Foot Fractures

Introduction

Although foot fractures account for approximately 5% to 8% of fractures in children, there is a scarcity of literature discussing complications of these injuries and complications arising from foot fracture treatment. Surgeons who treat foot injuries in children should be aware of certain injuries that are more inherently prone to complications, such as certain intraarticular hallux phalangeal fractures, distal phalangeal physeal fractures that extend through the nail matrix, Jones fifth metatarsal fractures, and rare severe fractures such as Lisfranc, talus, and calcaneus fractures. Careful attention to the preoperative, intraoperative, and postoperative care of foot fractures should help surgeons primarily avoid complications, but also be able to recognize and treat these potential complications.

Patient Factors

There are several patient factors and inherited conditions that can make pediatric patients more susceptible to foot fractures and affect their healing.

Increasing body mass index is associated with increased odds ratios of sustaining foot fractures, especially in the 6- to 11-year-old age range.

Fractures in children have been variably associated with vitamin D deficiency (8%–47%), and independent risk factors for vitamin D deficiency are older age and non-White skin. According to one case-control study, vitamin D deficiency is associated with an increased risk for fracture in the pediatric population, but the fracture risk is higher in upper extremity (UE) fractures than in lower extremity (LE) fractures. Vitamin D deficiency was 14.8 times higher than nonfracture controls in the UE fracture group and 2.9 times higher than controls in the LE fracture group. Certain inherited conditions such as type 1 diabetes, osteogenesis imperfect, and certain Ehlers–Danlos syndrome subtypes can be associated with increased risk of childhood fractures and impaired bone quality and healing. Asking patients about a personal or family history of these conditions is important.