Common Foot Fracture Patterns: A Descriptive Study on 558 Cases
-
Sayyed-Hadi Sayyed-Hosseinian
,
Mohammad Reza Sarshar
,
Mahdieh Parsaeian
,
Mohammad Hossein Ebrahimzadeh
,
Ali Birjandinejad
Abstract
Background: Foot fractures are relatively common among trauma patients, and further research is needed to identify prevalent fracture patterns. This study aimed to explore common foot fracture patterns.
Methods: This cross-sectional study included patients admitted to a trauma center between 2018 and 2020. All patients with acute foot injuries were identified using the hospital information system (HIS). Data such as age, sex, trauma mechanism, mobile injuries, hospitalization status, and whether the injury was open or closed were extracted from patient records. Radiographies were reviewed to evaluate the location of fractures or dislocations and their anatomical classification.
Results: A total of 558 patients with an average age of 35.70 ± 16.55 years were studied, of whom 489 (67%) were men. The most common mechanism of trauma was motor vehicle accidents (240/558, 43.1%). The forefoot was the most frequently affected area (48.7%). Among the different bones, the calcaneus had the highest fracture incidence (233/558, 41.8%). There were 63 patients with dislocations, with Lisfranc dislocation being the most common (32/558, 50.8%). Calcaneus fractures were significantly more common in men than in women (P = 0.008), while fractures of the second (P = 0.010) and fifth (P = 0.011) metatarsals were significantly more common in women.
Conclusion: Calcaneus fractures were most common, especially in men, while women had more metatarsal fractures. Motor vehicle accidents were the primary cause of trauma. The mechanism of injury plays a crucial role.
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Distributions according to Trauma Energy. Adv Orthop. 2022;2022:8695916. doi: 10.1155/2022/8695916. [PubMed:
36118169]. [PubMed Central: PMC9481388].
2. Rasmussen CG, Jørgensen SB, Larsen P, Horodyskyy M, Kjær IL, Elsoe R. Population-based incidence and epidemiology of 5912 foot fractures. Foot Ankle Surg. 2021;27(2):181-5. doi: 10.1016/j.fas.2020.03.009. [PubMed: 32499146].
3. DeOrio M, Erickson M, Usuelli FG, Easley M. Lisfranc injuries in sport.Foot Ankle Clin. 2009;14(2):169-86.
10.1016/j.fcl.2009.03.008. [PubMed: 19501801]. doi: 10.1016/j.fcl.2009.03.008. [PubMed: 19501801].
4. Ponkilainen VT, Laine HJ, Mäenpää HM, Mattila VM, Haapasalo HH. Incidence and Characteristics of Midfoot Injuries. Foot Ankle Int. 2019;40(1):105-12. doi: 10.1177/1071100718799741. [PubMed: 30269512].
5. Satya Pradana A, Mustamsir E, Agustono H, Cahyono G, Bimadi M, Pandiangan R, et al. The pattern of foot and ankle injury in a tertiary referral hospital in Indonesia: magnitude of traffic accident. Int J Res Med Sci. 2021;9:1893. doi: 10.18203/2320-6012.ijrms20212504.
6. Kale NN, Wang CX, Wu VJ, Miskimin C, Mulcahey MK. Age and Female Sex Are Important Risk Factors for Stress Fractures: A Nationwide Database Analysis. Sports Health. 2022;14(6): 805-11. doi: 10.1177/19417381221080440. [PubMed: 35243941]. [PubMed Central: PMC9631038].
7. Cammas C, Ancion A, Detrembleur C, Tribak K, Putineanu D, Cornu O. Frequency and risk factors of complications after surgical treatment of ankle fractures : a retrospective study of 433 patients. Acta Orthop Belg. 2020;86(3):563-74. [PubMed: 33581043].
8. van der Worp MP, ten Haaf DS, van Cingel R, de Wijer A, Nijhuis-van der Sanden MW, Staal JB. Injuries in runners; a
systematic review on risk factors and sex differences. PLoS One. 2015;10(2):e0114937. doi: 10.1371/journal.pone.0114937. [PubMed: 25706955]. [PubMed Central: PMC4338213].
9. Daoud AI, Geissler GJ, Wang F, Saretsky J, Daoud YA, Lieberman DE. Foot strike and injury rates in endurance runners: a retrospective study. Med Sci Sports Exerc. 2012;44(7):1325-34. doi: 10.1249/MSS.0b013e3182465115. [PubMed: 22217561].
