Cuboid Bone Syndrome: Symptoms and Treatment. Cuboid fractures Calcaneus and cuboid fractures

With a fracture of the scaphoid bone without displacement of fragments a plaster cast of the "boot" type is applied in moderate plantar flexion of the foot. A special metal instep support is inserted into the plantar part of the bandage to prevent flattening of the arch of the foot. Duration of immobilization up to 8 weeks. Dosed load on the foot is allowed after 3-4 weeks. In the course of treatment, X-ray control is periodically carried out.

For fractures of the scaphoid bone with displacement of fragments an attempt should be made to compare them manually under anesthesia or intraosseous anesthesia. The patient lies on the table, the leg is bent at the knee joint to a right angle. One assistant holds the heel, the other pulls the toes forward, flexes the foot and makes eversion. In this case, the space between the sphenoid bones and the head of the talus increases. At this moment, you need to put pressure with your thumb on the protruding fragment of the scaphoid bone, which in most cases is set into place. After control X-ray, a plaster cast of the "boot" type is applied.

In more difficult cases of dislocation of the scaphoid bone with a large displacement of fragments, reduction is performed using an apparatus of the design of Cherkes-Zade et al. One needle is passed through the calcaneus, the other through the metatarsal heads. After stretching by pressure on the displaced fragment of the scaphoid, its reduction is easily achieved.

Sometimes compression fractures of the scaphoid with dislocation of the foot in the Chopard joint present significant difficulties for conservative treatment. In such cases, open reduction is indicated.

For multi-splinter fractures of the scaphoid with a large displacement of fragments not amenable to conservative treatment, arthrodesis should be performed between the scaphoid bone and the head of the talus and the posterior surfaces of the three sphenoid bones. This intervention can lead to shortening of the inner edge or part of the foot and lowering of the inner arch - flat feet. Some authors suggest restoring balance by resecting part of the scaphoid. In our opinion, the use of a bone graft after refreshing the articular surfaces of the bones surrounding the scaphoid is more perfect. A tibial bone graft can be used. During the operation, a bone groove is formed in the heads of the talus and I sphenoid bones, where the bone graft is inserted; it is possible to fill the defect with cancellous bone taken from the wing of the ilium.

The scaphoid bone should not be removed even if it is significantly damaged, since the possibility of fusion is not excluded with prolonged plaster immobilization. Removal of the scaphoid bone can further affect the statics of the foot in the form of a pronounced flattening of the sole and valgus curvature of the forefoot. In case of severe damage to the scaphoid, arthrodesis is performed along the Chopard joint line with bone grafting. After the operation, a deaf plaster cast is applied up to the knee joint with a metal instep support for a period of 3 months. Loading the diseased limb in such a plaster cast begins after 5-6 weeks. After removing the plaster cast, physiotherapy exercises, massage, swimming in the pool or baths are prescribed. In the future, patients should wear orthopedic shoes for at least 6-8 months or instep insoles for up to a year or more.

Sphenoid bone fractures... All sphenoid bones, except for the first, are articulated on all sides with other bones of the foot. Therefore, isolated fractures are extremely rare. More often, fractures are combined with dislocations of the metatarsal bones in the Lisfranc joint. This damage is explained by the fact that the anterior articular surfaces of the sphenoid bones articulate with the posterior articular surfaces of the first three metatarsal bones, and the line passing between these bones forms the inner part of the Lisfranc joint.

Of the three sphenoid bones, the most often damaged is I, located at the inner edge of the foot and less protected from external influences. Nevertheless, fractures of all sphenoid bones are possible at the same time.

Intra-articular sphenoid bone fractures and belong to the category of severe injuries of the foot. In most cases, they result from compression or crushing of the sphenoid bones between the metatarsal and scaphoid bones. Basically, these fractures are the result of direct trauma - the fall of heavy objects on the dorsum of the foot. The prognosis for these fractures is good, but sometimes long-term pain remains. In elderly people, the development of arthrosis in the joints of the foot should be expected.

The technique of X-ray examination and the method of recognizing fractures of the sphenoid bones is the same as for fractures of the scaphoid bone. The difference is that the superposition of II and III sphenoid and metatarsal bones articulating with them often simulates the fracture line. A slight change in the direction of the X-rays avoids overlapping contours.

In case of fractures of the sphenoid bones without significant displacement of the fragments, a circular plaster cast of the "boot" type is shown. A metal instep support is inserted into the plantar part of the bandage to prevent the development of post-traumatic flat feet.

Walking is prohibited for 7-10 days, then a dosed load on the injured limb is allowed. The plaster cast is removed after 5-7 weeks and physiotherapy exercises, massage, baths are prescribed. It is recommended to wear shoes with an orthopedic cork insole throughout the year. Ability to work is restored after 8-10 weeks.

In case of fractures of the sphenoid bones with displacement of fragments, when conservative measures do not give the desired effect, an operation is performed with transarticular fixation with a metal Kirschner wire.

The prognosis for fractures of the sphenoid bones is generally favorable; however, pains are often observed that can last for a long time.

Cuboid fractures... The cuboid bone is the key to the outer arch of the foot and rarely breaks, even though it is located in the outer foot area. Practically, a cuboid fracture occurs as a result of direct trauma. In rare cases, the cuboid bone breaks into several fragments when it is compressed between the calcaneus and the bases of the IV and V metatarsal bones. A fracture of the cuboid bone can be caused by a fall of weight on the foot in a position of sharp bending of it. Most often, the fracture line of the cuboid bone runs in the sagittal or slightly oblique direction. The external fragment has a protrusion, which is limited in front by the groove for the long peroneal muscle.

Comminuted fractures of the cuboid bone often combined with fractures of other bones of the foot, in particular with fractures of the base of the metatarsal bones, III sphenoid and scaphoid bones. Isolated cuboid fractures are extremely rare. When diagnosing a cuboid fracture, one should not forget about the existence of additional bones that can be mistaken for an avulsion cuboid fracture. The separation of bone tissue from the cuboid bone is observed quite often in severe trauma in the midfoot area.

