Clinical Managing Foot Fractures in Urgent Care Urgent message: Acute injuries to the foot often send patients to an urgent care center—though on occasion they don’t present for weeks, or even months, after the injury occurred. Understanding the natural history of untreated fractures in the foot is imperative to positive outcomes. The first in a two-part series. Phillip H. Disraeli MD, FAAFP Introduction his article will focus pri- marily on two aspects of care: 1. Proper management of and follow-up for sim- ple nondisplaced frac- tures in the foot. 2. The role of the urgent care clinician in pa- tients with other sig- nificant fractures, the vast majority of whom will need to be referred to orthopedics for de- finitive care; this will include pitfalls to avoid in the acute as- sessment and manage- © iStockPhoto; Composite: Tom DePrenda ment of these patients. The scope of foot fractures seen in the urgent care set- ting varies by locale and demographics of the patient population. For example, young families in suburban ar- eas are more likely to present with forefoot fractures and stress fractures; in more urban or industrial environs, ur- T w w w. j u c m . c o m gent care clinicians are more likely to see injuries resulting from motor vehi- cle accidents or high-energy trauma leading to fractures and dislocations of the more rigid midfoot and hindfoot. Our examination of foot fractures in urgent care will be divided into two parts. In this first installment, we will discuss fractures of the toes, metatarsals, and Lis- franc joint (tarsal-metatarsal joints); the second will ap- pear in the January issue of JUCM and focus on injuries, particularly fractures, to the cuboid, cuneiforms, navicu- lar, talus, Chopart joint, and calcaneus, as well as com- partment syndrome. Great Toe (Hallux) The great toe, or hallux, and its metatarsal are anatom- JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | D e c e m b e r 2 0 0 8 11