The navicular bone articulates with the three cuneiform bones and occasionally the cuboid bone. Movement at the talonavicular joint is closely linked to subtalar and calcaneocuboid motion ( 9). The midfoot locks the hindfoot to the forefoot, enabling flexibility and stiffness. This tarsal bone complex is restrained by a network of ligaments, capsules, and fasciae. The midfoot is a complex anatomic association of five tarsal bones (navicular bone, cuboid bone, and three cuneiform bones) and their corresponding articulations. The hindfoot consists of the talus and calcaneus, which articulate at the subtalar joint. The ankle is stabilized by its bone and ligamentous anatomy. The ankle is a synovial hinge joint that comprises the tibia and fibula, which articulate around the central talus this complex is referred to as the ankle mortise ( 8). The ankle transfers force between the foot and the rest of the axial skeleton, enabling stability and foot movement ( 7). Since the ankle is a weight-bearing joint, tolerance for residual deformities from ankle and foot fractures is significantly lower than that for deformities related to upper extremity fractures ( 6). Midfoot and hindfoot fractures generally involve greater force, such as that from a fall from a height or from a higher-speed mechanism-for example, a bicycle or motor vehicle accident. MT fractures alone account for approximately 61% of all foot fractures ( 5). Forefoot (toe, phalangeal, and metatarsal ) fractures are the most frequent acute bone injuries of the foot. Foot fractures account for 5%–8% of all pediatric fractures and approximately 7% of growth plate fractures ( 4). The ankle sustains approximately 15%–20% of all growth plate injuries ( 1) and is the second most common site, after the distal radius, of physeal injuries ( 2, 3). Pediatric ankle and foot fractures, second in incidence to hand and wrist injuries only, account for 13% of all pediatric osseous injuries. The online slide presentation from the RSNA Annual Meeting is available for this article. In addition, the role of imaging in ensuring appropriate treatment, follow-up, and patient and parent counseling is highlighted. This information is intended to supplement radiologists’ understanding of developmental phenomena, anatomic variants, fracture patterns, and associated complications that affect the pediatric foot and ankle. These classification systems aid in diagnosis and treatment planning, facilitate communication, and help standardize documentation and research. The systems used to classify clinically important fractures, including the Salter-Harris, Dias-Tachdjian, Rapariz, and Hawkins systems, are described, with illustrations that reinforce key concepts. The different types of ankle and foot fractures are described, and the American College of Radiology guidelines used to determine appropriate imaging recommendations for patients who meet the Ottawa ankle and foot rules are discussed. Treatment strategies, whether conservative or surgical, are aimed at restoring articular congruency and functional alignment and, for pediatric patients specifically, protecting the physis. The authors describe normal developmental phenomena and injury mechanisms of the ankle and foot and associated imaging findings mimics and complications of acute fractures and dislocations that affect the pediatric ankle and foot. Important posttraumatic complications include premature physeal arrest, three-dimensional deformities and consequent articular incongruity, compartment syndrome, and infection. These injuries represent approximately 13% of all pediatric osseous injuries. In children, increasing participation in competitive sports activities has led to an increased incidence of acute injuries that affect the foot and ankle. Distinct biologic and mechanical attributes of the pediatric skeleton translate into fracture patterns, complications, and treatment dilemmas that differ from those of adults.
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