X-ray examination of the cuboid bone is most informative in direct projection.

Like fractures of the sphenoid bones, fractures of the cuboid bone are usually not accompanied by a large displacement of the fragments. Therefore, treatment is mainly reduced to immobilization of the foot with a plaster cast of the "boot" type, into the plantar part of which a special metal instep support is inserted.

Walking is prohibited during the first 5-7 days, then a dosed load on the injured limb is allowed. A plaster cast is applied for 4-6 weeks, after which physiotherapy exercises, massage, swimming in the pool or baths are prescribed. Orthopedic shoes with a cork insole should be worn throughout the year. Ability to work is restored after 6-8 weeks.

It is not uncommon for multi-splinter fractures to remain painful for several months, especially with prolonged walking. In such cases, it is necessary to promptly remove small fragments. If a comminuted fracture of the cuboid bone is accompanied by fractures of other bones of the foot, then surgical treatment is recommended.

Fractures of the cuboid bone are rare. This is due to the peculiarities of the anatomical position of the cuboid bone, in which it is protected from damage by the surrounding bones.

The main types of cuboid fractures are compression and avulsion fractures.

Fractures due to insufficient bone tissue are called stress fractures and are the third and least common group of injuries.

The most common type of cuboid fracture is an avulsion fracture in the area of ​​its outer surface.

Detachment occurs in the area of ​​attachment of the calcaneal-cuboid ligament, and the bone fragment, in fact, comes off with it.

These fractures are best seen on radiographs or CT scans.

They are often missed, mistaking the damage for a simple "sprain".

Patients describe the typical mechanism of trauma in the form of twisting of the foot, often the foot is tucked inward.

Clinically, with such fractures, pain will be localized along the outer edge of the foot.

Careful examination in such cases allows you to distinguish damage to the external ligaments of the ankle joint from an avulsion fracture of the cuboid bone.

The severity of subcutaneous hemorrhage and bruising in such fractures can vary.

Conservative treatment

The vast majority of avulsion fractures can be treated conservatively, since these are mostly fractures without displacement or with minimal displacement.

Surgery

Surgical intervention in patients with avulsion fractures of the cuboid bone is rarely indicated.

The operation is indicated primarily for patients with clinically pronounced pseudoarthrosis after an avulsion fracture, in which adequate conservative treatment has already been carried out, including immobilization for 8-12 weeks and modification of the shoes used.

In such cases, it is usually sufficient to remove the ununited fragment of the cuboid bone.

The second most common type of scaphoid fracture is compression fractures.

This type of fracture results from a relatively higher energy injury, most often from a fall on the foot.

These fractures are also often associated with damage to the Lisfranc joint or other fractures / dislocations of the tarsometatarsal joints, which requires special attention.

Patients usually have a history of high-energy trauma.

Soon after such an injury, pronounced swelling of the foot often develops. Patients with a similar foot injury are usually examined in the most careful way, since fractures of the cuboid bone are often combined with fractures or dislocations in other parts of the foot.

All patients after high-energy trauma that led to a fracture of the cuboid bone undergo computed tomography, since concomitant injuries of the tarsal and metatarsal bones are also common in these patients.

Conservative treatment

Patients with isolated cuboid fractures without displacement or with minimal displacement are shown to be immobilized with a short plaster splint, which allows the load on the leg.

Upon termination of immobilization, the plaster splint is changed to an orthopedic shoe and a dosed load on the foot is allowed.

Return to normal shoes is determined by the severity of pain and residual edema, the presence of radiological signs of adhesion.

Most often, patients begin to wear their usual shoes 8-12 weeks after the injury.

Surgery

The tactics of treating fractures of the cuboid bone with displacement of fragments is still a subject of debate, since there is no consensus as to how significant the displacement must be in order for the fracture to be unambiguously subject to surgical treatment.

Most doctors agree that the cuboid bone is an important stabilizer of the lateral column (outer edge) of the foot, and a change in the length of the lateral column inevitably leads to the development of foot deformity, flat feet and pain.

The most common deformity due to compression fracture of the cuboid bone is the shortening of the lateral column, so any surgical intervention should be aimed at restoring this length of the lateral column.

There are various surgical techniques. In our practice, we restore the length of the lateral column due to internal fixation of the fracture with plates and screws and, if necessary, bone grafting using supporting autografts from the iliac crest.

The results of treatment in all patients turned out to be good, and we apply this method of treatment for any fractures of the cuboid bone, accompanied by a collapse of its articular surface.

In case of multi-splinter fractures, the only way to restore the length of the lateral column of the foot can be a bridge osteosynthesis with a plate. If the fracture is accompanied by severe soft tissue damage, an external fixator may be the only treatment option. Regardless of the fixation technique used, all attention should be focused on maintaining the length of the lateral column of the foot, without which it is impossible to restore the normal shape and function of the foot.

Fractures due to insufficient bone tissue, or stress fractures of the cuboid bone, are usually characterized by the gradual development of pain in the area of ​​the outer edge of the foot, which increases with physical activity.

These fractures are rare and often remain undiagnosed.

Diagnostics often require advanced radiation imaging techniques.

Stress fractures of the cuboid bone are common in athletes.

Conservative treatment

Conservative treatment in most cases allows you to achieve the consolidation of a stress fracture of the cuboid bone.

Initially, the patient may be immobilized for 4-6 weeks.

In the absence of stress, this period is sufficient for the fracture to heal.

Upon completion of immobilization, the degree of stress on the leg and the level of physical activity will be determined by the patient's symptoms.

Surgery

Surgical treatment for these fractures is rarely indicated. It can be shown, for example, when the patient still has pain syndrome despite adequate conservative treatment.

Before making a final decision on surgical treatment, we prescribe our patients a course of high-energy shock wave therapy.

Surgical treatment may include bone grafting of the fracture area and stabilization with a compression screw. If it also proves ineffective, arthrodesis of the calcaneo-cuboid joint may be indicated.

Fracture of the foot bones is one of the most common injuries of this part of the lower limb, consisting of 26 large and small bones. The injury requires a long and complex treatment due to the fact that the foot is constantly involved in the motor function of the lower extremities.