10. Rowbotham SK, Blau S, Hislop-Jambrich J, Francis V. Fatal falls involving stairs: an anthropological analysis of skeletal trauma. Forensic Sci Med Pathol. 2018;14(2):152-62. doi: 10.1007/s12024-018-9964-z. [PubMed: 29564724].
11. Bugler KE, Clement ND, Duckworth AD, White TO, McQueen MM, Court-Brown CM. Open ankle fractures: who gets them and why? Arch Orthop Trauma Surg. 2015;135(3):297-303. doi: 10.1007/s00402-014-2140-3. [PubMed: 25596941].
12. Simske NM, Audet MA, Kim CY, Vallier HA. Open ankle fractures are associated with complications and reoperations. OTA Int. 2019;2(4):e042. doi: 10.1097/oi9.0000000000000042. [PubMed: 33937670]. [PubMed Central: PMC7997115].
13. Fadl SA, Sandstrom CK. Pattern Recognition: A Mechanism based Approach to Injury Detection after Motor Vehicle Collisions. Radiographics. 2019;39(3):857-76. 10.1148/rg.2019180063. [PubMed: 31059399].
doi: 10.1148/rg.2019180063. [PubMed: 31059399].
14. Popa Ș , Ciongradi CI, Sârbu I, Bîcă O, Popa IP, Bulgaru-Iliescu D. Traffic Accidents in Children and Adolescents: A Complex Orthopedic and Medico-Legal Approach. Children (Basel). 2023;10(9). doi: 10.3390/children10091446. [PubMed: 37761407]. [PubMed Central: PMC10527870].
15. Hunt KJ, Hurwit D, Robell K, Gatewood C, Botser IB, Matheson G. Incidence and Epidemiology of Foot and Ankle Injuries in Elite Collegiate Athletes. Am J Sports Med. 2017;45(2):426-33. doi: 10.1177/0363546516666815. [PubMed: 27802962].
16. Chauvin NA, Jaimes C, Khwaja A. Ankle and Foot Injuries in the Young Athlete. Semin Musculoskelet Radiol. 2018;22(1):104-17. doi: 10.1055/s-0037-1609012. [PubMed: 29409077].
17. Swenson DM, Henke NM, Collins CL, Fields SK, Comstock RD. Epidemiology of United States high school sports-related fractures, 2008-09 to 2010-11. Am J Sports Med. 2012;40(9): 2078-84. doi: 10.1177/0363546512453304. [PubMed: 22837429]. [PubMed Central: PMC3852886].
18. Hauret KG, Bedno S, Loringer K, Kao TC, Mallon T, Jones BH. Epidemiology of Exercise- and Sports-Related Injuries in a Population of Young, Physically Active Adults: A Survey of Military Servicemembers. Am J Sports Med. 2015;43(11):2645-53. doi: 10.1177/0363546515601990. [PubMed: 26378031].
19. Schneuer FJ, Bell JC, Adams SE, Brown J, Finch C, Nassar N. The burden of hospitalized sports-related injuries in children: an Australian population-based study, 2005-2013. Inj Epidemiol. 2018;5(1):45. doi: 10.1186/s40621-018-0175-6. [PubMed: 30556103]. [PubMed Central: PMC6295440].
20. Paavana T, Rammohan R, Hariharan K. Stress fractures of the foot - current evidence on management. J Clin Orthop Trauma. 2024;50:102381. doi: 10.1016/j.jcot.2024.102381. 38435398]. [PubMed Central: PMC10904895].
[PubMed: : PMC10904895].
21. Hoenig T, Ackerman KE, Beck BR, Bouxsein ML, Burr DB, Hollander K, et al. Bone stress injuries. Nat Rev Dis Primers. 2022;8(1):26. doi: 10.1038/s41572-022-00352-y. [PubMed: 35484131].
22. Troy KL, Davis IS, Tenforde AS. A Narrative Review of Metatarsal Bone Stress Injury in Athletic Populations: Etiology, 60 Biomechanics, and Management. Pm R. 2021;13(11):1281-90. doi: 10.1002/pmrj.12518. [PubMed: 33155355].
23. da Rocha Lemos Costa TM, Borba VZC, Correa RGP, Moreira CA. Stress fractures. Arch Endocrinol Metab. 2022;66(5):765-73. doi: 10.20945/2359-3997000000562. [PubMed: 36382766]. [PubMed Central: PMC10118812].
