Early Diagnosis and Treatment Vital in Cases of Foot Fractures

to the editor: I read with great interest the article, “Foot Fractures Frequently Misdiagnosed as Ankle Sprains,”¹ which provided a thorough discussion of the various types of talus fractures and how they can be missed initially on physical examination. This is of particular importance in children, because talus fractures in children are extremely rare^2–4 and may lead to lifelong morbidity unless they are diagnosed and treated appropriately. Furthermore, a large percentage of confirmed talus fractures are read as normal on initial radiographs.^1,3

During a seven-year period, only 15 patients (average age: five years, five months) were identified at our institution who had either a talar head, neck, or body fracture (avulsion fractures and osteochondral fractures were excluded).² The most common mechanism of injury was a motor vehicle crash, and the second most common was a fall from a height. Additionally, in 12 of these patients, the talar fracture occurred in conjunction with other ipsilateral lower extremity fractures. The initial radiographic diagnosis of these fractures was missed in 33 percent of the cases in the emergency department, which is similar to results found by Drs. Judd and Kim in the literature concerning lateral process fractures of the talus in adults.¹

Talus fractures in children often present with concomitant injuries to the lower limb, causing them to be missed on initial examination. Even though they are rare, it is important for the physician to have a high index of suspicion for these injuries and to perform a complete history and physical examination of every child. A clear understanding of the epidemiology of these injuries, as well as appropriate radiologic studies of the foot and ankle, are necessary to help ensure positive clinical outcomes in children and adults.