AdultPediatric
Cannot miss / life threats
Cannot miss / life threats
Diagnostic flow — check first
Diagnostic flow — check first
- Plantar ecchymosis after midfoot injury → Lisfranc until proven otherwise → weight-bearing XR ± CT.
- Diabetic foot ulcer with bone palpable on probe → osteomyelitis.
- Pain out of proportion + crush / fracture → compartment syndrome.
- Hot, deformed, but minimally painful diabetic midfoot → think Charcot vs infection (need MRI (with & without contrast)).
- Through-shoe puncture → Pseudomonas coverage.
Differential diagnosis — checklist
0/18
Check off each diagnosis as you consider it. Tap the name for unique exam, lab/imaging clues, first-line confirmatory test, and management.
Traumatic0/6
Atraumatic0/6
Diabetic / vascular0/6
Initial ED workup
Bedside0/5
- Vitals; check glucose if diabetic
- Inspect for plantar ecchymosis, ulcers, gangrene, FB
- Palpate per Ottawa foot rules: navicular, base of 5th MT
- Probe ulcers to bone
- Check dorsalis pedis + posterior tibial pulses; capillary refill; sensation (10-g monofilament if diabetic)
Labs0/3
- Glucose, A1c, CBC, CRP/ESR, lactate
- Wound + blood cultures
- Joint aspiration if effusion + fever
Imaging0/3
- Weight-bearing AP/lat/oblique foot XR (Lisfranc)
- MRI (without contrast) for osteomyelitis, Charcot, occult fracture, stress fracture
- CTA for arterial
Initial management0/4
- Hard-sole shoe, walking boot, or posterior splint
- Wound care, elevation, glycemic control
- IV antibiotics for osteomyelitis / nec fasc
- Emergent fasciotomy / surgical debridement / revascularization as indicated
Pearls / pitfalls
Pearls
- Lisfranc injuries are missed on non-weight-bearing XR — always weight-bear when clinical suspicion is high.
- Jones fracture (proximal 5th MT diaphysis) has high non-union risk → NWB and ortho.
- Probe-to-bone test in a diabetic ulcer is highly specific for osteomyelitis.