A 10-Year-Old Girl with Foot Pain After Falling from a Tree

Differential Diagnosis

• Fracture of the distal fourth metatarsal
• Plantar plate disruption
• Sesamoiditis
• Turf toe

Diagnosis

Angulation of the distal fourth metatarsal metaphyseal cortex and hairline lucency consistent with fracture.

 

Learnings/What to Look for

• Proximal metatarsal fractures are most often caused by crushing or direct blows
• In athletes, an axial load placed on a plantar-flexed foot should raise suspicion of a Lisfranc injury

 

Pearls for Urgent Care Management and Considerations for Transfer

• Emergent transfer should be considered with associated neurologic deficit, compartment syndrome, open fracture, or vascular compromise
• Referral to an orthopedist is warranted in the case of an intra-articular fracture, or with Lisfranc ligament injury or tenderness over the Lisfranc ligament

 

Acknowledgment: Images courtesy of Teleradiology Associates.