highest midpoint / ant tuberosity to midpoint; normal = 20-40deg; # if <20degMng: conservative if non-displaced and extra-articular; all need admissionNavicular #Rare; usually dorsal avulsion #; due to eversion inj; assoc with deltoid lig inj; risk of AVN; ortho review if displaced, intra-articular or comminutedLisfranc’s # / dislocation1668780107950Most common midfoot #MOI: high speed MVA; maybe rotational trauma; hyperextension of forefoot on midfoot dorsal dislocation at tarsoMT jt; may # 1st cuneiform and 2nd MT; # midfoot in 40%; Lisfranc lig runs from lat base medial cunieform to medial base of 2nd MTOE: may look normal; pain on passive movement / torsion of forefoot/midfoot with hindfoot heldXR: doesn’t line up as above; may need WB’ing views; bony displacement >1mm = unstable; need CT to see properly; should be <1mm between 1st and 2nd MTClassification: horizontal (all 5 MT’s move); partial / isolated (1 or 2 move); divergent (1st MT moves medially, others laterally)Mng: ortho review; maybe conservative if undisplaced; OT if displacedComplication: dorsalis pedis artery compression / laceration; reflex sympathetic dystrophy; ongoing pain and disability; compartment syndrome if significant injMost common midfoot #MOI: high speed MVA; maybe rotational trauma; hyperextension of forefoot on midfoot dorsal dislocation at tarsoMT jt; may # 1st cuneiform and 2nd MT; # midfoot in 40%; Lisfranc lig runs from lat base medial cunieform to medial base of 2nd MTOE: may look normal; pain on passive movement / torsion of forefoot/midfoot with hindfoot heldXR: doesn’t line up as above; may need WB’ing views; bony displacement >1mm = unstable; need CT to see properly; should be <1mm between 1st and 2nd MTClassification: horizontal (all 5 MT’s move); partial / isolated (1 or 2 move); divergent (1st MT moves medially, others laterally)Mng: ortho review; maybe conservative if undisplaced; OT if displacedComplication: dorsalis pedis artery compression / laceration; reflex sympathetic dystrophy; ongoing pain and disability; compartment syndrome if significant injBase 5th MT166878062865Following inversion inj; usually extra-articularTuberosity / styloid #: are prox to jtJones fracture: transverse # base 5th MT 1.5-3cm distal to prox tubercle; intra-articular (intermetatarsal jt between 4th + 5th MT’s); 35-50% non-union rate; OT if >30% articular surface / >2mm displacement (otherwise POP)Pseudo-Jones fracture: avulsion of peroneus brevis tendon (tuberosity); usually non-dispaced; POPDiaphyseal stress #Following inversion inj; usually extra-articularTuberosity / styloid #: are prox to jtJones fracture: transverse # base 5th MT 1.5-3cm distal to prox tubercle; intra-articular (intermetatarsal jt between 4th + 5th MT’s); 35-50% non-union rate; OT if >30% articular surface / >2mm displacement (otherwise POP)Pseudo-Jones fracture: avulsion of peroneus brevis tendon (tuberosity); usually non-dispaced; POPDiaphyseal stress #Phalanx #Buddy strap; OT if gt toe + unstable / intra-articularMT #If >3-4mm displacement or >10deg angulation, require OT ................
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