Fractures and Dislocations of the Forefoot: Operative and Nonoperative Treatment

Effective treatment of common bone injuries of the forefoot is dependent on a clear understanding of both the osseous anatomy of the foot and the biomechanics of gait. Obtaining a thorough history and performing a careful physical examination are especially important because the complex anatomy of the region often makes radiographic diagnosis difficult. The keys to making the correct diagnosis in the injured forefoot are detailed, with emphasis on obtaining the appropriate radiographic studies. Included in the discussion are injuries to Lisfranc's joint and the metatarsophalangeal and sesamoid joints, as well as metatarsal and phalangeal fractures. Guidelines for operative and nonoperative management of these injuries are presented.