Marginal fracture of the lateral cuboid. Fractures of the bones of the foot (scaphoid and cuboid). Tibialis posterior tendonitis

Foot fractures account for 2.5% to 10% of all trauma cases. It can happen as a result of a direct impact or be caused by an indirect injury, for example, an unsuccessful jump, a twist of the foot, or a fall. Such injuries require huge attention, since there is a high dependence between all elements of the foot. As a result, there may be subsequent problems associated with abnormal support on the injured leg, the development of a flat foot resting on the entire sole of the foot, without a notch, and grade 2 arthrosis.

If you remember the anatomy course, the foot includes 26 bones that are interconnected through joints and a large number of ligaments. It has 3 sections, including the tarsal and metatarsal and digital phalanges of the lower limb. The tarsus combines the calcaneus, talus, and cuboid bones. This section also includes the navicular bone of the foot and 3 wedge-shaped bones.

In the central region, the talus bone is connected to the bones of the lower leg. Away from the central part of the bone, the tarsal region is connected to the bones of the metatarsal, which form joints together with the phalanges of the fingers.

A foot fracture can be:

toes;
metatarsal bones;
tarsal bones, including fracture cuboid bone foot and navicular.

There is another classification:

Whole or partial disruption of the integrity of the bones, accompanied by displacement, which most likely can occur due to strong lateral pressure on the foot. As a result, bones and bone fragments change their position. Displacement contributes to difficulties in therapy.
Whole or partial violation of the integrity of bones without displacement. This happens as a result of a fall from a height. This can also happen due to something heavy falling. A non-displaced fracture is much easier to treat.
Whole or partial violation of the integrity of open bones, during which soft tissue injury occurs.
A closed foot fracture is not characterized by soft tissue injury.

If it so happens that a person witnesses a fracture of the bones of the foot, then he must have the knowledge to help the victim until the ambulance arrives. First of all, it is necessary to ensure immobility so that the injured leg is at rest. This can be done by bandaging a splint, the role of which will be performed by any plank, to the injured leg. After the patient is taken to the hospital, he will already be provided with qualified medical care.

If we talk about general manifestations, then in this case the patient may feel painful sensations. In this case, swelling of the tissues close to the site of damage is observed.

In addition to the above, experts identify the following signs of a foot fracture in the metatarsal region:

foot deformity;
appearance pain syndrome when palpating and when trying to lean on the affected limb;
swelling of the plantar side of the foot.

As for the injury of the digital phalanges, the signs of a foot fracture combine the following:

the appearance of hematomas;
soreness in active state and when groping;
swelling and cyanosis of the injured finger.

Symptoms of a tarsal limb fracture include:

the appearance of hematomas in damaged areas of the epithelium;
excessive pain when trying to lean on the sore leg;
excessive accumulation of fluid in the soft tissues around the ankle and at the site of injury.

A foot fracture has the following symptoms:

visually noticeable swelling of the entire foot;
excessive foot deformation;
severe pain on the injured area.

For a fractured foot, treatment depends on the location of the injury, and any actions and manipulations must be prescribed by a doctor. If there is a displacement on the face, then urgent medical procedure, in which bone fragments are compared for better fusion. Do not forget that if this procedure is delayed, then over time the comparison of bone fragments becomes difficult or completely impossible. If a closed medical procedure to compare bone fragments is unsuccessful, then the doctor prescribes either open reduction or skeletal traction.

In case of a fracture of the process in the back of the foot, a cast must be applied for 2-3 weeks. In other cases, the patient is forced to walk with a cast for 4-5 weeks. Starting from 3-4 weeks, you should remove the injured leg from the splint and do active movements ankle

Next, the patient is recommended medical treatment physical culture, massage courses and physiotherapeutic treatment. The patient is able to restore his ability to work no earlier than after 2.5-3 months. In order to prevent the development of traumatic flat feet, it is advisable to use special arch supports.

As for a fracture of the navicular bone of the foot, it is typical for direct injury, for example, if something heavy falls on the leg. Quite often this is observed with lesions of other bones of the foot.

In such a situation, the specialist uses a circular plaster cast. In this case, the arches of the foot must be carefully modeled, as with a displaced fracture. If the resulting bone fragments cannot be reduced, the doctor resorts to open reduction. The traumatologist fixes the plaster cast for 4-5 weeks.

In case of fractures of the cuboid or sphenoid bones, the doctor applies a plaster cast for 4-5 weeks. Afterwards, the instep support should be used for 1 year or more. If you pay attention to injuries of the metatarsal bones, they are the champions among all possible types fractures in this area.

In case of a fracture of the metatarsal bones without displacement, the patient is given a plaster splint for 3-4 weeks. If this occurs with displacement, then the bones are realigned or skeletal traction, which is fixed for up to 6 weeks. Then a cast with a heel is applied to the foot. Subsequently, orthopedic insoles are recommended.

In case of a fracture of the phalangeal bones without displacement, the patient needs a back splint made of plaster. In case of displacement, closed bone reduction is indicated. After this, the bone fragments are fixed with knitting needles. In case of a fracture of the nail phalanx without displacement, the traumatologist immobilizes the injury using an adhesive bandage. Depending on the complexity of the injury, the period of fixation can vary from 4 weeks to one and a half months.

If it happens that the bones of the foot have healed incorrectly after a fracture, then an operation is performed to arthrodesis or connect the two bones that form the joint. Moreover, such surgical intervention is performed on several joints at the same time.

In rare cases, such surgical intervention Complications may develop, which may include:

introduction of infectious diseases;
bleeding;
the need for repeated surgical intervention arises;
inability to connect joints;
damage to nerve endings.

As a rule, such complications can occur due to the patient’s smoking or the presence of any chronic pathologies.

Postoperative care after an arthrodesis procedure is no different. The patient's limb will be in plaster for 4 months.

The recovery period directly depends on the duration of wearing the splint and the complexity of the injury. If there is a fracture of the bones of the metatarsal part of the foot, then experts recommend exercise therapy, but in a gentle mode (2 months). Sometimes swelling of the foot may occur. If there is a displacement of the bones in the cast, then it is replaced with a version with a heel; the patient will wear it for several more weeks. After the traumatologist removes the plaster, the patient is recommended to use orthopedic insoles.

If a fracture of the tarsal bones occurs, this requires a longer recovery period. In this case, courses of therapeutic massage, physiotherapy, physical exercise in a gentle mode and the use of arch supports. Within 2-3 months, the patient should carry out all necessary measures under the supervision of a doctor, while instep supports should be used for a whole year.

If the bones of the phalanges of the foot are fractured, the patient must undergo a course of kneading massage every day. It is recommended to wear orthopedic shoes for at least 5 months.

In addition to the measures listed above, during the rehabilitation period, the patient’s diet should be reviewed in consultation with the attending physician. A special diet allows you to ensure that the patient’s body is saturated with the appropriate microelements and vitamins, which will speed up the healing process of the foot.

