Foot Case 2 Diagnosis

 

A common scenario is for a patient to get ankle x rays while waiting to be seen.  However, if there is tenderness over the 5th metatarsal on exam, order dedicated foot films.  Ankle x rays may or may not diagnose the injury but standard radiographs of the foot should be ordered and will easily demonstrate most metatarsal base fractures. 

The key landmark in properly characterizing fractures at the base of the 5th metatarsal is the tuberosity, which is 1.5cm from the tip of the styloid process of the 5th metatarsal.

• Fractures within 1.5cm of the tip of the styloid process are “avulsion” fractures.

• Fractures beyond 1.5cm from the tip of the styloid process are “metatarsal” or “diaphyseal” fractures.