Detecting and treating common fractures of the foot and ankle part 2: the midfoot and forefoot.

Midfoot and forefoot fractures commonly seen in a primary care practice include navicular and metatarsal stress fracture, tarsometatarsal fracture-dislocation, and acute fracture of the metatarsals, sesamoid, great toe, or lesser toes. A careful history to determine the mechanism of injury and a methodical physical exam to detect sites of tenderness are essential. X-rays are usually required, but stress fractures may warrant bone scans. Compared with ankle and hindfoot fractures, sports-related midfoot and forefoot fractures are more often treated conservatively with casting or wooden shoes. Tarsometatarsal disruption and Jones fractures are more likely to require surgery.