on the lateral view Images (C ), (D ), and (E ) show CT images of the triplane fracture in the coronal, axial, and sagittal planes, respectively CT best defines the fracture pattern (Reprinted with permission from McCarthy JJ, Drennan JC Drennan’s the Child’s Foot and Ankle 2nd ed Philadelphia, PA: Lippincott Williams & Wilkins; 2009.) Injuries of the Foot CLINICAL PEARLS AND PITFALLS Calcaneal fractures typically occur after a fall from a height, so the spine should also be evaluated for possible compression fracture Snowboarders are at risk of fractures of the lateral process of the talus Avascular necrosis of the body of the talus is a serious complication that can develop depending on the location of the fracture and extent of displacement CT is recommended for the evaluation of tarsometatarsal injuries and calcaneal and talar fractures, and it may also diagnose occult fractures If a fracture of the second metatarsal is present, a tarsometatarsal dislocation should be considered or a Lisfranc injury should be suspected if there is also a cuboid fracture present Compartment syndrome of the foot can involve any of the nine compartments and should be considered in the presence of swelling and increasing pain, especially after elevation Hindfoot and Midfoot Fractures In general, fractures of the hindfoot involving the talus or calcaneus are relatively uncommon in children Fractures of the lateral process of the talus can be misdiagnosed as ankle sprains due to the articulation of the talus and the lateral malleolus Nondisplaced fractures of the hindfoot may be treated with a bulky posterior splint and crutches with no weight-bearing and referral to an orthopedic surgeon Displaced talus fractures will require reduction under anesthesia Fractures of the midfoot involving the navicular, cuboid, and first, second, third cuneiforms and tarsometatarsal injuries are uncommon in children They are usually caused by blunt trauma that can result in significant soft tissue damage and potential neurovascular compromise with compartment syndrome ( Fig 111.54 ) Nondisplaced fractures may be treated in a short leg cast Displaced injuries of the tarsometatarsal joint will require reduction under anesthesia