Category: Midfoot

The Fenton classification system for cuboid fractures

Posted on August 12, 2023 by - Classification systems, F, Fractures, Midfoot


The Fenton Classification System offers a structured framework to categorize cuboid fractures, enabling healthcare professionals to make informed decisions. Fenton fractures are separated into three distinct types:

Type I: Undisplaced Fractures At the less severe end of the spectrum, Type I cuboid fractures involve minimal or no displacement of the fractured segments. While these fractures may still cause discomfort, their relative stability allows for more conservative treatment approaches.

Type II: Displaced Fractures Type II fractures are characterized by noticeable displacement of the fractured pieces within the cuboid bone. This classification helps healthcare practitioners gauge the extent of displacement and tailor treatment plans accordingly.

Type III: Fracture with Associated Injuries The Type III classification accounts for cuboid fractures that occur in conjunction with injuries to nearby structures, such as the lateral column of the foot or the calcaneocuboid joint. Understanding these associated injuries is vital for comprehensive treatment strategies.

Sangeorzan classification of navicular body fractures

Posted on August 12, 2023 by - Classification systems, Fractures, Midfoot, S

The Sangeorzan classification of navicular body fractures provides a comprehensive categorisation of navicular body fractures, segmenting them into three distinct types:

Type 1 – Coronal Fracture with No Dislocation: In this classification, Type 1 navicular fractures occur in a coronal pattern, involving a break without any accompanying joint dislocation. While the injury itself can be painful and debilitating, the absence of dislocation suggests a relatively more favorable prognosis. Medical intervention and treatment are essential, but the outcome might be less severe compared to other types.

Type 2 – Dorsolateral to Plantomedial Fracture with Medial Forefoot Displacement: Type 2 fractures present a more complex scenario. Here, the fracture extends from dorsolateral to plantomedial, leading to a displacement of the medial forefoot. This misalignment can cause significant discomfort and hinder mobility. Medical attention is crucial, as proper treatment can play a pivotal role in minimizing the impact of displacement and promoting proper healing.

Type 3 – Comminuted Fracture with Lateral Forefoot Displacement: Among the three types, Type 3 carries the most challenging prognosis. A comminuted fracture involving the navicular body leads to a fragmented pattern, often accompanied by lateral forefoot displacement. This type poses the highest risk of complications, demanding prompt and thorough medical intervention. Specialists may need to devise comprehensive treatment plans to address both the comminution and displacement.

Torg classification for fifth metatarsal fractures

Posted on August 12, 2023 by - Classification systems, Fractures, Midfoot, T

The Torg Classification, developed by Dr. J.W. Torg, is a classification system for fractures of the fifth metatarsal bone. This classification is primarily used to categorize fractures in athletes and guide treatment decisions based on the location and characteristics of the fracture.

The Torg Classification divides fifth metatarsal fractures into three zones:

Zone 1: Avulsion Fractures

  • Involves an avulsion of the tuberosity of the fifth metatarsal due to pull of the peroneus brevis tendon.
  • Often referred to as a “dancer’s fracture” or “pseudo-Jones fracture.”
  • Typically has a good prognosis and usually heals well with conservative treatment.

Zone 2: Jones Fractures

  • Occurs at the metaphyseal-diaphyseal junction of the fifth metatarsal, approximately 1.5 to 3 cm distal to the tuberosity.
  • These fractures are more prone to delayed or non-union due to limited blood supply in this area.
  • Often requires more aggressive treatment, including immobilization and sometimes surgical intervention.

Zone 3: Diaphyseal Fractures

  • Involves fractures of the diaphysis (shaft) of the fifth metatarsal, occurring more distally than Zone 2.
  • Generally has a better prognosis and often heals well with conservative treatment.

Hardcastle & Myerson classification for Lisfranc injuries

Posted on August 12, 2023 by - Classification systems, H, Midfoot

The Hardcastle and Myerson classification system is used to categorize injuries to the Lisfranc joint complex, which involves the tarsometatarsal joints in the midfoot. This classification system helps surgeons and medical professionals assess the severity of Lisfranc injuries and guide treatment decisions. Lisfranc injuries can range from mild sprains to severe fractures and dislocations.

The Hardcastle and Myerson classification system is divided into three main categories, which are further sub-divided based on the severity of the injury:

Type A: Homolateral Fracture Dislocation

  1. Type A1: Fracture of the base of the second metatarsal.
  2. Type A2: Fracture of the first and second metatarsals.
  3. Type A3: Fracture of all three medial metatarsals.

