Midfoot and Forefoot Fractures
A fractured foot involved the bones which make up the bulk of the foot. These bones are protected by soft tissue and ligaments so fractures to these areas are very rare. But knowing the types, symptoms, and treatment of a fractured foot is still important, so you're always ready just in case you or somebody you know experience such accident. Scroll down to know more about the types of foot fractures and the broken foot treatment!Fractured Foot: What You Need to Know About Midfoot & Forefoot Fractures
In this article:
- Understanding a Fractured Foot
- Evaluation of Midfoot Fractures
- Classification of Midfoot Injuries
- Treatment of Midfoot Injuries
- Navicular Fractures
- Cuboid Injury
- Tarsometatarsal Joint Injuries
- Forefoot Fractures
- Metatarsal Phalangeal Joint Injuries
Midfoot fractures make up only three to four fractures for every 100,000 population per year. Usually, it is the cuboid bone that is fractured (about 50 percent of the time), followed by the navicular fractures which make up 44 percent of all midfoot fractures.
There are five bones in the midfoot. These include the navicular, the cuboid, the medial cuneiform, the middle cuneiform, and the lateral cuneiform bone. There are multiple long and short ligaments which tie these bones together.
The main mechanism of injury is high energy trauma, which is seen in a motor vehicle accident or motorcycle injury. A fall from a great height, low energy injuries, and dance activities can cause a midfoot injury.
The patient with the midfoot fracture may have a simple limp or may have severe pain, swelling, and a lack of ambulation on the foot. Stress maneuvers of the foot will worsen the pain. Because of the risk of neurovascular injury, the nerve and blood vessel function should be evaluated at the time of the injury and serially thereafter.
X-rays of the front and sides of the foot and oblique views must be undertaken. Weight-bearing views and stress views of the foot should be obtained to pick up occult fractures. A CT scan can be helpful to see non-displaced fractures of the bones of the forefoot while Magnetic resonance imaging (MRI) can pick up ligamentous injuries and other soft tissue injuries of the foot.
A medial stress injury can happen if the midfoot is adducted to the hindfoot. This can cause avulsion fractures of the talus or navicular bone or avulsions of the cuboid or calcaneus bone. There can be severe injuries which cause dislocation of the bones of the forefoot. Some of the midfoot joints can become dislocated in a severe injury.
A longitudinal stress injury can pass forces up from the metatarsals, fracturing the navicular bone. Lateral stress injuries include the “nutcracker fracture” in which there is a lateral force on the forefoot crushing the cuboid bone. Sprains can occur if the force is directed at the plantar region of the foot; avulsion fractures of the navicular, calcaneus, and talus.
If the midfoot is just sprained, a non-rigid dressing can be used with partial weight bearing for 4-6 weeks. The midfoot needs to be immobilized if the sprain is severe. If there is a fracture of the midfoot, then a short leg cast is used with non-weight bearing for up to six weeks.
If there is a high energy fracture with displacement and dislocation, open reduction and internal fixation may be necessary. If the joints are involved, the prognosis is guarded. In cases of cuboid injuries, bone grafting may need to be done to rebuild the cuboid bone. Severe crush injuries require fusion of the bones to restore the arch of the foot.
Post-traumatic arthritis is likely in these types of injury. Sometimes fusion of the bones is necessary to relieve the pain of arthritis.