Every person knows from an early age that for strong bones one should consume foods enriched with calcium. Examples would be dairy products, cabbage, sardines, etc. To speed up the healing process, the body needs calcium and zinc. They are found in large quantities in seafood, wholemeal bread products, bananas, pumpkin seeds, etc. Dairy products in addition to everything they combine vitamin K, which speeds up the healing process bone tissue. It is also necessary to give preference to foods rich in protein. In addition, do not forget about such a product as cottage cheese.

A fracture of the foot bones can happen in the most unexpected place. In order to protect yourself, you should adhere to safety rules that will help protect each of us from the most serious consequences.

In case of a fracture, you should contact a traumatologist who will prescribe the necessary therapeutic procedures. The patient must follow all the doctor’s recommendations during the rehabilitation period to ensure restoration of the foot’s functionality. At the same time, no one canceled the regime and healthy eating.

In any case, if you seek medical help in a timely manner and if you follow all the recommendations of the attending physician, the patient will be able to achieve a quick cure and eliminate possible complications.

Foot sprain: treatment, causes, symptoms, what to do when sprained

No person is immune from various damages and injuries. A sharp wrong turn or movement - all this can cause a bruise or a fall. The heaviest load falls on the ligaments of large joints, which is why they suffer more often. One of the most common types of injuries is a sprained foot.

You can twist your leg when jumping, running, or simply walking on ice. It is easier, of course, to prevent such an injury. But if it does happen, you need to know what to do in such a situation, what to do and how to provide first aid. Your future condition will depend on your first actions. The faster and most importantly, the more correctly you act and react, the sooner the limb will heal.

What are the causes of foot sprains?

There are actually many reasons for this type of leg injury. However, before we begin to consider them, I would like to clarify one important nuance. The term for this type of injury, “strain,” is not entirely accurate. The fact is that the ligaments are equipped with several types of fibers. They are responsible for providing ligaments with strength and elasticity. None of the types of fibers can increase more than is provided by physiology. Therefore, what we used to call stretching is actually a rupture of fibers.

The main cause of foot sprains is excessive tension on the ligaments. Such injuries are more classified as domestic injuries than sports injuries. Stretching can be caused by:

previous injuries such as intra-articular fracture, dislocation, or sprain;
overweight;
constant load on the joints when carrying heavy objects, during sports, or during long walking;
flat feet or enlarged arches of the foot;
instability of the foot due to arthrosis changes.

In addition to athletes, those most susceptible to this type of injury are people with obesity, pathologies of the musculoskeletal system, and ankle diseases.

Symptoms

There are several degrees of foot sprain. The first is fiber rupture against the background of the overall structural integrity of the tissue. In this case, complaints are received about the appearance painful sensations. Symptoms often manifest themselves in the form of slight swelling.

The second degree is characterized by multiple breaks with partial damage capsules. The main symptoms include: moderate swelling, hemorrhages, intense pain, and the inability to lean on the affected foot.

The third degree is a complete sprain of the foot ligaments. There are complaints about following symptoms: intense pain and bruising.

The first and second degree of foot stretching is amenable to drug therapy. After about half a month, complete recovery occurs. Treatment of a sprained ligament is a labor-intensive and lengthy process and often requires surgery, because the foot ligaments themselves will not be able to recover and heal.

How to recognize a sprain by external signs, watch this video:

So, stretching is characterized by the following symptoms:

More details

pain syndrome varying degrees intensity;
hemorrhage;
swelling of the foot;
local increase in temperature;
inability to lean or stand on the affected limb.

Regardless of the type of injury (sprain, dislocation, fracture), the effectiveness of further treatment of the ligaments will depend on how correctly and timely first aid was provided.

It is important not so much to identify a sprain as to be able to distinguish this type of injury from others, for example, a fracture or dislocation. The symptoms of these injuries are actually similar. Painful sensations, as well as impaired movement, increase gradually.

If you suspect a ruptured foot ligament, immediately seek help from a traumatologist. Timely and appropriate treatment will contribute not only to a speedy recovery, but also to prevent the development of complications.

When stretched, intense pain and hyperemia of the affected area always appear. When you touch the injured area, there is an increase in pain. When the ligaments of the foot are sprained, swelling and swelling are also observed.

After some time, the symptoms become more pronounced. The formation of a hematoma and a local increase in temperature are noted. Due to severe pain, there is limited mobility in the foot.

The main signs that will help you distinguish a sprained ligament from a bone fracture include:

increased pain at night;
the average duration of swelling is three days;
limited movement of the foot;
palpation under the skin of a painful pit, which is a place of stretching.

First aid for sprains

As already mentioned, it was the correct and timely delivery of urgent Care will help reduce the consequences, prevent the development of complications and speedy recovery.

Treatment of ligamentous injury should begin immediately after injury. So, the main areas of pre-medical care that need to be provided at home include:

functional rest;
immobilization;
applying a cold compress;
elevation of the limb position;
minimizing pain.

Damaged ligaments need complete rest. It is strictly not recommended to move the limb after a sprain for two to three days. Any movement can cause further damage to the ligaments of the foot. And this will lead to aggravation of the patient’s condition and a worsening prognosis. Only after three days can you gradually begin to move the injured limb.

Prolonged immobilization of the foot can provoke atrophy of muscles and ligaments, and this can lead to a decrease in the range of motion in the future. The main guideline in this case is pain. If you feel them, limit your movements.

Second phase pre-medical treatment at home - immobilization ankle joint. In this case, it is necessary to bandage the foot with an elastic bandage. Instead of a bandage, you can use special orthopedic bandages for the feet - orthoses. They help minimize pain, swelling, as well as prevent the development of complications and prevent bleeding with the formation of hematomas.

How to properly bandage a foot if the ankle ligaments are damaged, watch the video:

You also need to use an elastic bandage wisely. Do not bandage too tightly, as this can cause circulatory problems. Before going to bed, the elastic bandage must be removed.

Immediately after a foot sprain, it is recommended to apply ice or cold compress. This will help narrow the blood vessels at the site of injury, reducing pain, swelling, and inflammation. The compress is applied for a quarter of an hour during the first four hours after injury to the limb.

The foot must be given an elevated position. To do this, simply place a cushion or pillow under it. This will help improve venous outflow blood, reducing pain and swelling.

If previous measures are ineffective (if the patient complains of severe pain), give the victim a painkiller before the doctor arrives. Remember, first aid should be provided quickly, since this will determine your well-being and general state patient.

What not to do

It is equally important to know what not to do when you sprain your foot, at least during the first three days. It is strictly not recommended to use heat for this type of damage. The use of warm compresses, hot baths, or dry heat can harm the victim. Should not be used folk remedies. Assign application unconventional means Only a specialist can.

It is prohibited to drink alcoholic beverages. This will provoke an increase in swelling, as well as a worsening prognosis. Moreover, treatment in this case may simply be ineffective.

Many people believe that the limb heals faster if massage is performed. It is indicated only in the recovery period. Massage during therapy will make the situation worse.