The cure period depends on the type and severity of the injury, correctly and in the required amount of medical care provided at all stages of treatment, the age of the victim, the general condition of the body and other factors.

A fracture of the bones of the foot occurs due to mechanical impact on the foot or a sharp movement of the leg from its wrong position. A heavy falling object can also disrupt the integrity of bone tissue. Most often, injury occurs due to a fall on the leg from a great height.

There is a pathological type of fracture, when a slight mechanical effect is enough to receive damage. This is due to the weakness of bone tissue caused by osteoporosis, osteochondrosis, the presence of oncological neoplasms, and autoimmune pathologies.

In accordance with the reasons leading to the injury, one of the bones is damaged, which is associated with a certain location and distribution of the load. Foot fractures according to the factor of influence are divided into the following:

Injury can occur due to excessive physical exertion, with intense sports. In such cases, a so-called stress fracture occurs. As a result of constant pressure, bone tissue cracks. Basically, this injury occurs with the talus and metatarsal bones.

How does it manifest?

Fractures of the foot bones differ in symptomatic presentation, depending on the type of damaged bone. The main symptoms of a foot fracture are as follows:

• Strong pain;
• Bruise;
• Swelling at the site of injury;
• Difficulty moving;
• Deformation.

Fractures of the foot bones are always accompanied by severe swelling and hematoma under the skin in the injured area. The intensity of the pain syndrome is different - from mild to unbearable. Signs of a foot fracture due to bone damage:

Often, during injury, mild pain occurs, and the victim does not immediately understand that a fracture has occurred, confusing the injury with a bruise. In such cases, an accurate diagnosis can only be made through a medical examination and X-ray.

First aid

After an injury has occurred, the victim must be taken to the trauma department, where a traumatologist will be able to determine whether there was actually a bruise or a fracture. Before the arrival of doctors, first aid is required.

It is forbidden to massage, knead the affected area to relieve pain. The person providing assistance should touch the leg as little as possible so as not to dislodge the broken bone.

A splint is needed to relieve pain and prevent misaligned fractures. In the case when a special medical device is not at hand, sticks, pieces of reinforcement, boards are used, they must be placed on both sides of the foot, bandaged to the injured limb with bandages, gauze, a rag, etc.

If the injury is of an open type (it is easy to find out by the presence of an open wound surface, bleeding), the wound must be treated with antiseptic drugs, hydrogen peroxide, Chlorhexidine, the edges of the wound should be lubricated with iodine. A bandage is applied to stop the bleeding.

When applying the splint, the material used to fix the foot must be wrapped with a rag or bandage so that the open wound does not come into contact with a dirty object.

How to treat?

Medical assistance to the victim begins with pain relief. For this, pain relievers are prescribed, and if they are not sufficiently effective, a blockade is placed - the introduction of an anesthetic directly into the site of injury.

1. In case of a foot fracture, treatment is selected on an individual basis and requires an integrated approach: If the injury is of a closed type, with no displacement, a long-term fixation of the foot by applying a plaster cast is necessary. The terms of wearing the plaster vary from 1 to 3 months, depending on the severity of the clinical case.
2. If a closed fracture is accompanied by a displacement, it is necessary to carry out a reduction - folding the bones in the right order. Reduction is carried out in two ways - open and closed, depending on the severity. After folding the bones in the desired primary position, a plaster cast is applied. If there were a lot of debris, medical staples and screws are used to fix them. After removing the plaster, the motor function of the foot is restored. The injured foot must be developed carefully and gradually.
3. Injury of the scaphoid bone in most cases is accompanied by a fracture of adjacent bones. Often, a bone fracture leads to a simultaneous dislocation. As a rule, this is accompanied by intense painful sensations - a blockade is placed to relieve the symptoms. If there is no dislocation and displacement, it is necessary to wear a cast for up to 5 weeks.
4. In case of dislocation with a fracture, the Elizarov apparatus is installed to reposition the bones. In severe clinical cases, the victim is assisted by an open operation - a bone fragment is fixed with a silk suture. The period of immobilization of the limb is up to 12 weeks.
5. A fracture of the sphenoid bone without displacement is treated with the imposition of a plaster cast, the period of wearing a plaster cast is from 1 to 1.5 months. Rehabilitation after a fracture can take more than 1 year.
6. Fracture of the cuboid bone involves the imposition of plaster for up to 2 months, in case of displacement, a closed reduction is performed.
7. With an injury to the fingers, it is very painful for a person to step on the foot, a cyanotic swelling appears at the site of injury. Treatment - a plaster cast, for a period of 4-6 weeks.

While in a cast, you must follow a diet. The basis of the diet should be fermented milk and dairy products, enriched with calcium, which helps to strengthen bones and accelerate their union.

Before removing the cast, you must undergo a medical examination. You can only find out if the bones have healed completely on an x-ray. After removing the plaster cast, a set of exercises is prescribed to restore the motor function of the foot.

Rehabilitation

The swelling after removing the plaster cast will persist for a long time. To stop this symptom, you can use drugs of the local spectrum of action - gels, ointments, creams. A massage is performed to dissolve the accumulated fluid.

Physiotherapy and special exercises are effective and mandatory means of rehabilitation, which can significantly shorten the period of complete recovery from injury. Without exercise therapy and physiotherapy, the muscles of the foot can atrophy, which will lead to a loss of motor function. The massage should only be performed by a specialist. If you do the massage yourself, the effect of it can be exactly the opposite, you can damage only the fused bones and soft tissues, increasing the swelling.

Before starting to develop the foot with exercises of physiotherapy exercises and massage, the patient is prescribed to wear instep supports immediately after removing the plaster, as a rule, for a year.

During the first 4-6 months after the injury, it is recommended to replace the usual orthopedic shoes. The complex of physiotherapeutic procedures is selected individually, aimed at reducing swelling, pain and accelerating the process of bone tissue fusion.

A person with a broken foot is unable to walk on both legs. Timely and correctly provided first aid to the victim will help prevent the development of severe complications. Competent treatment often includes wearing a plaster cast, following a specially selected diet and conducting complex rehabilitation (physiotherapy, massage, exercise therapy) at the final stage of treatment.

