Review Question - QID 107368

This previously sedentary elderly gentleman presents with traumatic foot swelling and inability to bear weight with a radiograph evidence a fracture on the posterior aspect of his foot. This is most likely a posterior talar fracture of the lateral tubercle and should be treated with immobilization or surgical fixation if necessary.

Clinical presentations of subtle fractures can be commonly confused with ligamentous injuries such as ankle sprains. These can lead to significant morbidity for the patient over the long-term. Pain on the posterior aspect of the foot in front of the Achilles tendon along with pain with plantar flexion should be suspicious for a fracture of the posterior part of the talus. The mechanism of these fractures is most commonly due to avulsion of the posterior talocalcaneal and posterior talofibular ligaments.

Figure A shows a coronal view of the mortise of the right foot significant for a fracture of the posterolateral part of the talus. Illustration A shows normal foot bony anatomy.

Incorrect Answers:
Answer 1 and 2: Tears of the gastrocnemius and soleus muscles would normally present with pain in the upper calf and they would be difficult to confirm without imaging such as a MRI. Gastrocnemius tears typically occur with the knee in full extension and present with pain when the foot is plantar flexed while the knee is in extension. Soleus tears typically present with pain when the knee is in flexion and the person is forced to plantar flexed.
Answer 3 and 4: Fibular and tibial fractures are common with ankle/foot injuries, especially the medial and lateral malleoli. Though these are common, the patient does not have tenderness in these areas and the radiograph does not show fractures in these areas.