Treatment of foot sprains

Only a qualified specialist can cure a sprained foot ligament, as well as distinguish a ligament rupture from a fracture. Often, treatment for mild sprains is conservative. In this case, the patient is not hospitalized. This type of injury can be treated at home. The main thing is to follow all the instructions of the attending physician.

As a rule, the use of drugs for local and internal use is prescribed:

non-steroidal anti-inflammatory and analgesic drugs: Diclofenac, Meloxicam, Indomethacin;
cooling agents, for example, Chlorethyl;
anesthetics, such as Benzocaine;
warming preparations (during the recovery period): ointments based on snake or bee venom;
antibiotics: Penicillin, Amoxicillin;
agents that help improve venous outflow: Troxevasin, Lyoton.

In order to speed up the process of tissue regeneration, the use of vitamin B and ascorbic acid is prescribed. Physiotherapy plays an important role in the treatment of foot sprains. Prescribed use: electrophoresis, UV irradiation, magnetic therapy.

Only a specialist can treat the disease. Check with your doctor about how much you need to take this or that drug. Moreover, do not use folk remedies without his knowledge. Traditional treatment may be ineffective, moreover, it may harm you.

Surgery

If treatment of the disease with medications is ineffective, surgery is prescribed. The choice of technique is made by a specialist after examining the patient and assessing the severity of the sprain. Often, reconstructive plastic surgery is performed on the ligaments of the foot, during which an implant is implanted into the damaged area.

The success of the operation largely depends on the recovery period. In order to restore the functioning of the ankle joint (ligaments, muscles), massage, therapeutic exercises, electrophoresis, magnetic therapy, laser therapy, ultrasound treatment, paraffin and ozokerite therapy. Remember, a speedy recovery depends not so much on the prescribed therapy, but on following all the instructions and recommendations of the attending physician. On full recovery It will take six months for the foot (ligaments and muscles) to function after surgery.

Treatment of joints Read more >>

Never try to treat a sprained foot on your own. You are unlikely to be able to cure the pathology with an elastic bandage or inappropriate use of drugs alone.

Complications of a sprain

Ignoring the symptoms of the disease and inappropriate use of drugs can cause complications. These are: disruption of the motor mechanisms of the joint due to improper fusion of ligaments; systemic inflammation due to open wound and penetration of infection into the bloodstream; inflammation in the cartilage, bones and soft tissues of the joint or periarticular area.

If you start treating the disease in time, the development of such complications can be prevented.

How to strengthen foot joints and prevent various diseases related to this, they tell in the “Health Line” program:

Fractures of the bones of the foot often account for a tenth of all fractures. The cause of their occurrence is not only direct injuries, but also unsuccessful landings on the foot, its twisting, and various falls.

For fractures of the navicular or cuboid bones of the foot, complex treatment and an appropriate period of rehabilitation are recommended, since a change in the shape of any of them can lead to a disruption in the shape of the entire foot and its basic functions.

Bone Anatomy

There are about 26 bones in the foot, connected to each other by the ligamentous-articular apparatus. It is customary to distinguish the following main departments:

metatarsal;
tarsal;
phalanges of fingers.

The sphenoid bone and navicular bone are located in the tarsal region, forming this section together with the calcaneus, talus and three wedge-shaped bones.

The navicular bone is located closer to the inner edge of the foot. At the back it connects with the talus bone, and at the front with the three sphenoid bones. on her bottom surface there is a concavity, and on the outside there is a characteristic lumpiness, which can be easily felt through the skin.

The cuboid bone gets its name from its irregular cube shape. It has a connection with the navicular bone, one of the sphenoid bones, the calcaneus and metatarsal bones (fourth and fifth). There is a noticeable groove and irregularities on the surface.

The navicular and cuboid bones bear the supporting load when walking, taking a direct part in it. A fracture of any of them entails a loss of motor activity, which can persist for a long period of time, especially with incorrect treatment tactics. It is important to seek prompt medical attention for any injuries.

Scaphoid fracture

Among all the causes of scaphoid fractures, the main one is the fall of heavy objects on the outer surface of the foot.

Professional athletes suffer from such fractures due to intense contractions of the tibialis muscle during exercise. This leads to the separation of the bone fragment that is attached to this muscle.

Other reasons include:

injuries arising from forced intense flexion of the plantar part of the foot, resulting in pinching of the navicular bone between the sphenoid bones and the talus;
Road accident - the cause of the fracture is compression;
unsuccessful landing after jumping or falling from a height;
stress fractures - occur among ballet dancers, professional athletes and gymnasts due to prolonged high loads on the foot, entailing restructuring of bone structures.

As a result of the injury, fractures of the scaphoid bone in the area of its dorsal part, body or tubercle are possible. Often in back side of the foot, bone fragments are displaced.

The following symptoms are typical:

the occurrence of pain and swelling in the area of the suspected fracture, often extending to the ankle joint;
bone fragments are well palpated under the skin (if displaced);
the support function suffers, the victim can only lean on the heel;
movement of the foot up and down and left and right is impossible.

X-ray examination helps to establish an accurate diagnosis, after which appropriate treatment is prescribed.

Important! It is necessary to differentiate tubercle avulsion from the presence of a congenital additional scaphoid bone, which occurs in some people and is not considered a pathology. In this situation, x-rays of both feet are needed because accessory structures are usually found on both sides.

Cuboid fracture

The cuboid bone is not prone to fractures. This usually happens when there is a joint fracture with other bones of the foot due to heavy objects falling on the foot, an unsuccessful landing, or a fall on the feet from a height.

Typical symptoms include:

pain that gets worse when you try to move your foot;
swelling on the dorsal inner surface of the foot;
inability to fully lean on the foot;
palpation reveals a characteristic deformation (indicating displacement of bone fragments).

X-rays are crucial in making an accurate diagnosis.

Important! Fractures of the cuboid or scaphoid often cause damage to the surrounding soft fabrics. To identify all damage, in some cases, computer or magnetic resonance imaging is prescribed.

Treatment options

When fractures of the scaphoid or cuboid bones are not accompanied by displacement of fragments, a traumatologist applies a plaster cast (circular).

Modeling of the lower arch of the foot is necessary. When a bandage in the form of a “boot” is applied, a metal instep support is additionally installed, which is necessary to prevent flattening of the arch of the lower limb.

When bone fragments are displaced, reposition is required under intraosseous anesthesia or intravenous anesthesia. Dislocation and fracture of the scaphoid bone requires the installation of a special design, Circassian-zade, when one wire is passed through calcaneus, and the other passes through the metatarsal bones (their heads).

In severe cases, surgical treatment is performed, after which it is necessary to wear plaster cast Not less than a month. To control dynamics they do x-rays. It is necessary to understand that everything bone structures in the foot are interconnected, so it is necessary to completely restore the fracture site.

