Broken Foot (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Broken foot facts
- What is the structure of the foot?
- What are the causes of a broken foot?
- Pictures of the bones in the foot
- What are the symptoms of a broken foot?
- When should I call the doctor for foot pain?
- How is a broken foot diagnosed?
- What is the treatment for a broken foot?
- What are the complications of a broken foot?
- Can a broken foot be prevented?
- Find a local Doctor in your town
How is a broken foot diagnosed?
The diagnosis begins with the health care practitioner taking a history of how the injury occurred. The mechanism of injury will give clues as to what type of injury may exist and importantly, what other associated injuries may also be potentially present. It is helpful to know how much time has passed from when the injury occurred to when the patient presents for care. Past medical history is important; those with diabetes or other conditions that suppress the immune system are at greater risk for infection with foot injuries.
Physical examination may include the following:
- Inspection of the foot for swelling, bruising, deformities and open wounds.
- Palpation allows the health care professional to feel where the pain is located. This is very helpful if X-rays are taken, since it allows the health care professional to correlate areas of tenderness with the anatomy seen on the X-Ray. (This is particularly important in children whose bones may not have yet calcified. Fractures may be easily missed since they occur through cartilage instead of bone.)
- An exam of the circulatory system, feeling for pulses, and assessing how quickly blood returns to the tip of a toe after it is pressed and the toe turns white (capillary refill).
- A neurologic exam, assessing sensation such as light touch and pin prick sensations
- Motor function, asking the patient to move the injured area. This assists in assessing muscle and tendon function. The ability to move the foot means only that the muscles and tendons work, and does not guarantee bone integrity or stability.
- A range of motion exam of the foot may be helpful in assessing ligament stability. However, if the fracture is obvious, the health care practitioner may choose to keep the foot immobilized to prevent further pain.
X-rays are often taken to evaluate the status of the bones in the foot and to check for fracture. Usually three views are taken to help the health care professional and radiologist adequately view the bones. Special views may be taken if there is concern for a fracture of the calcaneus.
X-rays may not be taken for simple toe injuries, since the result may not affect the treatment plan.
For some foot fractures, X-rays may not be adequate to visualize the injury. This is often true for metatarsal stress fractures, where bone scans may be used if the history and physical examination suggest a potential fracture, but the plain X-rays are normal.
Computerized tomography (CT) may be used to assess fractures of the calcaneus and talus, since it may better be able to illustrate the anatomy of the ankle and midfoot joint and potential associated injuries. Magnetic resonance imaging (MRI) may be used in some cases of foot fractures.
The Lisfranc joint describes the connection between the first, second, and third metatarsals and the three cuneiform bones. A Lisfranc fracture dislocation often requires a CT scan to evaluate this region of the foot. While X-rays may hint at the damage in this type of injury, the CT can delineate the numerous bones and joints that may be damaged.
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