Traumatic Injuries of the Foot The foot is the distal extremity of the human body and it is essential to ensure the upright position and to walk on both legs. In anatomical terms the foot is divided into three segments, tarsus, corresponding to a solid struture with bone superimposeds, the metatarsus, the further elongated tarsal bones with five bones, and finally with two small bones in the hallux, the first finger and three in the other, the phalanges, totaling composed of twenty-six bones. The bone structures are joined together by a complex ligament system, forming joints between them, surrounded by a fibrous joint capsule. Over the skeletal structure is a set of tendons and muscles responsible for motility, as well as vessels and nerves responsible for circulation and enervation. As all segments of the human body, the foot is also exposed to traumatic injuries that can reach any of its constituent structures. The mechanism of injury and the intensity of the trauma it is important to achieve the diagnosis. The trauma can occur directly or indirectly on the foot by twist or traction forces. The most frequent injury is a simple contusion, resulting from traumatic direct action on this anatomic region, affecting mainly the skin, subcutaneous tissue and other adjacent soft tissue, usually producing a small hematoma that will be reabsorbed naturally. A more violent trauma can overcome bone strength and lead to its fragmentation, producing fractures. Injuries repeated in time which by themselves are not capable of causing fractures, can then cause stress fractures. All bones can be fractured, from which composes the row of phalanges of the fingers to each of the long bones that extend the metatarsals. The most common fracture is the base of the 5th metatarsal, which clinically can be confused with an ankle sprain or fracture of the peroneal malleolus, due to proximity to these structures. The calcaneus is the largest bone in the foot and forms the heel. Calcaneal fractures usually occur from falls at height, often associated with fractures of spine, that should be screened. Fractures of the talus, have a prognosis conditioned by the fact that this is a little vascularized bone, which makes difficult their consolidation. This bone is also a frequent bone of osteochondral lesions of the articular surface corresponding to the ankle, which partially affects the articular cartilage. May, in addition to the lesions described,occur small bony avulsions. In addition to fractures, skeletal injuries must also consider the dislocations, which in essence consists in a bone disengagement with respect to another due to a trauma of the joint. There is usually achieving structures being primarily maintaining joint stability, such as capsule and ligaments. These lesions are relatively frequent at the phalanges, causing the interphalangeal dislocations, but can occur in all joints. A particular case is the dislocation of the tarsometatarsal joint, Lisfranc joint, often associated with fracture of the metatarsals, and has almost always surgical indication. Also tendons trauma can be established either by repetitive mechanisms, causing tendinitis or by mechanisms commonly associated with acute soft tissues injuries, causing its section, but may also occur spontaneous rupture of tendons,beeing the most common the peroneus brevis. For diagnosis is crucial careful clinical history oriented to the lesion . By inspection we can see changes as deformities, swellings, and skin changes. The initial imagiology exam is the X-Ray, which shows only the bone lesions, and it is important to confirm or exclude fractures or dislocations, which can be complemented by CT - primarily for the study of bone lesions - or MRI. Treatment depends on the lesion diagnosed and ismostly conservative ranging through the discharge, ice and symptomatic treatment in the case of sparis or soft tissues injuries to the reduction of fractures and dislocations.and immobilization with plaster casts Fractures of the calcaneus, astragalus, metatarsals and a Lisfranc fracture dislocation or articular fractures usually require surgical reduction associated with fixation eventually with wires or plates and screws. For soft tissues injuries may be required surgical correction with repair of the affected structures.
Posted on: Sun, 09 Jun 2013 18:12:17 +0000