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

The huge number of bones in the foot, the colossal loads that these bones have to withstand daily, the lack of minimal knowledge about the prevention of foot fractures make this complex anatomical formation especially vulnerable.

Anatomical excursion

The foot is the lower part of the lower limb, which has a vaulted structure and is designed to absorb shocks that occur when walking, jumping and falling.

The feet have two main functions:

• firstly, they maintain body weight;
• secondly, they provide the 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), the 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 highly durable, so a dislocation of the foot occurs much less often than a fracture.

Since we are talking about fractures, let's pay special attention to the bony skeleton of the foot, which consists of the following bones:

1. Calcaneal. This is the largest bone in the foot. It has the shape of a complex three-dimensional rectangle with depressions and protrusions to which muscles are attached and along which nerves, vessels and tendons pass.
2. Ram (supracal). It ranks second in size, is unique in its high percentage of articular surface and in that it does not contain any attachment of bone or tendon. Consists of the head, body and the neck connecting them, which is the least resistant to fractures.
3. Cuboid. 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 tendon of the peroneus longus muscle can fully function.
4. Scaphoid. Forms joints with the talus and three sphenoid bones. Occasionally, the development of this bone is disrupted and the 27th bone of the foot can be observed - an accessory scaphoid bone connected to the main cartilage. With an unskilled reading of an X-ray photograph, the accessory bone is often mistaken for a fracture.
5. Wedge-shaped. Attached to other bones on all sides.
6. Metatarsal. Short tubular bones, used for shock absorption.
7. Phalanges of the 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.
8. Sesamoid. Two very small (smaller than a pea) but extremely significant round bones are located inside the tendons and are responsible for flexion of the first toe, which receives 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).

Among the fractures of the foot, the most common are:

• talus - less than 1%, of which about 30% of cases lead to disability;
• calcaneal - 4%, of which 83% - as a result of a jump on straight legs from a great height;
• cuboid - 2.5%;
• scaphoid - 2.3%;
• Metatarsal is the most common type of foot bone injury.

Moreover, athletes are characterized by a fracture of the fifth metatarsal bone 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. For children, such an injury is not typical, there are incomplete fractures (cracks).

At a young age, split fractures are frequent, after 50 years - depressed.

Causes of injury

Fractures of the bones of the foot can occur for several reasons:

• falling of heavy objects on the foot;
• jump (fall) from a great height with landing on feet;
• on a kick;
• on impact 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 impact in an accident. Upon impact, body weight is transferred to the talus, it cuts into the heel and splits it into pieces.

Fractures are usually unilateral, usually complex.

Fatigue fracture of the calcaneus stands apart, the main cause of which is chronic overload of the bone with anatomical defects.

It should be noted that the very fact of the presence of an anatomical defect does not lead to a fracture; constant and rather serious loads are necessary for its occurrence, therefore, most often such a fracture is noted in army recruits and amateur athletes who neglect medical examination before the appointment of 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 blows and is often combined with injuries to the lumbar spine and other fractures (the calcaneus usually suffers from the bones of the foot along with the talus).

The injury is considered serious, in a third of cases it leads to disability. This state of affairs is associated with a lack of blood circulation provoked by trauma.

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

Cuboid fracture

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

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

Scaphoid fracture

It is formed as a result of a heavy object falling on the back of the foot at a time when the bone is in tension. A fracture with displacement and in combination with fractures of other bones of the foot is characteristic.

Recently, fatigue fractures of the scaphoid have been noted, which used to be a great rarity - 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 sphenoid bones between the metatarsal and scaphoid.

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 frequently diagnosed, are subdivided into traumatic (arising from a direct blow or twisting

feet) and fatigue (resulting from deformation of the foot, prolonged repeated loads, improperly selected shoes, osteoporosis, pathological bone structure).

A fatigue fracture is often incomplete (it does not go further than a fracture in the bone).

Injury of the phalanges of the fingers

A fairly common fracture, usually caused by direct trauma.

The phalanges of the fingers are devoid of protection from external influences, especially the distal phalanges of the first and second fingers, which are noticeably protruding forward compared to the rest.

Almost the entire spectrum of fractures can be observed: there are transverse, oblique, T-shaped, comminuted fractures. Displacement, if observed, is usually on the proximal phalanx of the thumb.

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

Sesamoid fracture

A relatively rare type of fracture. The bones are small, located under the end of the metatarsal bone of the big toe, they usually break due to sports activities associated with a large load on the heel (basketball, tennis, long walking).

It is sometimes easier to remove the sesamoid bones than to treat the fracture.

Symptoms depending on the location

Symptoms of foot fractures, regardless of the type:

• pain,
• edema,
• inability to walk
• bruising in the area of ​​injury,
• change in the shape of the foot with a fracture with displacement.

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

Specific signs:

In the photo, a characteristic symptom of a foot fracture is swelling and cyanosis.

• with a talus fracture: displacement of the talus (noticeable on 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 scaphoid fractures: acute pain in the location of the corresponding bone, when trying to retract or bring the anterior part of the foot, edema on the entire anterior surface of the ankle joint.

Diagnostic methods

Diagnostics usually boils down to X-ray examination, which is carried out in one or two projections, depending on the site of the alleged fracture.

If there is a suspicion of a talus fracture, X-ray examination is uninformative; computed tomography is the best diagnostic method.

First aid

The only type of first aid for suspected foot fracture is to ensure the immobility of the foot. It is carried out in mild cases by a ban on movement, in the rest - by imposing a tire.

Then the victim should be taken to the clinic. If swelling occurs, you can apply cold.

Therapeutic measures

Treatment is prescribed depending on several factors:

• the kind of broken bone;
• closed or open fracture;
• complete or incomplete (crack).

Treatment consists of the application of 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 fractures of the sphenoid bones with displacement (in this case, an operation with transarticular fixation with a metal Kirschner wire is indicated) or for fractures of the sesamoid bones.

