(516) 869-3300  -Manhasset
(631) 427-3678  -Huntington
(516) 681-8866  -Woodbury
(718) 639-0499  -Maspeth
(516) 741-3338  -Williston Park
(516) 741-3338  -Mineola
By Dr Tyler Miranda
August 30, 2019
Category: Foot Care
Tags: Fractures   and Nutcrackers   Sprains  
Injuries to the outside of the foot and ankle are very common and wide ranging in severity. Ankle sprains are by far the most common injury to this area of the body, registering roughly 3 million incidents every year. Most lateral foot and ankle injuries only involve soft tissue but in some cases there can be an injury to one or more bones. The fibula, talus, cuboid, and 5th metatarsal are all possible sites of bone injury. 
When an injury occurs an important piece of information a doctor will ask for is called the 'mechanism of injury' which describes the direction the foot and ankle moved or twisted, the position of the foot, and what activity was being performed at the time of injury. Sometimes patients will be able to describe in meticulous detail the mechanism of injury while other times patients will say "Doc it happened so fast I cant remember." Luckily the team at Advanced podiatry can use a careful physical exam, Xrays, and diagnostic ultrasound to investigate the injury. To evaluate the injury in real time we have an on-site C-arm flouroscopy to provide pinpoint diagnosis - this imaging tool lets the doctor and patient see the bony injury on the screen and also assess the motion of the bone at the same time.
The 5th metatarsal bone is particularly susceptible to compromise during a lateral foot trauma. Patients will come into the office limping, describing a mechanism of injury sometimes similar to an ankle sprain but with pain further down from the ankle along the outside of the foot. The 5th metatarsal bone can sustain multiple types of injuries. The most well known is a Jones fracture, a horizontal fracture of the bone near the middle of its shaft. Another type of injury is an avulsion fracture. This is were the tendon that pulls on the bone is stretched too quickly and removes part of the bone as it tears away from its insertion. These injuries can be treated with immobilization and/or surgical repair depending on their severity. 

Jones Fracture

5th Metatarsal Avulsion Fracture

Nutcracker Fracture of Cuboid


The cuboid is a less commonly fractures bone. When a fracture does happen it is important that it is identified and treated as soon as possible. Sometimes these fractures are not easily visible on conventional X-rays and will require C-arm flouroscopy or CT scan for an accurate assessment. One type of cuboid injury is known as the Nutcracker fracture. The mechanism of injury is forced abduction of the forefoot: where the front of the foot is pushed outwards and the cuboid is crushed like a nut between the calcaneus (heel bone) and the 4th and 5th metatarsals. This injury will require time to heal in cast or CAM boot immobilization and may require surgery with internal or external fixation. 
The take home message here is that if you have an injury to the outside of the foot or ankle go get it checked out. If you think you simply sprained your ankle but that pain is lingering or even getting worse there may be a more serious injury present. 


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Advanced Podiatry of Manhasset at the Americana

Manhasset, NY Office
Advanced Podiatry
2110 Northern Blvd.
Manhasset, NY 11030

(516) 869-3300

Huntington, NY Office
Advanced Podiatry
181 Main St.
Huntington, NY 11743

(631) 427-3678

Coram, NY Office
Advanced Podiatry
100 Middle Country Rd.
Coram, NY 11727

(631) 696-9636

Woodbury, NY Office
Advanced Podiatry
20 Crossways Park North Suite 304
Woodbury, NY 11797

(516) 681-8866

Mineola, NY  Office
Advanced Podiatry
155 Mineola Boulevard, Suite B 
Mineola, NY 11501

(516) 741-3338

Maspeth, NY  Office
Advanced Podiatry
70-01 Grand Ave
Maspeth, NY 11378

(718) 639-0499

Williston Park, NY Office
Advanced Podiatry
479 Willis Ave,
Williston Park, NY 11596

(516) 741-3338

Plainview, NY Office
 *Recently Moved to Woodbury