Compound fractures confined to the calcaneus may be treated on conservative lines, but if associated with other injuries of the foot they may necessitate amputation.
_The tuberosity of the calcaneus_, into which the tendo Achillis is inserted, is sometimes separated by forcible contraction of the calf muscles, or from a fall on the ball of the foot. The separated fragment may be pulled up for a distance of 1 or 2 inches, and the rough surface from which it has been torn may be recognisable. The patient may be able to walk immediately after the accident, although with difficulty; or he may have pain for many months.
A good functional result is usually obtained by relaxing the calf muscles and fixing the foot in the position of extreme plantar flexion with the knee flexed, but in some cases it is advisable to peg the fragments, either through the skin or after exposing them by operation.
The #other bones of the tarsus# are rarely fractured separately. The _tuberosity of the navicular_ is sometimes torn away by violent traction on the ligaments attached to it.
#Fractures of the metatarsals and phalanges# usually result from direct violence, such as a crush of the foot, in which the soft parts are severely damaged. The use of the Röntgen rays has shown, however, that certain painful conditions in the foot following comparatively slight injuries, such as kicking a stone, are due to a fracture of one of the metatarsals or phalanges.
When simple, these injuries are often overlooked, on account of the difficulty of eliciting the signs of fracture from the swelling which accompanies them. They are best treated in a moulded splint.
Compound fractures are more common, and are to be treated on the same principles as govern such injuries elsewhere.
_A fracture of the base of the fifth metatarsal_ has been described by Sir Robert Jones. It is produced by the patient coming down forcibly on the lateral edge of the foot while the foot is inverted and the heel raised--as, for example, in dancing. There is a localised swelling over the base of the fifth metatarsal, and pain when the patient puts weight on the foot. There is no crepitus or deformity. The fracture is readily recognised by the Röntgen rays. Massage and movement are employed from the first.