Type B: Isolated Lisfranc Ligament Injuries

  1. Type B1: Sprain or rupture of the Lisfranc ligament with or without fractures.

Type C: Divergent Dislocation

  1. Type C1: Dislocation of one or two metatarsals.
  2. Type C2: Dislocation of three or more metatarsals.

Each type is associated with varying degrees of instability and severity. Treatment options and outcomes depend on the specific type of Lisfranc injury.

It’s important to note that Lisfranc injuries can be complex and may require careful evaluation by a medical professional, often including imaging studies like X-rays or CT scans. Treatment can range from non-surgical approaches (such as casting or bracing) for less severe injuries to surgical intervention (such as stabilization with screws or plates) for more severe injuries.

If you suspect a Lisfranc injury, it’s crucial to seek prompt medical attention to ensure an accurate diagnosis and appropriate management to prevent potential long-term complications, such as chronic pain and instability in the midfoot.

Dorsal osseous compression syndrome (DOCS)

Posted on April 13, 2023 by - D, Midfoot

Dorsal osseous compression syndrome (DOCS), also known as dorsal compression syndrome or dorsalis pedis compression syndrome, is a medical condition characterized by compression of the dorsal (top) surface of the foot, usually by adjacent bones or structures. It can cause pain, discomfort, and other symptoms in the affected foot.

The condition typically occurs due to abnormal pressure or compression on the dorsum of the foot, which can result from various causes, including:

  1. Tight footwear: Wearing shoes that are too tight, narrow, or constrictive can compress the bones and soft tissues on the top of the foot, leading to dorsal osseous compression syndrome.
  2. Bone deformities: Some individuals may have anatomical variations in their foot bones, such as prominent dorsal bones or accessory bones, which can lead to compression of nearby structures.
  3. Trauma: Previous injuries or trauma to the foot, such as fractures or dislocations, can result in changes in the alignment of the foot bones, leading to dorsal compression syndrome.
  4. Overuse or repetitive activities: Repeated activities that involve excessive dorsiflexion of the foot, such as running, jumping, or wearing high-heeled shoes for prolonged periods, can cause compression of the dorsum of the foot.

Symptoms of foot dorsal osseous compression syndrome may include pain, tenderness, swelling, bruising, and limited range of motion in the affected foot. The pain may worsen with activity, walking, or wearing tight shoes, and may improve with rest and elevation of the foot.

Treatment options for foot dorsal osseous compression syndrome depend on the underlying cause and severity of the condition. Conservative treatments may include rest, ice, elevation, compression, wearing properly fitting footwear, and avoiding activities that exacerbate the symptoms. Orthotic devices, such as padding or shoe inserts, may also be recommended to alleviate pressure on the affected area.

In some cases, if conservative treatments are ineffective, more advanced interventions may be required, such as corticosteroid injections, physical therapy, or in rare cases, surgical interventions to address any bone deformities or structural abnormalities causing the compression.

If you suspect you may have foot dorsal osseous compression syndrome or are experiencing foot pain or discomfort, it is important to consult with a healthcare professional for a proper diagnosis and appropriate treatment plan tailored to your individual needs.

Lapidus procedure

Posted on March 29, 2023 by - L, Midfoot, Surgical

The Lapidus procedure is a surgical procedure used to treat hallux valgus, a condition in which the big toe drifts away from the midline of the foot, causing a bunion. It involves fusing the first metatarsal bone to the medial cuneiform bone in the midfoot to correct the alignment of the bones and reduce the deformity. This procedure is typically reserved for cases of severe hallux valgus or for patients who have not responded to more conservative treatments.

During the procedure, the surgeon makes an incision on the top of the foot and removes a small piece of bone from the base of the first metatarsal. The metatarsal bone is then repositioned and fixed in place with screws or a plate to hold it in the desired alignment. Over time, the bones grow together and form a solid fusion, which helps to stabilize the midfoot and reduce the severity of the bunion.

After the surgery, the patient may need to wear a cast or brace for several weeks to protect the foot and allow the bones to fuse together. Physical therapy may also be recommended to help improve strength, flexibility, and range of motion in the affected foot. While the Lapidus procedure can be highly effective in correcting hallux valgus, it does require a period of immobilization and recovery, and may have some potential risks and complications, such as non-union, nerve injury, or infection. It is important to discuss the potential risks and benefits of the Lapidus procedure with a qualified healthcare professional before undergoing the procedure.