Important! In the case of comminuted fractures, sometimes it is not possible to completely collect and fix all the fragments, which entails the need for partial removal of the bone and subsequent filling with a bone graft. This can be done by a section of the tibia or artificial materials.

Possible complications

Failure to promptly contact a medical facility or failure to comply with all the instructions of the treating doctor in case of a fracture of the cuboid or scaphoid often leads to complications.

These include:

appearance of lameness;
presence of chronic pain syndrome;
the occurrence of flat feet or flattening of the sole;
manifestations hallux valgus forefoot;
loss of ability to work.

At surgical treatment the consequence may be shortening of the foot, and in the most severe cases, disability is often given.

To prevent the development of the listed complications, it is necessary to follow all the recommendations of the orthopedic traumatologist and complete the full course rehabilitation measures.

Rehabilitation

After applying a plaster cast for fractures of the cuboid or scaphoid bones, it is recommended to rest the leg for a week, after which you can proceed to rehabilitation. Loads in the presence of multiple fractures are possible only after a month and a half.

Important! The main goal of all rehabilitation measures is to restore the anatomical integrity of the bones of the foot and normalize its spring functions. This is necessary to soften repulsion and protect internal organs from various sharp shocks while walking and shocks when jumping or running.

Rehabilitation includes several activities.

Massage

Necessary for restoring adequate blood supply, tissue nutrition and preventing the development of muscle atrophy. Performed at the most early stages, before removing the cast from the leg. Helps relieve swelling and pain.

It is important to massage not only the injured limb (around and under the plaster cast), but also the healthy one, since the load on it increases.

After removing the cast, massage helps restore mobility to the leg, eliminate residual signs of atrophy, and restore muscle tone and elasticity.

Transverse and longitudinal stroking, rubbing and vibration are performed. All massage movements alternate with regular stroking.

Physiotherapy

Performed in conjunction with massage, it helps relieve pain and swelling. The most commonly prescribed procedures are magnetic therapy, electrical stimulation, interference currents, electrophoresis and UHF.

Exercise therapy

Physical exercises while wearing a cast are necessary to improve blood circulation; exercise increases the tone of the whole body.

During this period, simple flexion and extension with the fingers, movements in the area of the hip and knee joints, and pressure on the surface of the sole with the help of a support or the hands of an assistant are sufficient. Contractions of the muscles of the sole and walking with the help of crutches will be useful.

The second stage of exercise therapy is the restoration of mobility in the joints. It is necessary to restore the supporting and spring functions of the foot and strengthen the muscle frame. To do this, you need to perform exercises to flex the sole and extend it, grab medicine balls and small objects with your feet and fingers, and work on exercise machines. The main goal of all exercises is to restore full walking.

Pool

It is useful to use different types of walking in water and a variety of exercises. A good effect was noticed after swimming with fins. All of the above exercises are allowed only after the cast is removed.

Proper nutrition

Consumption of foods high in calcium and vitamin D is beneficial. Fermented milk products, milk and seafood should be included in the diet. Vitamin and mineral complexes are recommended.

The final stage of all these measures is the complete restoration of the biomechanics of walking. We need to relearn how to jump and run. Strengthening the endurance of the muscles of the lower limb plays a huge role. Bouncing, jumping and running exercises will be useful.

Important! All exercises during the recovery period must be performed under the supervision of specialists and with their help. If pain or muscle spasm you should stop immediately and stop exercising. The injured leg should be loaded gradually.

Additional events

In addition to all of the above rehabilitation measures, after discharge from the hospital it will be useful to undergo Spa treatment, continue to eat right, do hiking and exercise regularly.

flexion and extension of toes;
standing on tiptoes and then lowering onto your heels;
turns the foot to the right and left;
rolling a ball on the floor.

It is useful to pick up pencils and pens from the floor with your fingers or alternately stretch your foot away from you and towards you.

Long-term wearing of an instep support, orthopedic shoes, special insoles or orthosis is mandatory. A conclusion about complete recovery is given by a traumatologist or orthopedist.

Conclusion

Fractures of the bones of the foot are always a difficult ordeal, as they lead to impaired motor activity and interfere with daily activities.

Injuries require quite a long therapy and an equally long recovery period. You should always be careful and try to avoid situations that could lead to a fracture. The human body is a fragile thing, so you need to take care of it.

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A foot fracture is one of the most common types of fracture.

The huge number of bones in the foot, the enormous loads that these bones must withstand every day, and the lack of minimal knowledge about the prevention of foot fractures make this complex anatomical formation especially vulnerable.

Anatomical excursion

Foot – lower section lower limb, which has a vaulted structure and is designed to absorb impacts that occur when walking, jumping and falling.

The feet perform two main functions:

Firstly, maintain body weight;
Secondly, provide movement of the body in space.

These functions determine the structural features of the feet: 26 bones in each foot (a quarter of all bones in the human body are located in the feet), joints connecting these bones, a large number of powerful ligaments, muscles, blood vessels and nerves.

The joints are inactive, and the ligaments are elastic and high-strength, so they occur much less frequently than a fracture.

Since we're talking about fractures, let's reverse Special attention on the bony skeleton of the foot, which consists of the following bones:

Heel. This is the largest bone of the foot. It has the shape of a complex three-dimensional rectangle with depressions and protrusions to which muscles are attached and through which nerves, vessels and tendons pass.
Astragalus (supracalcaneal). It is in second place in size, unique high percentage articular surface and the fact that it does not contain a single attachment of bone or tendon. It consists of a head, a body and a neck connecting them, which is the least resistant to fractures.
Cuboid. It is located in front of the heel bone, closer to the outside of the foot. Forms the arch of the foot and forms a groove, thanks to which the peroneus longus tendon can fully work.
Scaphoid. Forms joints with the talus and three sphenoid bones. Rarely, the development of this bone is disrupted and the 27th bone of the foot, an accessory navicular bone connected to the main cartilage, may be observed. When an unskilled X-ray is read, an accessory bone is often mistaken for a fracture.
Wedge-shaped. Attached to other bones on all sides.
Metatarsals. Short tubular bones, serve for depreciation.
Phalanges of fingers. They are similar to the phalanges of the fingers in number and location (two flanks for the thumbs and three for each other finger), but shorter and thicker.
Sesamoids. Two very small (less than a pea) but extremely significant round bones are located inside the tendons and are responsible for the flexion of the first toe, which bears the maximum load.

Every tenth fracture and every third closed fracture occurs in the foot (for military personnel this figure is slightly higher and amounts to 13.8% in peacetime).

The most common foot fractures are:

ram bones - less than 1%, of which about 30% of cases lead to disability;
calcaneal- 4%, of which 83% - as a result of jumping on straight legs from high altitude;
cuboid — 2,5%;
scaphoid — 2,3%;
metatarsal- the most common type of foot bone injury.

Moreover, a fracture of the fifth is typical for athletes. metatarsal under excessive loads, and for people experiencing unusual excessive loads, often in uncomfortable shoes, a second fracture, sometimes 3 or 4, and rarely 1 or 5.

