Have you ever been working at 3am and wondered, “Am I missing something? I’ll just splint and instruct the patient to follow up with their PCP in 1 week.” This is a reasonable approach, especially if you’re concerned there could be a fracture. But we can do better. Enter the “Can’t Miss” series: a series organized by body part that will help identify injuries that ideally should not be missed. This list is not meant to be a comprehensive review of each body part, but rather to highlight and improve your sensitivity for these potentially catastrophic injuries. We’ve already covered the elbow and wrist. Now: the foot and ankle.
- 4% of all visits to the ED involve the ankle .
- The foot is a complex part of human anatomy and is a frequent cause for a visit to the Emergency Department .
- High morbidity if unstable injuries are missed.
Want a basic x-ray interpretation approach to traumatic ankle imaging?
Want a basic x-ray interpretation approach to the traumatic foot imaging?
Other radiology resources
First things first: always make sure to do a thorough ankle exam.
Check out Radiopaedia’s approach to the ankle x-ray.
Don’t Forget the Bubbles has a great post on their approach and pediatric considerations.
StartRadiology has a more comprehensive approach to the ankle.
- Handel et al. Chapter 273. Ankle Injuries. In: Tintinalli’s Emergency Medicine. A Comprehensive Guide, 8th edition. New York: McGraw-Hill Education, 2016.
- Wedmore, I. et al. Emergency Department evaluation and management of foot and ankle pain. Emerg Med Clin N Am 33. Issue 2. May 2015. PMID: 25892727
- Hunt et al. High Ankle Sprains and Syndesmotic Injuries in Athletes. J AM Acad Ortop Surg. Vol 23. No 11. November 2015. PMID: 26498585
- Kellet, J. et al. Diagnostic imaging of ankle syndesmosis injuries: A general review. J Med Imaging Radiat Oncol. Vol 62. No 2, April 2018. PMID: 29399975
- Aiyer, AA et al. Management of Isolated Lateral Malleolus Fractures. J Am Acad Orthop Surg. Vol 27. No 2, January 2019. PMID: 30278012
- Englanoff, G. et al. Lisfranc fracture-dislocation: A frequently missed diagnosis in the ED. Annals of Emergency Medicine. Volume 26, Issue 2. August 1995. PMID 7618790