These fractures are often the result of high-energy injuries, and are often associated with other injuries, both in the foot and the rest of the body.
In the multiply-injured patient, foot fractures are often overlooked and are picked up on the secondary survey. In the unconscious patient one must rely on a careful physical examination. Swelling, crepitus and a deformity are suggested signs of underlying injury and should be followed up with appropriate x-rays.
In many cases there is swelling and tenderness. In comminuted fractures, deformity may be present.
Conventional x-rays will often show the fracture.
CT with sagittal and coronal reformation is useful in obtaining a three-dimensional understanding of the injury. The CT protocol should call for thin cuts with large overlap. The fragments are small and easily missed on thicker cuts.