The average duration of disability for a toe injury is 19 days. This is not typical for children; incomplete fractures (cracks) occur.

IN at a young age Split fractures are common, and after 50 years - depressed.

Causes of injury

A fracture of the foot bones can occur for several reasons:

heavy objects falling on the foot;
jump (fall) from a great height and land on your feet;
when kicked;
when hit on the leg;
with subluxation of the foot due to walking on uneven surfaces.

Features of fractures of different bones

There are different types of fractures depending on the bone that was injured.

Calcaneal fracture

The main cause of occurrence is landing on the heels when jumping from a significant height, the second most common is a strong blow during an accident. Upon impact, the weight of the body is transferred to the talus, it crashes into the heel and splits it into pieces.

Fractures are usually unilateral and usually complex.

A special feature is the stress fracture of the calcaneus, the main cause of which is chronic overload of the bone, which has anatomical defects.

It should be noted that the mere fact of the presence of an anatomical defect does not lead to a fracture; constant and fairly serious loads are required for its occurrence, therefore, most often such a fracture is observed in army recruits and amateur athletes who neglect a medical examination before prescribing high loads.

Trauma to the talus

A relatively rare fracture that occurs as a result of a fall from a great height, an accident or impacts and is often combined with injuries lumbar region and other fractures (of the bones of the foot, the heel usually suffers along with the talus).

The injury is considered severe and leads to disability in a third of cases. This state of affairs is associated with a lack of blood circulation provoked by injury.

Even if the vessels are not ruptured, due to their compression, the supply of nutrients to the bone is disrupted, and the fracture takes a very long time to heal.

Cuboid fracture

The main cause of a fracture is a heavy object falling on the leg; a fracture due to an impact is also possible.

As is clear from the mechanism of occurrence, it is usually one-sided.

Scaphoid fracture

Formed as a result of a heavy object falling onto back part feet at a time when the bone is under tension. A fracture with displacement and in combination with fractures of other bones of the foot is typical.

Recently, stress fractures of the scaphoid bone have been observed, which was previously very rare - this is primarily due to the increase in the number of non-professional athletes who train without medical and coaching support.

Damage to the sphenoid bone

The consequence of a heavy object falling on the dorsum of the foot and crushing the wedge-shaped bones between the metatarsals and naviculars.

This mechanism of occurrence leads to the fact that fractures are usually multiple, often combined with dislocations of the metatarsal bones.

Metatarsal fractures

The most commonly diagnosed are divided into traumatic (arising as a result of a direct blow or twisting

feet) and fatigue (occur due to foot deformation, prolonged repeated loads, improperly selected shoes, osteoporosis, pathological bone structure).

A stress fracture is often incomplete (it does not go beyond a crack in the bone).

Trauma to the phalanges of the fingers

A fairly common fracture, usually caused by direct trauma.

The phalanges of the fingers lack protection from external influences, especially distal phalanges the first and second fingers, which protrude noticeably forward compared to the others.

Almost the entire spectrum of fractures can be observed: transverse, oblique, T-shaped, and comminuted fractures are found. A displacement, if observed, is usually by proximal phalanx thumb.

In addition to displacement, it is complicated by the penetration of infection through the damaged nail bed, and therefore requires sanitary treatment of the fracture site even if the fracture at first glance seems closed.

Sesamoid fracture

A relatively rare type of fracture. The bones are small, located at the end of the metatarsal bone of the big toe, and are usually broken due to sports activities associated with heavy load on the heel (basketball, tennis, long walking).

Sometimes it is easier to remove the sesamoids than to treat the fracture.

Symptoms depending on location

Symptoms of foot fractures, regardless of type:

pain,
edema,
inability to walk,
bruising in the area of injury,
change in the shape of the foot due to a displaced fracture.

Not all symptoms may be present, and the severity of the symptoms depends on the specific injury.

Specific signs:

On the picture characteristic symptom foot fracture - swelling and cyanosis

with a talus fracture: displacement talus(noticeable upon palpation), pain when trying to move the thumb, sharp pain in the ankle when moving, the foot is in a flexion position;
with cuboid and navicular fractures: acute pain in the location of the corresponding bone, when trying to abduct or adduct the forefoot, swelling on the entire anterior surface of the ankle joint.

Diagnostic methods

Diagnosis usually comes down to an x-ray examination, which is carried out in one or two projections, depending on the location of the suspected fracture.

If a talus fracture is suspected, an x-ray examination is not informative; optimal method diagnostic is computed tomography.

First aid

The only type of first aid for suspected foot fractures is ensuring foot immobility. This is carried out in mild cases by prohibiting movement, in other cases by applying a splint.

The victim should then be taken to the clinic. If swelling occurs, cold can be applied.

Therapeutic measures

Treatment is prescribed depending on several factors:

type of broken bone;
closed or open fracture;
complete or incomplete (crack).

Treatment consists of applying a plaster splint, plaster cast, bandage or fixator, surgical or conservative treatment, including physical therapy and special massage.

Surgical treatment is carried out in exceptional cases- for example, for displaced fractures of the sphenoid bones (in this case, surgery with transarticular fixation with a metal Kirschner wire is indicated) or for fractures of the sesamoid bones.

Recovery after injury

Recovery after injury is achieved through special massage and exercise therapy, reducing the load on the affected limb, using arch supports, and refusing to wear heels for a long period.

With fractures of the sphenoid bones, prolonged pain may occur.

Complications

Complications are rare, with the exception of extremely rare fractures of the talus.

Foot fractures are not life-threatening. However, the quality of later life largely depends on whether the injured person received treatment.

That is why it is important, if symptoms of injury occur, not to self-medicate, but to seek qualified medical help.

In addition, I would like to draw the attention of non-professional athletes and physical educators to the fact that thoughtlessly increasing loads and using inappropriate shoes during exercise is a direct way to close the opportunity to engage in physical education forever.

Even a high-quality recovery from a foot injury will never allow you to return to super-intense training. Prevention is always easier than cure.

If we consider the human skeleton, the foot consists of the front, rear and middle sections. The calcaneus and talus bones form the back part, three wedge-shaped, navicular and cuboid bones form its middle part, and the front part of the foot consists of 5 metatarsals and 14 bones that form the phalanges of the fingers.

One of the most common injuries in adults, adolescents, and young children is a broken foot. This is not surprising, since the foot of the lower limb is formed by 26 thin and fragile bones. The most vulnerable of them are the phalanges of the fingers, tarsal and metatarsal bones.

Causes

A fracture of the foot bones occurs:

from an incorrect jump;
powerful blow;
falling from a height;
unsuccessful turn of the leg.

It happens that the foot for a long time are exposed to stress, which can cause microcracks or stress fractures in the foot. The most sensitive are the talus and metatarsal bones.

Often, discomfort or pain that occurs in the foot is not particularly frightening, but should alert you. After all, after receiving even a minor injury, the integrity of the bone conglomerate may be disrupted - a bone fracture may occur, and the consequences may be different.

