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.
Almigdad A, Mustafa A, Alazaydeh S, Alshawish M, Bani
Mustafa M, Alfukaha H. Bone Fracture Patterns and
Distributions according to Trauma Energy. Adv Orthop.
2022;2022:8695916. doi: 10.1155/2022/8695916. [PubMed:
36118169]. [PubMed Central: PMC9481388].
2.
3.
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].
Foot
DeOrio M, Erickson M, Usuelli FG, Easley M. Lisfranc injuries in
sport.
Ankle
Clin.
2009;14(2):169-86.
10.1016/j.fcl.2009.03.008. [PubMed: 19501801].
doi:
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:
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:
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:
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].
Mustafa M, Alfukaha H. Bone Fracture Patterns and
Distributions according to Trauma Energy. Adv Orthop.
2022;2022:8695916. doi: 10.1155/2022/8695916. [PubMed:
36118169]. [PubMed Central: PMC9481388].
2.
3.
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].
Foot
DeOrio M, Erickson M, Usuelli FG, Easley M. Lisfranc injuries in
sport.
Ankle
Clin.
2009;14(2):169-86.
10.1016/j.fcl.2009.03.008. [PubMed: 19501801].
doi:
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:
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:
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:
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 | |
| Keywords | ||
| Fracture, Trauma, Foot, Dislocation | ||
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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.
