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INTRODUCTION

Foot injuries are a common presentation in the ED and are frequently missed.1–3 These injuries typically occur in work, athletic, and traffic environments.4,5 Foot injuries can be associated with substantial medical and economic costs.6,7 Sport-related foot and ankle injuries require care so the athlete can return to the demands of the sport as quickly as possible.3 Motor vehicle crash patients with a foot or ankle injury typically have a higher injury severity score than those without such injuries.8 The majority of foot injuries involve fractures of the metatarsals.9

ANATOMY

The foot is divided into three sections: the hindfoot, the midfoot, and the forefoot. The Chopart joint separates the hindfoot from the midfoot. The Lisfranc joint divides the midfoot and the forefoot. The hindfoot is composed of the talus and the calcaneus. The midfoot encompasses the medial, middle, and lateral cuneiforms; the navicular; and the cuboid. The tarsus refers to the bones of the hind and midfoot. The forefoot includes the metatarsals and the proximal, middle, and distal phalanges (Figure 277-1). Ligaments and muscles enable foot movements of eversion, inversion, adduction, and abduction.

FIGURE 277-1.

A. Diagram of normal bony anatomy of the foot. B. Radiograph of normal bony alignment of the foot. [Panel B image used with permission of Robert DeMayo, MD.]

Vascular supply of the foot originates from branches of the popliteal artery: the anterior tibial artery, with its branch the dorsalis pedis supplying the dorsal aspect of the foot; and the posterior tibial and peroneal arteries supplying the sole (Figure 277-2).

FIGURE 277-2.

A. Arteries of the dorsum of the foot. B. Vessels, muscles, and nerves of the sole of the foot and nerves of the sole of the foot. a. = artery; aa. = arteries; n., nn. = nerves; m. = muscles.

The sural, saphenous, peroneal, and lateral plantar nerves innervate the foot for both motor and sensory function and originate in branches from the sciatic and femoral nerves.

CLINICAL FEATURES

HISTORY

Ask about the mechanism of injury and direction of force. Obtain key information, including ability to bear weight after the injury, prior injury or surgery to the area, and any other potential injuries. Because it requires great force to fracture the foot, other injuries can coexist, and foot pain can distract from other serious injuries, or conversely, other injuries can distract from foot pain, leading to a high miss rate of foot fractures in polytrauma patients.5

PHYSICAL EXAMINATION

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