Kinds

The severity and consequences of the injury directly depend on the type of fracture. They can be classified:

Open fracture - with visible external damage to soft tissues and bone fragments. This is the most dangerous type.
A closed fracture occurs without compromising the integrity of the skin and soft tissues.
Damage to the foot without displacement of the bones or bone fragments that remain in place.
A displaced foot fracture is when a bone or parts of it are displaced and may not heal properly.

Sometimes numerous foot fractures occur, which require immediate hospitalization and long-term treatment with a long recovery period - after all, rehabilitation after a fracture is mandatory.

According to the typical classification, fractures are distinguished:

splintered;
fragmentary;
oblique
transverse.

The bones of the foot are very thin, so any injury can be destructive to their integrity.

Particularly painful and dangerous injuries are:

talus, calcaneus;
phalanges of the lower extremities;
bones of the metatarsus and tarsus;
sphenoid bone;
cuboid, scaphoid bones.

Trauma to the talus is one of the most serious, as it bears the pressure of bearing down on the entire foot. It forms the arches of the feet without having ligaments with any muscle. The fracture occurs most often due to inversion of the lower limb. The seriousness of the incident can be recognized by the signs that the size of the foot begins to increase sharply, accompanied by immobilization.

Treatment and recovery period long-term, due to insufficient blood supply - this bone is surrounded by small vessels.

A fracture of the navicular bone of the foot is also considered a difficult injury, since it is often accompanied by damage to the adjacent bones. This occurs due to prolonged compression of the midfoot and results in long-term treatment.

As a result of an unsuccessful jump or dismount, the heel bones come under attack, since they take the entire impact of the landing. The impact crushes the talus bone. The injury can be simple, comminuted, extra-articular, fragmented, intra-articular, without displacement or with displacement.

A cuboid fracture (like a sphenoid fracture) is rare, despite its location on the outside of the foot. Injury occurs from a sharp direct blow when the leg is bent, as well as from a direct traumatic impact on it, for example, a fall of a heavy load, or when the foot is run over by a car wheel. It is difficult to diagnose such damage due to the appearance of multiple debris. However, motor activity may be partially maintained during heel strike.

The bones of the metatarsus break when objects fall on them or when subjected to strong compression. In this case, one or more bones that make up the metatarsus are injured with damage to the neck, head or body.

When receiving a strong direct blow to the foot, it is usually the toes that are affected. In this case, you may not immediately pay attention and continue moving with damaged phalanges. This results in malunion, stiffness or post-traumatic arthrosis.

Symptoms and signs

Immediately after injury to the lower limb, discomfort may occur. The victim will be able to recognize the first symptoms of a foot fracture on his own. They appear:

sharp pain;
swelling of soft tissues;
color change skin– redness or pallor;
deformation of the foot;
wound or bruise.

It happens that the signs of a foot fracture do not appear to a significant extent immediately after the injury - it is simply painful for the victim to step on the foot or a slight swelling occurs. A person may think that he will limp a little and everything will go away, so it is not necessary to contact a specialist. This is the main misconception of many people. It must be remembered that any bruise or fracture must be diagnosed and treated by specialists.

First aid

Even if after an injury there is only one sign of a foot fracture, the victim must be sent to a medical facility where he can receive the necessary medical care.

If immediate hospitalization is not possible, you can provide assistance to the victim yourself.

If a foot fracture is suspected, it is necessary to fix injured limb by applying a splint. This can be any plank or a second limb, to which the injured leg is tied using any piece of fabric.
If an open fracture of the foot occurs, it is necessary to stop the bleeding and treat the damaged tissue with disinfectants and apply a sterile bandage.

When providing first aid yourself, do not forget that this is only a temporary measure. The main treatment and recovery is carried out in a clinical setting.

Treatment

IN medical institution a specialist examines the foot along with part of the lower leg in order to clarify the symptoms.

Having diagnosed a fracture using x-rays, and in more complex cases, ultrasound, osteoscintigraphy or computed tomography, the doctor prescribes a comprehensive treatment for a foot fracture, the timing of which is purely individual.

The duration and methods of treatment depend on the type of fracture, how serious the injury is, which of the 26 bones are damaged, and how quickly the swelling subsides.

Fractures of the foot bones are treated:

Full or partial fixation using a special bandage or shoes.
Surgically.
Injections, ointments.

For each type of injury, the specialist prescribes individual treatment.

For a tarsal fracture, skeletal traction is used, bone fragments are repositioned, and a cast is applied for up to 10 weeks.
If the patient is diagnosed with a fracture of the calcaneus, then he is given a plaster cast from the fingers of the lower limb to the knee joint.
If the metatarsus or phalanges of the fingers are fractured, a plaster splint up to the knee is applied to the lower limb.
In the case of multiple fractures, the patient undergoes skeletal traction with manual reposition of bone fragments. If conservative treatment is not effective, then surgical treatment is used.

With a fractured foot, walking is possible with the help of crutches.

Rehabilitation period

How long is it in a cast for a broken foot? Everyone will have to wear a plaster cast differently, but on average this period is 1.5 months. The need to remove the plaster is determined by a control x-ray examination after this period.

After removing the fixing bandage, you need to constantly develop the damaged foot, using:

massage of the lower leg and foot;
special physical therapy exercises;
physiotherapy;
shoe instep supports or special orthopedic shoes.

Massage and physiotherapy for foot fractures is an integral part rehabilitation period and is selected by the doctor individually for each patient.

The rehabilitation period depends on a number of factors:

complexity of injury;
nature of the damage;
age and health status of the patient.

For foot injuries, rehabilitation can last several months. The exception is the phalanges of the fingers - they grow together quickly thanks to proper treatment.

Complications and consequences

What are the dangers of foot fractures that are not treated in a medical facility:

When bones are damaged with displacement, there is a danger of deformation of the foot in one direction or the other due to weakness of the ligamentous apparatus, and only a specialist can correct the situation.
Bone fragments may heal incorrectly, which in itself is painful, and this situation can lead to movement restrictions in the future.
The fracture may not heal completely.
Quality of life deteriorates due to consequences improper treatment– arthrosis of the joints.
With open fractures, this threatens with osteomyelitis or phlegmon of the foot.

How to correctly diagnose, carry out treatment, how to relieve swelling and pain, how to develop and restore a sore foot - this is the competence of the attending physician exclusively, therefore various types of self-medication for foot fractures are excluded.

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Most midfoot fractures are intra-articular. With these fractures, the anatomical relationships in the Lisfranc and Chopart joints are often disrupted, which subsequently leads to such serious disorders as limited pronation, supination, adduction and abduction of the foot, long-term lameness, pain, loss of ability to work, and sometimes disability.

Clinical signs of fractures of the navicular, sphenoid and cuboid bones are a sharp swelling in the middle part of the foot, spreading to the anterior surface of the ankle joint, severe deformation of this part immediately after the injury, pain at the fracture site when palpating and pushing the finger along the axis, and the inability to load the injured limb. The final diagnosis is established using data x-ray examination.

