Anatomical Features and Biomechanics
The foot performs shock-absorbing, balancing, and propulsive functions thanks to its complex structure and the presence of longitudinal and transverse arches. Anatomically, three regions are distinguished:
- Hindfoot: talus and calcaneus.
- Midfoot: navicular, cuboid, and cuneiform bones, which exhibit the least mobility.
- Forefoot: metatarsals and phalanges of the toes.
The most important structures are also the Chopart joint (transverse tarsal joint) and the Lisfranc joint (tarsometatarsal joint).
Hindfoot Fractures
Injuries to the talus occur under axial load and sharp dorsiflexion. Neck fractures are the most common. Due to its blood supply characteristics, they are frequently complicated by avascular necrosis. In children under 16, the posterior process of the talus may be radiologically visualized as a separate bone.
Fractures of the calcaneus typically result from a fall from a height. The tuber-joint angle (Böhler's angle) is of key diagnostic importance: its increase beyond 140–160° leads to arch flattening and serves as an indication for reduction.
Midfoot and Forefoot Injuries
Midfoot fractures (navicular, cuboid, and cuneiform bones) usually have a direct mechanism and are accompanied by a disruption of foot arch strength without significant displacement.
Fractures of the metatarsal bones and phalanges result from direct or indirect impact, as well as crush injuries in children. A characteristic diagnostic sign is Jacobson's sign — increased pain upon pressure on the head of the corresponding metatarsal bone.
Principles of Diagnosis and Treatment
Diagnosis is based on clinical examination and radiological evaluation, for which standard radiographs are usually sufficient.
Treatment tactics depend on the presence of displacement:
- For non-displaced fractures, conservative treatment is used (cast immobilization for 4 to 7 weeks depending on localization).
- For displaced fractures and irreducible fracture-dislocations, surgical intervention is indicated (open reduction, osteosynthesis, or skeletal traction).
- After immobilization is removed, prolonged wearing of custom arch supports (orthotic insoles) plays a key role.
Remembering the three parts of the foot is easier with the rule "H-M-F": Hindfoot (support and heel), Midfoot (stable arch), Forefoot (toes and support during walking).
Class and exam questions
What mechanism is characteristic of talus fractures?
Talus fractures occur with a combination of axial loading and sharp dorsiflexion of the foot, such as when falling from a height onto the feet or during sudden automobile braking.
What does Jacobson's sign indicate in metatarsal injuries?
Jacobson's sign manifests as increased pain in the fracture zone upon axial pressure on the head of the corresponding metatarsal bone.
What are the main complications of neck and body fractures of the talus?
Due to compromised blood supply, avascular necrosis of the talus frequently develops in such fractures.
What else to study on this topic
- Anatomical and biomechanical features of Chopart and Lisfranc joints
- Classification of talus fractures by degree of displacement
- Skeletal traction techniques on the Cherkez-Zade frame
- Long-term consequences of tibial growth plate injuries in children
- Prevention and duration of wearing orthopedic arch supports after foot injuries
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