24. Khodadadi F, Moosavi Z, Sadr S, Mirshahi A, Kazemi Mehrjerdi H. Evaluation of Protective Effects of Pomegranate Seed Oil on Experimental Osteoporosis in Rats. Iran J Vet Surg. 2024;19(1): 36-42. doi: 10.30500/ivsa.2023.422083.1371.
25. Tadros AM, Eid HO, Abu-Zidan FM. Epidemiology of foot injury in a high-income developing country. Injury. 2010;41(2):137-40. doi: 10.1016/j.injury.2009.05.031. [PubMed: 19570532].
26. Dhillon MS, Aggarwal S, Dhatt SS, Jain M. Epidemiological pattern of foot injuries in India: preliminary assessment of data from a tertiary hospital. J Postgrad Med Educ Res. 2012;46(3):144-7. doi: 10.5005/jp-journals-10028-1032.
27. Vosoughi AR, Borazjani R, Ghasemi N, Fathi S, Mashhadiagha A, Hoveidaei AH. Different types and epidemiological patterns of calcaneal fractures based on reviewing CT images of 957 fractures. Foot Ankle Surg.
2022;28(1):88-92. 10.1016/j.fas.2021.02.002. [PubMed: 33563519]. doi: 0.1016/j.fas.2021.02.002. [PubMed: 33563519].
28. Rasouli MR, Nouri M, Zarei MR, Saadat S, Rahimi-Movaghar V. Comparison of road traffic fatalities and injuries in Iran with other countries. Chin J Traumatol. 2008;11(3):131-4. doi: 10.1016/s1008-1275(08)60028-0. [PubMed: 18507940].
29. Huang K, Guo Q, Zhu Y. The epidemiology and clinical features of calcaneus osteomyelitis following calcaneus fracture: a retrospective study of 127 cases. Ann Palliat Med. 2021;10(3): 3154-61. doi: 10.21037/apm-21-208. [PubMed: 33849100].
30. Mitchell MJ, McKinley JC, Robinson CM. The epidemiology of calcaneal fractures. Foot (Edinb). 2009;19(4):197-200. doi: 10.1016/j.foot.2009.05.001. [PubMed: 20307476].
31. Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-7. doi: 10.1016/j.injury.2006.04.130. [PubMed: 16814787].
32. Sarpong N, Swindell H, Trupia E, Vosseller J. Metatarsal Fractures. Foot Ankle Orthop. 2018;3(3):247301141877509. doi: 10.1177/2473011418775094.
33. West TA, Pollard JD, Chandra M, Hui RL, Weintraub MR, King CM, et al. The Epidemiology of Metatarsal Fractures Among Older Females With Bisphosphonate Exposure. J Foot Ankle Surg. 2020;59(2):269-73.
doi: 10.1053/j.jfas.2019.02.008. [PubMed: 32130989]. [PubMed Central: PMC7831749].
Distributions according to Trauma Energy. Adv Orthop. 2022;2022:8695916. doi: 10.1155/2022/8695916. [PubMed:
36118169]. [PubMed Central: PMC9481388].
2. Rasmussen CG, Jørgensen SB, Larsen P, Horodyskyy M, Kjær IL, Elsoe R. Population-based incidence and epidemiology of 5912 foot fractures. Foot Ankle Surg. 2021;27(2):181-5. doi: 10.1016/j.fas.2020.03.009. [PubMed: 32499146].
3. DeOrio M, Erickson M, Usuelli FG, Easley M. Lisfranc injuries in sport.Foot Ankle Clin. 2009;14(2):169-86.
10.1016/j.fcl.2009.03.008. [PubMed: 19501801]. doi: 10.1016/j.fcl.2009.03.008. [PubMed: 19501801].
4. Ponkilainen VT, Laine HJ, Mäenpää HM, Mattila VM, Haapasalo HH. Incidence and Characteristics of Midfoot Injuries. Foot Ankle Int. 2019;40(1):105-12. doi: 10.1177/1071100718799741. [PubMed: 30269512].
5. Satya Pradana A, Mustamsir E, Agustono H, Cahyono G, Bimadi M, Pandiangan R, et al. The pattern of foot and ankle injury in a tertiary referral hospital in Indonesia: magnitude of traffic accident. Int J Res Med Sci. 2021;9:1893. doi: 10.18203/2320-6012.ijrms20212504.