Fractures of the scaphoid are isolated and can be combined with fractures of other bones of the foot. Isolated fractures are rare. According to the literature, scaphoid fractures account for 2.2-2.5% of all foot bone fractures. As you know, the inner part of the foot bears almost the entire weight of the body. The injury causes the space between the sphenoid bones and the head of the talus to narrow, causing the scaphoid to be crushed or splintered and pushed out of its seat.

This compromises the strength longitudinal arch foot, which must be taken into account when treating this injury. According to our data, fractures of the scaphoid were observed in 14 patients, of which isolated - in 6, in combination with other bones of the foot - in 8. As a result of direct trauma, the fracture occurred in 10 patients, indirect - in 4. In 3 patients, compression fractures of the scaphoid bones were combined with a dislocation in the Chopart joint. Such a fracture-dislocation occurs when the foot is forcibly abducted or adducted, when a weight falls on the midfoot, or when a wheel of a moving vehicle collides. In most cases, scaphoid fractures were the result of a weight falling on the foot with increased plantar flexion.

These fractures are accompanied by displacement of the fragments, the degree of which depends on the magnitude and direction of the traumatic force and the presence or absence of rupture of the ligaments surrounding the scaphoid bone.

Rice. 4.8. Types of scaphoid fractures.
a - compression fracture; b - separation of the horizontal plate; c — fracture in the sagittal direction; d - additional external tibial bone at the inner edge of the scaphoid; d — separation of a fragment of the tuberosity of the scaphoid bone in the area of attachment of the tibial muscle.

As a rule, the displacement occurs on the dorsal side, since the ligaments located on the dorsal surface between the talus, sphenoid and cuboid bones are less strong than on the plantar side. A tear of the horizontal plate of the scaphoid can subsequently cause long-term pain when walking (Fig. 4.8).

Sometimes there is a displacement of fragments to the inner edge of the foot. Typically, such a fragment is a fragment of the tuberosity of the scaphoid bone, formed after a blow or as a result of separation of the tibial muscle at the site of its attachment to the scaphoid bone. These fractures are uncommon and are usually mistaken for the accessory lateral tibia. Therefore, when planning to formulate a diagnosis, you need to take into account that, unlike the additional bone, which has smooth contours, the fragment has jagged contours. In doubtful cases, radiographs of both feet should be compared.

Avulsion of the scaphoid tuberosity is more common than many authors assume. A fresh fracture, as a rule, is mistaken for a bruise and the correct diagnosis is established already at the stage of a formed pseudarthrosis, when pain appears when walking, especially at the moment of rolling the foot. The fracture line in the tuberosity area is often transverse.

There are fractures of the scaphoid with a longitudinal fracture line; the bone is then divided into two closely adjoining fragments - internal and external. The scaphoid fracture line, running from anterior to posterior, is a continuation of the line between the medial and intermediate cuneiform bones. Sometimes the medial fragment is displaced along with the medial cuneiform and first metatarsal bones along the line of the Lisfranc joint posteriorly and inwardly. We observed such displacement in divergent fracture-dislocations in the Lisfranc joint. With fractures of the scaphoid in the sagittal direction, damage to the head or neck of the talus or fractures of the sphenoid bones are often observed, which may be combined with a separation of the inner end of the cuboid or the anterior end of the calcaneus.

With compression fractures of the navicular bone with dislocation of the foot in the Chopart joint, displacement of the fore and middle sections of the foot is possible towards the rear, towards the sole, inwards and very rarely outwards.

Clinical picture

With an isolated fracture of the navicular bone, loading the foot is impossible due to pain, the position of the foot is forced - the patient tries to keep it in a supination position and avoid pronation. When fragments are displaced, they can be felt under the skin. The clinical picture of a fracture-dislocation in the Chopart joint is characterized by a sharp deformation of the midfoot and ankle joint, severe pain when palpating the fracture area, and the inability to put weight on the damaged foot. Foot deformation occurs in the first hours after injury. Sometimes a dislocation in the Chopart joint is accompanied by paralysis of the medial and lateral plantar nerves with numbness of the plantar surface of the fingers and paralysis of the lumbrical muscles. The fingers acquire a claw-like deformity (similar to a “clawed paw” in case of paralysis of the fingers).

X-ray diagnostics

The scaphoid bone is examined in direct (plantar) and lateral (axial) projections. A compression fracture is characterized by a wedge-shaped deformation of the scaphoid with the tip of the wedge facing the plantar side, as well as compaction of the shadow of the bone due to compression of the bone beams. All these signs stand out in relief on photographs in a lateral projection.

Treatment

If a fracture of the navicular bone is not accompanied by displacement of the fragments, a boot-type plaster cast should be applied in moderate plantar flexion of the foot, with a special metal arch support placed in the plantar part to prevent flattening of the arches of the foot. The duration of immobilization is up to 8 weeks. Dosed loads on the foot are allowed after 3-4 weeks. Periodic X-ray monitoring is required during treatment.

If fragments are displaced, you should try to compare them manually under anesthesia or intraosseous anesthesia with the patient lying on the table with the leg bent at the knee joint to a right angle. The reposition technique is as follows. One assistant holds the heel, the other pulls the toes forward, bends the foot and makes an eversion.

The space between the sphenoid bones and the head of the talus increases, and at this moment you need to press your thumb on the protruding fragment of the scaphoid bone; in most cases, the fragment is reduced. After a control x-ray, a boot-type plaster cast is applied.

In case of avulsion of the navicular tuberosity, it is necessary to place the foot in the most supinated position in order to bring the tuberosity together with the tendon closer to its place. In a plaster cast applied in this position, the load is not allowed for 2 weeks; the plaster cast is removed after 6-8 weeks. After this, the pain may persist for a long time - for several months, until the fragments are completely fused, and only after that there is a complete restoration of the function of the limb. If the torn tuberosity of the scaphoid bone, together with the ligament, grows back into place, a violation of statics will not occur.

In more difficult cases of fracture-dislocation of the scaphoid with large displacement of fragments, we perform reduction using a device of our own design.

Reduction method: one wire is passed through the heel bone, the other through the heads of the metatarsal bones; after stretching the bed of the scaphoid, pressing on the displaced fragment, it is easily set.

Compression fractures of the scaphoid with dislocation of the foot at the Chopart joint, difficult to treat conservatively, require open reduction.

In case of comminuted fractures of the scaphoid with significant displacement of fragments that are not amenable to conservative treatment, one should resort to arthrodesis, performing it in two directions - between the scaphoid and the head of the talus and between the scaphoid and rear surfaces three sphenoid bones. However, this intervention can lead to shortening of the inner edge or part of the foot and to lowering of the inner arch - flat feet. Some authors suggest resecting part of the scaphoid to restore balance.

