Foot Fault: Can You Find the Injury?

June 23, 2016

A 32-year-old man arrives at the ED unable to walk after jumping from a wall. This foot injury is often missed on x-ray. Do you see it?

A 32-year-old man presents to the emergency department with a foot injury that occurred when he landed on a rock after jumping down from a 7-foot wall onto uneven ground. He denies other injury and points to the forefoot and lateral malleolus as the areas of most severe pain. He is unable to walk.

On physical exam, the skin is intact and there is mild foot swelling, but no deformity, bruising or tense compartments. There is tenderness to entire proximal foot and to the lateral malleolus so plain film x-rays are ordered. The AP and mortise views are normal. The lateral view is shown in the Figure, left.

What fracture is shown?  Make sure to click on image to enlarge and view magnified version; look carefully.

(Hint: fracture of this bone is frequently missed.)

For answer and discussion, please click here.