6. Kale NN, Wang CX, Wu VJ, Miskimin C, Mulcahey MK. Age and Female Sex Are Important Risk Factors for Stress Fractures: A Nationwide Database Analysis. Sports Health. 2022;14(6): 805-11. doi: 10.1177/19417381221080440. [PubMed: 35243941]. [PubMed Central: PMC9631038].
7. Cammas C, Ancion A, Detrembleur C, Tribak K, Putineanu D, Cornu O. Frequency and risk factors of complications after surgical treatment of ankle fractures : a retrospective study of 433 patients. Acta Orthop Belg. 2020;86(3):563-74. [PubMed: 33581043].
8. van der Worp MP, ten Haaf DS, van Cingel R, de Wijer A, Nijhuis-van der Sanden MW, Staal JB. Injuries in runners; a
systematic review on risk factors and sex differences. PLoS One. 2015;10(2):e0114937. doi: 10.1371/journal.pone.0114937. [PubMed: 25706955]. [PubMed Central: PMC4338213].
9. Daoud AI, Geissler GJ, Wang F, Saretsky J, Daoud YA, Lieberman DE. Foot strike and injury rates in endurance runners: a retrospective study. Med Sci Sports Exerc. 2012;44(7):1325-34. doi: 10.1249/MSS.0b013e3182465115. [PubMed: 22217561].
10. Rowbotham SK, Blau S, Hislop-Jambrich J, Francis V. Fatal falls involving stairs: an anthropological analysis of skeletal trauma. Forensic Sci Med Pathol. 2018;14(2):152-62. doi: 10.1007/s12024-018-9964-z. [PubMed: 29564724].
11. Bugler KE, Clement ND, Duckworth AD, White TO, McQueen MM, Court-Brown CM. Open ankle fractures: who gets them and why? Arch Orthop Trauma Surg. 2015;135(3):297-303. doi: 10.1007/s00402-014-2140-3. [PubMed: 25596941].
12. Simske NM, Audet MA, Kim CY, Vallier HA. Open ankle fractures are associated with complications and reoperations. OTA Int. 2019;2(4):e042. doi: 10.1097/oi9.0000000000000042. [PubMed: 33937670]. [PubMed Central: PMC7997115].
13. Fadl SA, Sandstrom CK. Pattern Recognition: A Mechanism based Approach to Injury Detection after Motor Vehicle Collisions. Radiographics. 2019;39(3):857-76. 10.1148/rg.2019180063. [PubMed: 31059399].
doi: 10.1148/rg.2019180063. [PubMed: 31059399].
14. Popa Ș , Ciongradi CI, Sârbu I, Bîcă O, Popa IP, Bulgaru-Iliescu D. Traffic Accidents in Children and Adolescents: A Complex Orthopedic and Medico-Legal Approach. Children (Basel). 2023;10(9). doi: 10.3390/children10091446. [PubMed: 37761407]. [PubMed Central: PMC10527870].
15. Hunt KJ, Hurwit D, Robell K, Gatewood C, Botser IB, Matheson G. Incidence and Epidemiology of Foot and Ankle Injuries in Elite Collegiate Athletes. Am J Sports Med. 2017;45(2):426-33. doi: 10.1177/0363546516666815. [PubMed: 27802962].
16. Chauvin NA, Jaimes C, Khwaja A. Ankle and Foot Injuries in the Young Athlete. Semin Musculoskelet Radiol. 2018;22(1):104-17. doi: 10.1055/s-0037-1609012. [PubMed: 29409077].
17. Swenson DM, Henke NM, Collins CL, Fields SK, Comstock RD. Epidemiology of United States high school sports-related fractures, 2008-09 to 2010-11. Am J Sports Med. 2012;40(9): 2078-84. doi: 10.1177/0363546512453304. [PubMed: 22837429]. [PubMed Central: PMC3852886].
18. Hauret KG, Bedno S, Loringer K, Kao TC, Mallon T, Jones BH. Epidemiology of Exercise- and Sports-Related Injuries in a Population of Young, Physically Active Adults: A Survey of Military Servicemembers. Am J Sports Med. 2015;43(11):2645-53. doi: 10.1177/0363546515601990. [PubMed: 26378031].
19. Schneuer FJ, Bell JC, Adams SE, Brown J, Finch C, Nassar N. The burden of hospitalized sports-related injuries in children: an Australian population-based study, 2005-2013. Inj Epidemiol. 2018;5(1):45. doi: 10.1186/s40621-018-0175-6. [PubMed: 30556103]. [PubMed Central: PMC6295440].