Recovery from injury

Recovery after injury is achieved through special massage and exercise therapy, reducing the load on the injured limb, using orthopedic insoles, instep supports, heel pads and refusing to wear heels for a long period.

Long-term pain may occur with fractures of the sphenoid bones.

Complications

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

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, when 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 athletes to the fact that a thoughtless increase in loads and the use of unsuitable shoes when exercising is a direct way to close yourself the opportunity to do physical education forever.

Even good recovery from a foot injury will never allow you to return to super-intense workouts. Preventing is always easier than curing.

Causes of sharp and pulling pain in the foot when walking, in the morning and constant

Pain on the outside of the foot is caused by a number of reasons. It can be on the inside (medial) and on the outside (lateral), in the arch, instep, in the upper part and on the soles, sharp and, on the contrary, aching.

In accordance with how and under what circumstances the pain syndrome arose, gradually over time or abruptly, after an injury, and also taking into account specific symptoms, it will be easier to figure out what is causing it.

Let's take a look at the most common causes of severe pain on the outside of the foot. We will dwell on the general causes of each condition, how they manifest themselves, their classic signs and symptoms. At the end of the article, there is a simple guide to diagnostics. Read and learn more about the most effective treatment options for each case.

Common Causes

1) stress fractures

Stress fractures are a common cause of this problem. These are small cracks in one of the bones, usually as a result of repetitive movements during sports activities.

What areas are affected most often? The location of the pain depends on what is damaged. Fractures of the calcaneus or navicular bone cause pain on the side of the foot, stress fractures of the metatarsal bones on either side of the foot.

In this case, it usually hurts at first not much, pulls, but gradually the condition worsens.

2) Sprained ankle ligaments

Ankle sprains are the most common cause of severe pain in the outside of the foot (from ankle injuries). It accounts for up to 85%. This happens to the ankle during inversion.

Any ligament can be stretched, but the anterior talus-peroneal ligament suffers most often. It is damaged when we twist the leg inward. The ankle is shifted outward. This is known as inversion trauma. It ruptures some or all of the fibers in the ligament, causing severe pain, swelling, bruising, and joint instability.

35% of people who have ankle sprains have ongoing pain and instability problems. It also contributes to future sprains. You can avoid the problem by thoroughly rehabilitating after the first injury.

3) Cuboid Bone Syndrome

Cuboid syndrome (see picture) is a less common cause of side pain in the foot, but it is often diagnosed as leading to symptoms that persist for a long time.

It happens when one of the small bones of the foot is partially dislocated after an injury such as a sprained ankle or as a result of constant overstrain of the leg.

The most common symptom is external pain that extends down to the toes. It starts to hurt more in the morning, when walking and running, especially on uneven surfaces and when jumping. There is redness and swelling. Symptoms, if diagnosed accurately and treated immediately, usually resolve within a few weeks.

If the leg does not pass for more than 3 months, the next thing to suspect after the ankle is cuboid bone syndrome, which occurs in almost 7% of people with ankle sprains.

4) Peroneal tendonitis

Peroneal tendonitis is another common cause of pain around the outside of the foot and in the heel area. The disease occurs when the peroneal tendon of the foot is repeatedly overstrained, causing irritation, inflammation, and degeneration.

It is usually caused by frequent long distances, abnormal foot position, muscle imbalance, and occurs after an ankle sprain. With tendinitis, the condition worsens gradually over several weeks or months, and the foot hurts especially badly with the first steps in the morning, as well as with the beginning of activity after rest.

5) the Tarzal Coalition

Tarsal coalition is one of the rarest causes of leg pain, affecting about 1 in 100 patients.

The condition is caused by the fact that 2 or more bones grow together with each other. It is a congenital problem and symptoms usually appear in the second decade of life.

They often come very unexpectedly, they are pain, fatigue and cramps. It can also affect in such a way that you walk abnormally. There are other problems, such as ankle sprains and abnormal biomechanics of the foot. Treatment usually includes surgery, shoe inserts, and leg immobilization.

6) Bunyon

Bunion is a common cause of deformity and pain in the big toe.

It develops when the thumb is turned inward, pointing towards others. This causes the bones at the base of the thumb to bulge. The result is pain, inflammation, redness, and swelling around it. The medical term for bunion is hallux valgus. Sometimes this problem also happens with the little finger.

It is believed that there is a genetic link to bursitis. It affects especially those whose joints are overly flexible, but it can also be due to poor shoes, in which the toes are crowded inward. The risk is increased by diseases such as gout and rheumatoid arthritis. In cases of moderate severity, special devices that align the fingers are helpful, but in more complex cases, surgery may be required.

7) Corns

Calluses appear on any part of the leg, often from behind, from above and from the side. They form when a patch of skin is subjected to repeated friction and it tries to defend itself by creating additional layers.

Calluses are usually painless, but deep ones are very unpleasant. There are simple rules for their treatment and prevention.

8) Posterior tibial tendon tendonitis

Tibialis posterior tendonitis causes pain on the inside of the foot.

The tendons are connected to the inside of the ankle. Its main function is to support the inner arch of the foot. Like all other types of tendonitis, this develops when the tendon becomes irritated, inflamed, or degenerated, usually due to constant irregular stress or injury.

The pain increases with activity and recedes when the legs are resting. Tendenitis sufferers often have flat feet.

9) Arthritis

Arthritis can cause pain anywhere in the lower limb, but most of the time it occurs on the instep and sideways. There are 2 common types of arthritis - rheumatoid (inflammatory) and osteoarthritis (degenerative). More often the leg hurts due to rheumatoid arthritis. Symptoms of varying severity come and go, and there are seizures.

How to diagnose your condition

As you can see, there are a number of different causes of this ailment. If the problem is trauma-related, it is most likely a sprain or cuboid syndrome; if the pain came on gradually, it could be a stress fracture or tendinitis. In adolescents, this is most likely due to the tarsal coalition. People over the age of 50 are more likely to have arthritis. If the skin feels dry and thickened, callus or callus tissue is present.

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Fracture of the cuboid bone

The cuboid bone is located in the area of ​​the outer part of the foot, but despite this, its isolated fractures are quite rare.