In our opinion, it is more appropriate to use a bone graft after refreshing the articular surfaces of the bones surrounding the scaphoid. In the absence of allobone, a bone graft from the tibia can be used. A bone groove is made in the head of the talus and medial sphenoid bones, where a bone graft is inserted or the defect is tightly filled with spongy substance taken from the wing of the ilium.

The scaphoid bone should not be removed even if it is significantly damaged, since with prolonged plaster immobilization it is possible to achieve fusion. Removal of the navicular bone may subsequently affect the statics of the foot due to a sharp flattening of the sole and valgus curvature of the forefoot. The scaphoid bone can be removed only if it is very severely damaged, but at the same time arthrodesis along the line of the Chopart joint and bone grafting should be performed using the method described above.

After the operation, a blind plaster cast is applied to the knee joint with a metal arch support for 3 months. Loading the affected limb in such a bandage begins after 5-6 weeks. After removing the plaster cast, physical therapy, massage, swimming in the pool or baths are prescribed. In the future, patients must wear orthopedic shoes for at least 6-8 months or insoles-instep supports for a year or more.

Fractures of the sphenoid bones. Due to the fact that all sphenoid bones, except the medial one, articulate with other bones of the foot on all sides, isolated fractures are extremely rare. This fracture is often combined with dislocations of the metatarsal bones in the Lisfranc joint. This is explained by the fact that the anterior articular surfaces of the sphenoid bones articulate with the posterior articular surfaces of the I, II and III metatarsal bones, and the line between these bones is inner part Lisfranc joint (Fig. 4.9).

Of the three wedge-shaped bones, the medial one is most often damaged, located at the inner edge of the foot and less protected from external influences. However, fractures of all sphenoid bones are possible at the same time.

Fractures of the sphenoid bones are intra-articular and belong to the category of severe foot injuries. In most cases, they are caused by compression or crushing of the wedge-shaped bones between the metatarsals and scaphoid.

Basically, these fractures are the result of direct trauma - falling heavy objects on the dorsum of the foot. The prognosis for these fractures is favorable, but sometimes long-term pain remains. Elderly people may develop static arthrosis in the joints of the foot.

Rice. 4.9. Scheme of a fracture of the medial sphenoid bone with dislocation of the I, II, III metatarsal bones in the Lisfranc joint.

We observed 13 patients with fractures of the sphenoid bones: in 3 - isolated, in the rest - multiple in combination with fractures of other bones of the foot. In 10 patients, the fracture was the result of direct trauma, in 3 – indirect.

Clinical picture

There is a sharp swelling of the dorsum of the foot, spreading to the anterior surface of the ankle joint and the area of the base of the I, II and III metatarsal bones, subcutaneous hemorrhage (hematoma) and sharp pain on palpation. In the area where the traumatic force is applied, indentation of the soft tissues is determined. There is pathological mobility of the entire forefoot.

Damage to the arch of the foot due to fractures of the wedge-shaped bones occurs when a large crushing force is applied, which could displace the broken bones towards the sole and cause traumatic flat feet. However, more often, fractures of the sphenoid bones occur without significant displacement of the fragments.

X-ray diagnostics

The X-ray examination technique and the method for recognizing fractures of the sphenoid bones are the same as for fractures of the scaphoid bone; the only difference is that the overlap of the intermediate and lateral cuneiforms and the metatarsal bones that articulate with them often simulates a fracture line. Slight change in direction x-rays makes it possible to avoid overlapping contours.

Treatment

Fractures of the sphenoid bones most often occur without significant displacement of the fragments, so treatment is reduced to the application of a circular plaster cast like a boot with a metal instep support built into the plantar part to prevent the development of post-traumatic flatfoot. Walking is prohibited for 7-10 days, then dosed loads are allowed on the injured limb. The plaster cast is removed after 5-7 weeks, after which physical therapy, massage, and baths are performed. It is recommended to wear shoes with orthopedic cork insoles for a year. Working capacity is restored after 8-10 weeks.

Fractures of the sphenoid bones with displacement of fragments, when conservative measures do not have an effect, are treated surgically with transarticular fixation of fragments with a metal Kirschner wire.

In general, the prognosis for fractures of the sphenoid bones is favorable, except for pain, often long-lasting. Fractures of the cuboid bone. The cuboid bone is the key to the outer arch of the foot and breaks very rarely, although it is located in the area of the outer part of the foot. Almost always, its fracture is the result of a direct injury, but can be caused by a weight falling on the foot in a position of sharp flexion. In rare cases, when the cuboid bone is compressed between the heel bone and the bases of the IV and V metatarsal bones, it splits into several fragments. The fracture line most often occurs in a sagittal or slightly oblique direction. The external fragment has a protrusion, which is limited anteriorly by a groove for the peroneus longus muscle.

Comminuted fractures of the cuboid bone are often combined with fractures of other bones of the foot, in particular the base of the metatarsal bones, the lateral cuneiform and navicular bones. Isolated fractures of the cuboid bone are extremely rare. When a cuboid bone is fractured, one should not forget about the existence of additional bones, which can be mistaken for a fragment of the cuboid bone. Severance of a piece of bone tissue from the cuboid bone occurs quite often with severe trauma in the midfoot area.

We observed 8 patients with cuboid bone fractures. In 6 of them there was an isolated fracture and in 2 it was combined with fractures of the bases of the IV and V metatarsal bones. In 5 patients the fracture was the result of direct trauma and in 3 patients it was due to indirect trauma.

Clinical picture

With a fracture of the cuboid bone, sharp local pain and hemorrhage are observed, involving the entire outer part of the foot. Often a fragment is felt between the base of the fifth metatarsal bone and the cuboid bone; in this case, the latter moves up, forward or down. The fragment is usually mobile. When the bone is severely damaged, the outer edge of the foot is usually elevated. Passive movements in the Chopart joint are sharply limited and painful, it is possible complete blockade joint In most cases, there is no significant displacement of fragments. Fracture lines can be very different (Fig. 4.10). The nature of the fractures is most often comminuted.

X-ray diagnostics

X-ray examination of the cuboid bone is carried out in direct and lateral projections. The most informative picture is in direct projection.

Rice. 4.10. The most common fractures of the cuboid bone.

Treatment

Like fractures of the sphenoid bones, fractures of the cuboid bone are usually not accompanied by large displacement of the fragments, so treatment mainly comes down to immobilizing the foot with a plaster cast like a boot with a metal arch support cast into the plantar part.

Dosed loads on the injured limb are allowed no earlier than after 5-7 days. After removing the plaster cast (after 4-6 weeks), physical therapy, massage, swimming in the pool or baths are prescribed. Working capacity is restored after 6-8 weeks. For a year, the patient must wear orthopedic shoes with a cork insole.

With comminuted fractures, the patient often suffers from pain for several months, especially when walking for a long time. In such cases, it is necessary to promptly remove small fragments. When a comminuted fracture of the cuboid bone is combined with fractures of other bones of the foot, preference is given to surgical treatment.

Foot surgery
D.I.Cherkes-Zade, Yu.F.Kamenev