20. Paavana T, Rammohan R, Hariharan K. Stress fractures of the foot - current evidence on management. J Clin Orthop Trauma. 2024;50:102381. doi: 10.1016/j.jcot.2024.102381. 38435398]. [PubMed Central: PMC10904895].
[PubMed: : PMC10904895].
21. Hoenig T, Ackerman KE, Beck BR, Bouxsein ML, Burr DB, Hollander K, et al. Bone stress injuries. Nat Rev Dis Primers. 2022;8(1):26. doi: 10.1038/s41572-022-00352-y. [PubMed: 35484131].
22. Troy KL, Davis IS, Tenforde AS. A Narrative Review of Metatarsal Bone Stress Injury in Athletic Populations: Etiology, 60 Biomechanics, and Management. Pm R. 2021;13(11):1281-90. doi: 10.1002/pmrj.12518. [PubMed: 33155355].
23. da Rocha Lemos Costa TM, Borba VZC, Correa RGP, Moreira CA. Stress fractures. Arch Endocrinol Metab. 2022;66(5):765-73. doi: 10.20945/2359-3997000000562. [PubMed: 36382766]. [PubMed Central: PMC10118812].
24. Khodadadi F, Moosavi Z, Sadr S, Mirshahi A, Kazemi Mehrjerdi H. Evaluation of Protective Effects of Pomegranate Seed Oil on Experimental Osteoporosis in Rats. Iran J Vet Surg. 2024;19(1): 36-42. doi: 10.30500/ivsa.2023.422083.1371.
25. Tadros AM, Eid HO, Abu-Zidan FM. Epidemiology of foot injury in a high-income developing country. Injury. 2010;41(2):137-40. doi: 10.1016/j.injury.2009.05.031. [PubMed: 19570532].
26. Dhillon MS, Aggarwal S, Dhatt SS, Jain M. Epidemiological pattern of foot injuries in India: preliminary assessment of data from a tertiary hospital. J Postgrad Med Educ Res. 2012;46(3):144-7. doi: 10.5005/jp-journals-10028-1032.
27. Vosoughi AR, Borazjani R, Ghasemi N, Fathi S, Mashhadiagha A, Hoveidaei AH. Different types and epidemiological patterns of calcaneal fractures based on reviewing CT images of 957 fractures. Foot Ankle Surg.
2022;28(1):88-92. 10.1016/j.fas.2021.02.002. [PubMed: 33563519]. doi: 0.1016/j.fas.2021.02.002. [PubMed: 33563519].
28. Rasouli MR, Nouri M, Zarei MR, Saadat S, Rahimi-Movaghar V. Comparison of road traffic fatalities and injuries in Iran with other countries. Chin J Traumatol. 2008;11(3):131-4. doi: 10.1016/s1008-1275(08)60028-0. [PubMed: 18507940].
29. Huang K, Guo Q, Zhu Y. The epidemiology and clinical features of calcaneus osteomyelitis following calcaneus fracture: a retrospective study of 127 cases. Ann Palliat Med. 2021;10(3): 3154-61. doi: 10.21037/apm-21-208. [PubMed: 33849100].
30. Mitchell MJ, McKinley JC, Robinson CM. The epidemiology of calcaneal fractures. Foot (Edinb). 2009;19(4):197-200. doi: 10.1016/j.foot.2009.05.001. [PubMed: 20307476].
31. Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-7. doi: 10.1016/j.injury.2006.04.130. [PubMed: 16814787].
32. Sarpong N, Swindell H, Trupia E, Vosseller J. Metatarsal Fractures. Foot Ankle Orthop. 2018;3(3):247301141877509. doi: 10.1177/2473011418775094.
33. West TA, Pollard JD, Chandra M, Hui RL, Weintraub MR, King CM, et al. The Epidemiology of Metatarsal Fractures Among Older Females With Bisphosphonate Exposure. J Foot Ankle Surg. 2020;59(2):269-73.
doi: 10.1053/j.jfas.2019.02.008. [PubMed: 32130989]. [PubMed Central: PMC7831749].
| Files | ||
| Issue | Vol 11 No 2 (2025) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v11i2.18882 | |
| Keywords | ||
| Fractures Trauma Foot Dislocation Fracture | ||
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How to Cite
1.
Sayyed-Hosseinian S-H, Sarshar MR, Parsaeian M, Ebrahimzadeh M, Birjandinejad A. Common Foot Fracture Patterns: A Descriptive Study on 558 Cases. J Orthop Spine Trauma. 2025;11(2):55-60.