Among the fractures of the bones of the foot, fractures of the cuboid bone account for about 2.5%, and among the fractures of the bones of the skeleton - 0.14%.

The cuboid bone (thallus os cuboideum) refers to the bones of the tarsus of the foot.

Its articular surfaces (formed by cartilage) are articulated with the fourth and fifth metatarsal bones and the calcaneus.

The cuboid bone is located at the outer edge of the foot between the calcaneus and the metatarsus.

Causes and mechanisms

Fractures of the cuboid bone result from direct trauma, such as a blow and fall on the foot of a heavy object.

Symptoms

Symptoms common to fractures come to the fore: pain, dysfunction, with passive movements, the pain intensifies, swelling, hemorrhage.

But a careful examination reveals symptoms that characterize the unconditional presence of a cuboid fracture: acute pain on palpation corresponds to the location of the cuboid bone, the presence of deformation of its contours, stepped performances with displacement of fragments, exacerbation of pain with axial pressure on the IV-V metatarsal bones, when trying to divert or bring the forefoot, with rotational movements.

In cases where a fracture of the cuboid bone occurs simultaneously with a fracture of the scaphoid with subluxation of the bones, deformity occurs, which depends on the degree of displacement of fragments with flattening of the arch with a deviation of the forefoot outward or inward.

On palpation, an aggravation of pain occurs when touching all the bones of the site, with axial pressure on all toes.

Fractures with displacement, subluxation or dislocation of fragments violate the contours of the bones along the dorsum with the presence of stepwise deformity.

Diagnostics

The final diagnosis is made after X-ray examination.

But it should be remembered that there are additional bones: the peroneal epiphysis of the tuberosity of the V metatarsal bone (described by V. Gruber in 1885) - is located in the angle between the cuboid and V metatarsal bone, closer to its posterior surface.

Os regneum - appears under the tuberosity of the cuboid bone, at the junction of the cuboid and calcaneus bones and can consist of two parts - os cuboideum secundarium in the form of a cuboid process that goes towards the scaphoid os cuboideum secundarium - a bone that is located between the calcaneus, talus , cuboid and scaphoid bones.

On radiographs, all additional bones have clear surfaces, edges, while with fractures, the plane of the fracture is uneven, jagged. In addition, on palpation, they are painful, there is no hemorrhage.

First aid

First aid for a fracture of the cuboid bone corresponds to the actions rendered to the victim in case of fractures of other bones of the tarsus and metatarsus.

It is necessary to fix the ankle and knee joint to prevent the displacement of the fragments. For this, you can use any available means (boards, sticks, iron rods, towels, scarves, any other fabrics).

As a last resort, you can bandage the injured leg to the healthy one.

Treatment

Usually, fractures of the cuboid bone are not accompanied by severe displacement of the fragments, as in the case of fractures of the sphenoid bones.

Therefore, the treatment is reduced to immobilization with a plaster cast of the "boot" type, in the plantar part of which there is a metal instep support.

A plaster cast is applied from the fingertips to the middle third of the lower leg for 6 weeks. In this case, it is important to correctly model the arch of the foot.

Rehabilitation

In the first week after the injury, it is forbidden to walk, then a dosed load on the injured leg is allowed.

After removing the immobilization, the patient is prescribed physiotherapeutic treatment, mechanotherapy for the development of the ankle joint, and physiotherapy exercises. The ability to work returns in about 8-10 weeks.

Why does my foot hurt when walking?

After each kilometer traveled, the legs are subjected to a load of 60 tons. Although the limbs can handle a lot, they are also prone to stress and disease.

Forefoot diseases

The front third of the foot consists of the metatarsal bones, phalanges and ligaments between them. Calluses, blisters, mycoses, hammer toes, Morton's neuroma, hallux valgus, gout - various conditions are associated with the pathology of these elements of the foot. Metatarsalgias are any pains for which the cause has not been established. Traumatic injuries or too tight shoes increase the likelihood of foot pain when walking.

While movement is extremely beneficial for your health, pain that gets in the way of every step is a serious cause for concern.

Extensor tendonitis of the foot develops due to constant overstrain of the lower leg - prolonged walking in uncomfortable shoes can be the main cause. The pain increases when you try to bend or straighten your fingers.

Stress fractures threaten overweight people, which puts increased stress on the bones. Even seasoned athletes doing marathons and running can suffer from repeated bouts of pain. They get worse with walking and don't stop over time.

Diseases of the middle part of the foot

The middle third of the foot is represented by the bones of the tarsus and their joints. They account for a significant part of the medial longitudinal arch of the foot arch. Pain in the midfoot when walking occurs as a result of fatigue fractures, pinching of the lateral plantar nerve, equine deformity (associated with too high an arch), sprains of the tibial posterior tendon ligaments, tibial nerve syndrome, extensor tendinitis. Treatment directly depends on the diagnosis, with which it is better not to delay, as cascading pains can worsen.

Fractures of the second, third, and fourth metatarsal bones are common in people who do morning jogging. Gradually, it is felt that the foot of the leg hurts when walking. The pain rises upward, accompanied by edema.

The scaphoid bone runs along the inner midfoot and fractures are more complex. Initially, pain only worries during exertion and disappears after rest, but over time the recovery periods become longer.

Dislocation fractures in the Lisfranc joint, formed by the accumulation of small bones in the arch region, are due to the anatomy of the first and second metatarsal bones, which do not have ligaments. This leads to dislocation when making sharp turns or jumping.

Micro-tears of the thick plantar fascia often affect the heel area, but women's legs, whose joints are unstable, suffer from painful attacks after rising in the morning. Medicines, physiotherapy come to the aid of patients.

If the foot hurts when walking, the influence of shoes cannot be ruled out, especially for people who go in for sports, carry a child, and suffer from arthritis. Too soft a sole sags and does not support the foot, therefore, after any walk, discomfort arises.

