Fractures of the talus and calcaneus are uncommon in children
Fracture of the talar neck occurs most frequently in hindfoot fractures of children and may be complicated by osseous necrosis – these should be referred to the Orthopaedic Team
Intra-articular fractures of the calcaneus should be referred to the Orthopaedic Team
Minimally displaced talar and non intra-articular calcaneal fractures are managed in a below knee plaster backslab and followed up in the Orthopaedic Fracture clinic in 7 days.
Fracture of neck of talus
Talar dome fracture – looks simple on plain X ray but CT shows multiple intra-articular bony fragments.
Fractures of the navicular, cuboid, cuneiform and tarsometatarsal junction (Lisfranc) are rare in children and are usually seen in combination with other foot fractures
Be wary of compartment syndrome in major midfoot fractures
Avulsion fractures of the navicular or cuboid are managed in a below knee plaster backslab and followed up in the Orthopaedic Fracture clinic in 7 days.
Tarsometatarsal fractures (Lisfranc) and complex fractures should be referred to the Orthopaedic Team.
Minimally displaced fractures of the metatarsals are managed in a non-weight bearing below knee backslab and followed up in the Orthopaedic Fracture clinic in 7-10 days.
A cam boot may be suitable for undisplaced shaft fractures of the 1st to 4th metatarsals
Displaced or multiple metatarsal fractures should be discussed with the Orthopaedic Team
Avulsion fracture at the base of the fifth metatarsal (insertion of peroneus brevis) is a relatively common fracture in children. These are immobilised in a CAM boot with Orthopaedic Fracture clinic follow up in 7 days. Differentiate avulsion fractures of the base of the fifth metatarsal with Jones fractures which involve the 4th and 5th intermetatarsal joint – these are managed in a below knee backslab with Orthopaedic Fracture clinic followup.
The degree of soft tissue injury is often more important than the fracture in phalangeal fractures
Compound fractures, proximal phalanx and intra-articular fractures of the great toe should be referred to the Orthopaedic Team.
Proximal phalangeal fracture of the great toe should be immobilised in a Darco Shoe, non-weight bearing and followed up in Orthopaedic Fracture Clinic
Other phalangeal fractures can be managed with buddy strap and Darco walking shoe or sturdy shoes and do not require specific follow up
Dislocations of the phalanges can be reduced in the Emergency Department and buddy strapped. No specific follow up is required.
Minimally displaced oblique fracture of 5th metatarsal
Fracture of base of 5th metatarsal following inversion injury
Fractures of distal 2nd-4th metatarsals
Angulated Salter-Harris II fracture of 5th proximal phalanx
Dorsally displaced transverse fracture of neck of 3rd proximal phalanx
Fractures of Foot Requiring Urgent Orthopaedic Referral
Hindfoot (talar and calcaneal) fractures
Midfoot fractures (Lisfranc injury)
Referrals and follow-up
Simple phalangeal fractures and dislocations require no specific follow up
Other foot fractures should be followed up in the Orthopaedic Fracture clinic in 7-10 days. See Outpatient Clinics.
All children who have a plaster placed should have a plaster check at 24 hours. They can return to the Emergency Department to be assessed by the triage nurse.