Patient recollection of the exact motion of the foot during the injury (supination, pronation, external rotation, internal rotation) often does not reliably correlate with the injury pattern seen on imaging or in the operating room. Therefore, the initial focus should be as follows:
- Get a basic history (eg, whether injury occurred during a fall from a height, a sports activity, or a car accident).
- Perform a thorough physical examination, including assessment for neurovascular deficit.
- Reduce the fracture if necessary (particularly if there is a neurovascular deficit).
- Evaluate x-rays for stability.
In most cases, patients will present immediately after an injury. Swelling can progress rapidly, and the degree of swelling has a major impact on the timing of surgery and can lead to complications.