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March 2002
By Theodore E. Keats, MD
A 45-year-old man twisted his foot in a fall and now has pain and
swelling in the midfoot. What is your interpretation of the lateral
projection of his foot?
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ANSWER
The correct diagnosis is fracture of the anterior process of the
calcaneus (arrow), the most common form of avulsion fracture of
the calcaneus. It is the result of adduction of the forefoot while
the foot is in the equinus position. For this reason, such fractures
are most commonly seen in women who have fallen while wearing high-heeled
shoes.
For further reading, see L.F. Rogers: Radiology of Skeletal Trauma,
2nd ed., New York, Churchill Livingstone, 1992, p. 1445.
Emerg Med 34(3):67, 2002
This series of diagnostic quizzes that challenge your ability
to read a variety of x-ray films is edited by Dr. Keats, professor
of radiology and professor of orthopedics at the University of Virginia
School of Medicine in Charlottesville.
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