Journal of Urgent Care Medicine

Practice Management

A Construction Worker with Sudden Foot Pain After Stepping Into a Hole

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The Resolution

 Differential Diagnosis

  • Foot dislocation
  • Metatarsal fracture
  • Plantar plate disruption
  • Soft tissue ankle injury
  • Lisfranc fracture dislocation

Diagnosis

This patient has fractures of the metatarsal bases of digits 2 and 3, and likely 4, as noted. Metatarsal malalignment is diagnostic for Lisfranc fracture dislocation.

Learnings/What to Look for

  • Mechanism of injury is direct crush injury, or an indirect load onto a plantar flexed foot
  • Disability will occur if the injury is untreated

 

Pearls for Urgent Care Management and Considerations for Transfer

  • Internal fixation is the most common treatment

 

Acknowledgment: Images and case provided by Teleradiology Specialists, www.teleradiologyspecialists.com.

 

 

A Construction Worker with Sudden Foot Pain After Stepping Into a Hole