The diagnosis begins with the health care practitioner taking a history of how the injury occurred. The mechanism of injury will give clues as to what type of injury may exist and importantly, what other associated injuries may also be potentially present. It is helpful to know how much time has passed from when the injury occurred to when the patient presents for care. Past medical history is important; those with diabetes are at greater risk for infection with foot injuries.

Physical examination

• Inspection of the foot for swelling, bruising, deformities, and open wounds.
• Palpation, which allows the health care practitioner to feel where the pain is located. This is very helpful if X-rays are taken, since it allows a more careful inspection of the area where the tenderness exists. This is particularly important in children whose bones may not have yet calcified. Fractures may be easily missed since they occur through cartilage instead of bone.
• Examination of the circulatory system, feeling for pulses, and a neurologic exam, assessing sensations such as light touch and pin prick along with motor function.
• Examination of the range of motion of the foot, which may help assess ligament stability. However, if the fracture is obvious, the health care practitioner may choose to keep the foot immobilized to prevent further pain.

Imaging

X-rays are often taken to evaluate the status of the bones in the foot and check for fracture. Usually three pictures are taken to help the health care practitioner and radiologist adequately view the bones. Special views may be taken if there is concern for a fracture of the calcaneus.

X-rays may not be taken for simple toe injuries, since they may not affect the treatment plan.

For some foot fractures, X-rays may not be adequate to visualize the injury. This is often true for metatarsal stress fractures, where bone scans may be used if the history and physical examination suggest a potential fracture, but the plain X-rays are normal.

Computerized tomography (CT) may be used to assess fractures of the calcaneus and talus, since it may better be able to illustrate the anatomy of the ankle and midfoot joint and potential associated injuries.

The Lisfranc joint describes the connection between the first, second, and third metatarsals and the three cuneiform bones. A Lisfranc fracture dislocation often requires a CT scan to evaluate this region of the foot once plain X-rays delineate the injury.

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