Back foot diseases

The back third of the foot consists of the calcaneus and talus, and the joints that connect them together. The answer to the question of why the heel hurts lies in the anatomy of the foot. When walking, the heel is the first to hit the ground, and tremendous forces affect its tissues. Pain in this area is the most common complaint in adults. Inappropriate shoes and injuries are at the top of the list of causes that relate to this symptom. Plantar fasciitis, contusion of the heel, stress fractures, tarsal tunnel syndrome, entrapment of the medial calcaneal nerve, bursitis of the Achilles tendon and calluses bother the heels, and the left leg suffers more often than the right.

How to restore ease of gait?

Any disease is easier to prevent, since irreversible processes require expensive and protracted treatment. Caring is the main condition for the beauty and health of the legs. You cannot walk in shoes with a narrow nose and high heels for a long time. It is advisable to use special orthopedic insoles prescribed by an orthopedist.

Try to maintain excess weight and include calcium-rich foods in your diet to strengthen your bones. If possible, it is better to avoid standing on your feet for a long time, not to sit with one leg over the other, as this impairs blood circulation. Sports and other physical activities should be reasonable, and training shoes with quality instep supports.

After a hard day at work, your legs need a decent rest. Treatments include relaxing sea salt and essential oil baths and light massage.

It is better to solve problems with the legs with an orthopedist, who develops a full cycle of gymnastics for every day. Even the usual "bicycle" exercise, stretching the feet in different directions, away from you and towards yourself with the help of a towel, reduces the load on the arch. If you raise your legs up and just shake them well, you can get rid of edema and normalize blood flow. Protect your feet!

Are there side spurs on the soles of the feet?

Vladimir Priorov

Usually, a heel spur causes pain when you step on the foot, that is, from the bottom of the heel.

MuDaKoV.net Alexey

certainly))))))

Alena Khazova

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In most cases, midfoot fractures are intra-articular. With these fractures, the anatomical relationships in the Lisfranc and Chopard joints are often violated, which further leads to such serious disorders as limitation of pronation, supination, adduction and abduction of the foot, to prolonged lameness, pain, disability, and sometimes to disability.

Clinical signs of fractures of the scaphoid, sphenoid and cuboid bones are a sharp edema in the middle section of the foot, extending to the anterior surface of the ankle joint, pronounced deformation of this section immediately after injury, pain at the fracture site on palpation and pushing the finger along the axis, the impossibility of loading the injured limb. The final diagnosis is made using X-ray data.

Scaphoid fractures 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 fractures of the foot bones. As you know, almost all the weight of the body falls on the inner part of the foot. Trauma narrows the gap between the sphenoid bones and the head of the talus, causing the scaphoid to be crushed or split and pushed out of its bed.

In this case, the strength of the longitudinal arch of the foot is disturbed, 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 injury, a fracture occurred in 10 patients, indirect - in 4. In 3 patients, compression fractures of the scaphoid bones combined with dislocation in the Chopard joint. Such a fracture dislocation occurs when the foot is forcibly abducted or adducted, when a weight falls on the middle section of the foot, or when a wheel of a moving vehicle hits. In most cases, scaphoid fractures were the result of a drop in weight on the foot with increased plantar flexion.

These fractures are accompanied by displacement of 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 outer tibial bone at the inner edge of the scaphoid bone; e - separation of a fragment of the tuberosity of the scaphoid in the area of ​​attachment of the tibial muscle.

As a rule, the displacement occurs to the dorsum, since the ligaments located on the dorsum between the talus, sphenoid and cuboid bones are less strong than on the plantar side. Detachment of the horizontal plate of the scaphoid bone in the future can cause prolonged pain when walking (Fig. 4.8).

Sometimes there is a displacement of fragments to the inner edge of the foot. Usually, such a fragment is a fragment of the tuberosity of the scaphoid, formed after an impact or as a result of detachment of the tibial muscle at the place of its attachment to the scaphoid. These fractures are uncommon and are usually mistaken for an additional external tibial bone. Therefore, when going to formulate a diagnosis, it must be borne in mind that, unlike an additional bone, which has smooth contours, the fragment has jagged contours. In cases of doubt, the radiographs of both feet should be compared.

The tearing of the tuberosity of the scaphoid is more common than many authors suggest. 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 of the foot. The fracture line in the area of ​​tuberosity 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 line of fracture of the scaphoid, going from front to back, is a continuation of the line between the medial and intermediate sphenoid bones. Sometimes the medial fragment is displaced along with the medial sphenoid and I metatarsal bones along the line of the Lisfranc joint posteriorly and medially. We observed such a displacement with diverging 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 is often noted, possibly their combination with the separation of the inner end of the cuboid or anterior end of the calcaneus.

In compression fractures of the scaphoid with dislocation of the foot in the Chopard joint, the displacement of the fore and middle parts of the foot is possible to the rear, to the sole, to the inside, and very rarely to the outside.

Clinical picture

With an isolated fracture of the scaphoid, the load of the foot due to pain is impossible, the position of the foot is forced - the patient seeks to keep it in the supination position and avoid pronation. When the fragments are displaced, they are felt under the skin. The clinic for fracture dislocation in the Chopar joint is characterized by a sharp deformation of the midfoot and ankle joint, severe pain on palpation of the fracture area, the inability to load the injured foot. Deformation of the foot occurs in the first hours after the injury. Sometimes a dislocation in the Chopard 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 vermiform muscles. The fingers acquire a claw-like deformation (like a "clawed paw" with 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 bone shadow due to compression of the bone trabeculae. All these signs stand out in relief in the images in the lateral projection.

Treatment

If the fracture of the scaphoid is not accompanied by displacement of the fragments, a boot-type plaster cast should be applied in moderate plantar flexion of the foot, plastering a special metal instep support into the plantar part to prevent flattening of the arches of the foot. Duration of immobilization up to 8 weeks. Dosed load on the foot is allowed after 3-4 weeks. In the course of treatment, periodic X-ray control is required.

If the fragments are displaced, one should try to compare them manually under anesthesia or under intraosseous anesthesia in the patient's position lying on the table with the leg bent at the knee joint to a right angle. The reduction technique is as follows. One assistant holds the heel, the other pulls the toes forward, flexes the foot and makes 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; in most cases, the fragment is reduced. After control X-ray, a plaster cast is applied like a boot.

