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Work- and athletic-related injuries are two of the most common areas from which foot injuries arise. Work-related injuries vary widely in the body area injured; one study estimates that 20% of all injuries in the U.S. occur in the workplace, with 60% involving injury to the musculoskeletal system; 10% of these are foot and ankle injuries.1 Medical costs and wages lost are two of the primary reasons that timely and appropriate care of foot-related work injuries is so crucial.2 Foot and ankle sport-related injuries are also extremely common and returning the athlete to his or her sport demands the utmost attention.3 Motor vehicle crash patients with a foot or ankle injury had a higher injury severity score than those without these injuries.4 Many of these patients will likely seek their initial care in the ED and early intervention is essential.

The foot is divided into three sections: the hindfoot, the midfoot, and the forefoot. Chopart joint separates the hindfoot from the midfoot. Lisfranc joint divides the midfoot and the forefoot. Although bones are not the only components of the foot, they are the focus of the following discussion. The hindfoot is comprised of the talus and the calcaneus. The midfoot encompasses the medial, middle, and lateral cuneiforms; the navicular; and the cuboid. The tarsus refers to the bones of the hind and midfoot. The forefoot includes the metatarsals and the proximal, middle, and distal phalanges (Figure 274-1). Several ligaments and muscles aid these bones in the multiple movements the foot can engage in, including eversion, inversion, adduction, and abduction. The construction of the foot serves as the foundation for many of the dynamic movements the rest of the body engages in.

Figure 274-1.

A. Diagram of normal bony anatomy of the foot. B. Radiograph of normal bony alignment of the foot. (B. Courtesy of Robert DeMayo, MD.)

For the neurovascular supply of the foot, the popliteal artery gives rise to several branches: the anterior tibial artery, with its branch the dorsalis pedis supplying the dorsal aspect of the foot; the posterior tibial and peroneal arteries supply the sole (Figure 274-2).

Figure 274-2.

A. Arteries of the dorsum of the foot. B. Vessels and nerves of the sole of the foot. a. = artery; aa. = arteries; Abd. hall. = abductor hallucis; Ant. lat. = anterior lateral; Ant. med. = anterior medial; br. = branch; brev. = brevis; dig. = digitorum; Flex. = flexor; Lat. = lateral; Med. plant. = medial plantar; n. = nerve; nn. = nerves; Post. = posterior; Quad. = quadratus; Superf. = superficial; ...

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