1. Image Bank: Foot Fractures Image 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

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 MT Unstable 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.

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 fractures Tx: Ice, elevation, NWB, f/u ortho for possible pinning given loose fragment

39. A/P Oblique

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