If the tuberosity of the scaphoid is torn off, it is necessary to give the foot 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 that, pain can 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 limb function. If the detached tuberosity of the scaphoid bone along with the ligament grows into place, there will be no violation of statics.

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

Reduction technique: one needle is passed through the calcaneus, the other through the heads of the metatarsal bones; after stretching the bed of the scaphoid, pressing on the displaced fragment, it can be easily adjusted.

Compression fractures of the scaphoid with dislocation of the foot in the Chopard joint, which are difficult to treat conservatively, require open reduction.

For multiple fractures of the scaphoid with significant displacement of fragments that cannot be treated conservatively, one should resort to arthrodesis, performing it in two directions - between the scaphoid and the head of the talus and between the scaphoid and the posterior surfaces of the three sphenoid bones. However, this intervention can lead to a shortening of the inner edge or part of the foot and to the lowering of the inner arch - flat feet. Some authors suggest resecting part of the scaphoid to restore balance.

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

It is not necessary to remove the scaphoid even if it is significantly damaged, since with prolonged plaster immobilization it is possible to achieve fusion. Removal of the scaphoid in the future may affect the statics of the foot due to the sharp flattening of the sole and the valgus curvature of the forefoot. It is possible to remove the scaphoid only if it is very severely damaged, but at the same time, arthrodesis along the Chopard joint line and bone grafting should be performed according to the above technique.

After the operation, for 3 months, a deaf plaster cast is applied up to the knee joint with a metal instep support. Load the diseased limb in such a bandage after 5-6 weeks. After removing the plaster cast, physiotherapy exercises, massage, swimming in the pool or baths are prescribed. In the future, patients should wear orthopedic shoes for at least 6-8 months or insoles-instep support for a year or more.

Fractures of the sphenoid bones. Due to the fact that all wedge-shaped bones, except for the medial, are articulated from all sides with other bones of the foot, isolated fractures are extremely rare. Such a fracture is more often combined with dislocations of the metatarsal bones in the Lisfranc joint. This is due to the fact that the anterior articular surfaces of the sphenoid bones are articulated with the posterior articular surfaces of the I, II and III metatarsal bones, and the line between these bones is the inner part of the Lisfranc joint (Fig. 4.9).

Of the three sphenoid bones, the medial bone is most often damaged, located at the inner edge of the foot and less protected from external influences. Nevertheless, 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 injuries of the foot. In most cases, they are caused by compression or crushing of the sphenoid bones between the metatarsal and scaphoid.

Basically, these fractures are the result of direct trauma - the fall of heavy objects on the dorsum of the foot. The prognosis of 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. Diagram 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, extending 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 of ​​application of the traumatic force, the impression of soft tissues is determined. Pathological mobility of the entire forefoot is noted.

Injury to the arch of the foot from fractures of the sphenoid bones occurs when a large crushing force is applied, which could displace the broken bones to 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; the only difference is that the superposition of the intermediate and lateral wedge-shaped and articulating metatarsal bones often simulates the fracture line. A slight change in the direction of the X-rays makes it possible to avoid overlapping contours.

Treatment

Fractures of the sphenoid bones are most often found without significant displacement of the fragments, therefore, treatment is reduced to the imposition of a circular plaster cast like a boot with a metal instep support mounted in the plantar part to prevent the development of post-traumatic flat feet. Walking is prohibited for 7-10 days, then a dosed load on the injured limb is allowed. The plaster cast is removed after 5-7 weeks, after which exercise therapy, massage, baths are carried out. It is recommended to wear shoes with an orthopedic cork insole throughout the year. Working capacity is restored after 8-10 weeks.

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

In general, the prognosis for fractures of the sphenoid bones is favorable, except for pain, often prolonged. Fractures of the cuboid bone. The cuboid bone is the key to the outer arch of the foot and rarely breaks, although it is located in the outer part of the foot. Almost always, its fracture is the result of direct trauma, but it can be caused by a fall of weight on the foot in the position of its sharp bending. In rare cases, when the cuboid bone is compressed between the calcaneus and the bases of the IV and V metatarsal bones, it is split into several fragments. The fracture line most often occurs in the sagittal or slightly oblique direction. The external fragment has a protrusion, which is bounded in front by a groove for the long peroneal 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 sphenoid and scaphoid bones. Isolated cuboid fractures are extremely rare. With a fracture of the cuboid bone, one should not forget about the existence of additional bones, which can be mistaken for a fragment of the cuboid bone. The separation of a piece of bone tissue from the cuboid bone is observed quite often in severe trauma in the midfoot area.

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

Clinical picture

With a fracture of the cuboid bone, there is a sharp local soreness and hemorrhage, capturing the entire outer part of the foot. Often, a fragment is felt between the base of the V metatarsal bone and the cuboid bone; while the latter is shifted up, forward or down. The fragment is usually mobile. If the bone is severely damaged, the outer edge of the foot is usually raised. Passive movements in the Chopard joint are sharply limited and painful, complete blockade of the joint is possible. In most cases, there is no significant displacement of fragments. Fracture lines can be very different (Fig. 4.10). By nature, the fractures are most often comminuted.

X-ray diagnostics

X-ray examination of the cuboid bone is performed in frontal and lateral projections. The most informative photograph is in direct projection.

Rice. 4.10. The most common cuboid fractures.

Treatment

Like fractures of the sphenoid bones, fractures of the cuboid bone are usually not accompanied by a large displacement of the fragments, therefore, treatment is mainly reduced to immobilization of the foot with a plaster cast of the boot type with a metal instep support inserted into the plantar part.

Dosed load on the injured limb is allowed no earlier than after 5-7 days. After removing the plaster cast (after 4-6 weeks), physiotherapy exercises, massage, swimming in the pool or baths are prescribed. Ability to work is restored after 6-8 weeks. During the year, the patient must wear orthopedic shoes with a cork insole.

With multi-splinter fractures, the patient often suffers from pain for several months, especially with prolonged walking. 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, surgical treatment is preferred.

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