Differential Diagnosis

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


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.



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