Nutcracker fracture

Posted on March 16, 2023 by - Fractures, Midfoot, N

A nutcracker fracture is a type of foot fracture that occurs when the cuboid bone, located on the outer side of the foot, is crushed between the heel bone and the fourth and fifth metatarsal bones.

This type of fracture can occur as a result of a sudden injury, such as a fall or a direct blow to the foot, or from overuse or repetitive stress on the foot. Symptoms of a nutcracker fracture of the cuboid may include pain, swelling, bruising, and difficulty bearing weight on the affected foot.

Diagnosis is typically made through a physical exam and imaging tests, such as X-rays or CT scans. Treatment for a nutcracker fracture of the cuboid may depend on the severity of the fracture, but generally involves immobilizing the affected foot with a cast or brace and allowing time for the bone to heal. In some cases, surgery may be necessary to realign the fractured bone and stabilize the foot. Physical therapy may also be recommended to help restore range of motion and strength to the affected foot.

Köhler disease

Posted on March 10, 2023 by - K, Midfoot, Paediatrics

Köhler disease, also known as osteochondrosis of the navicular bone, is a rare condition that affects the navicular bone in the foot. It is most commonly seen in children between the ages of 5 and 10 years old, and is more common in boys than girls.

The exact cause of Köhler disease is unknown, but it is believed to be related to a disruption in blood flow to the navicular bone. This can lead to a decrease in bone density and the development of small fractures in the bone.

Symptoms of Köhler disease typically include pain and swelling in the midfoot, particularly on the top of the foot. The affected foot may also appear flattened or widened, and there may be a limp or difficulty walking.

Treatment for Köhler disease usually involves rest and immobilization of the foot with a cast or brace to allow the bone to heal. Pain relievers may also be prescribed to manage discomfort. In rare cases, surgery may be necessary to remove damaged tissue or realign the bones in the foot. With appropriate treatment, most children with Köhler disease recover fully and have no long-term complications.

Midfoot arthritis

Posted on March 9, 2023 by - M, Midfoot, Rheumatology

Midfoot arthritis is a condition characterized by pain and stiffness in the midfoot area, which includes the arch and the ball of the foot. It can be caused by wear and tear of the joints in the midfoot, rheumatoid arthritis, or trauma to the foot. Symptoms may include pain, swelling, stiffness, and difficulty walking or standing. Treatment options for midfoot arthritis may include over-the-counter or prescription pain relievers, physical therapy, shoe inserts or custom orthotics, and in severe cases, surgery to fuse the affected joints together or remove the damaged joints and replace them with an artificial joint. It is important to seek medical attention if you experience persistent foot pain or discomfort.

Metatarsus adductus

Posted on March 9, 2023 by - M, Midfoot, Paediatrics

Metatarsus adductus is a foot deformity in which the front part of the foot turns inward, causing the toes to point inward as well. It can occur in both children and adults, and can range from mild to severe. Here are some key facts about metatarsus adductus:

Causes:

  • Metatarsus adductus is usually caused by abnormal foetal positioning in the womb, which can cause the foot to develop in a curved or angled position.
  • It can also be caused by genetic factors or conditions that affect muscle or bone development, such as cerebral palsy.

Symptoms:

  • Symptoms of metatarsus adductus can include a visible inward curve of the foot, with the toes pointing inward as well.
  • In more severe cases, the foot may be painful or may cause difficulty walking or wearing shoes.

Diagnosis:

  • A diagnosis of metatarsus adductus is usually made based on a physical examination of the foot and the patient’s medical history.
  • X-rays may be ordered to rule out other conditions or to assess the severity of the deformity.

Treatment:

  • Treatment for metatarsus adductus depends on the severity of the deformity and the patient’s age.
  • In infants, mild cases may resolve on their own with stretching exercises or the use of special shoes or braces.
  • More severe cases may require casting or surgery to correct the position of the foot.

Prognosis:

  • With appropriate treatment, most cases of metatarsus adductus can be corrected.
  • However, in some cases, the deformity may persist or may recur later in life.
  • Patients with metatarsus adductus may need to wear special shoes or orthotics to support the foot and prevent future complications.