{"id":11493,"date":"2022-08-18T15:11:14","date_gmt":"2022-08-18T13:11:14","guid":{"rendered":"https:\/\/www.physiotutors.com\/?post_type=wiki&amp;p=11493"},"modified":"2022-08-18T15:11:14","modified_gmt":"2022-08-18T13:11:14","slug":"midfoot-zone-algorithm","status":"publish","type":"wiki","link":"https:\/\/www.physiotutors.com\/wiki\/midfoot-zone-algorithm\/","title":{"rendered":"Midfoot Zone Algorithm"},"featured_media":11494,"template":"","class_list":["post-11493","wiki","type-wiki","status-publish","has-post-thumbnail","hentry"],"acf":{"sections":[{"acf_fc_layout":"page-header-detail-page","background":{"background_image":11494,"background_image_alt_text":"Midfoot Zone Algorithm"},"heading":"Midfoot Zone Algorithm | Ankle Fracture Assessment in Children","subheading":"Screening","content_editor":"","button_type":"internal_link","button_label":"Check our shop","button_style":"button-five","button_internal_link":"","button_anchor":"","button_url":"","button_file":"","label":""},{"acf_fc_layout":"submenu","links":[{"button_type":"anchor","button_label":"Learn","button_internal_link":null,"button_anchor":"section-number-3","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Assessment E-Book","button_internal_link":null,"button_anchor":"section-number-4","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Reviews","button_internal_link":null,"button_anchor":"section-number-5","button_url":"","button_file":null}],"dropdown_label":"Go to","button_right":{"button_type":"internal_link","button_label":"Become a member","button_style":"button-three","button_internal_link":16662,"button_anchor":"","button_url":"","button_file":""},"button_description":"Find this wiki on the Physiotutors platform"},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"<h4>Learn<\/h4>"},"column_right":{"content_editor":"<h6>Midfoot Zone Algorithm | Ankle Fracture Assessment in Children<\/h2>\n<span style=\"font-weight: 400;\">The midfoot zone algorithm was developed by <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/15231460\/\" target=\"_blank\" rel=\"noopener\">Dayan et al. (2004)<\/a>. Their goal was to develop a maximally sensitive clinical prediction rule to identify fractures after ankle injuries in children younger than 18 years of age. This includes fractures of the base of the metatarsals, navicular bone, the calcaneus, cuboid, or cuneiform. They argue the importance of such a new CPR as validation studies of the Ottawa Ankle Rules in a population of children resulted in conflicting results.<\/span>\n\n<span style=\"font-weight: 400;\">A recent systematic review by <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28764972\/\" target=\"_blank\" rel=\"noopener\">Barelds et al. (2017)<\/a> looked at various clinical prediction rules for ankle and midfoot fractures and reports a sensitivity of 95% and specificity of 32% for the midfoot zone algorithm.\u00a0<\/span>\n\n<span style=\"font-weight: 400;\">The CPR has yet to reach further validation and the authors report several possible limitations, which is why for now, we give it a moderate clinical value.<\/span>\n<div class=\"embed-container\">\n\n[embed]https:\/\/www.youtube.com\/watch?v=EOO3cRP8wEQ[\/embed]\n\n<\/div>\n<span style=\"font-weight: 400;\">The midfoot zone algorithm goes as follows and aims to identify significant or high-risk fractures in children younger than 18 years of age after an acute twisting ankle injury.<\/span>\n\n<span style=\"font-weight: 400;\">The one and only step is to check for tenderness over the fifth metatarsal or cuboid. If that is the case, there is high risk of fracture that would warrant radiographic imaging.<\/span>\n\nBe aware that this doesn't mean that there is a high chance for a fracture (still below one 1 out of 3 due to the low sensitivity), but we cannot safely rule out a fracture.\n\n&nbsp;\n\n[cta]\n\n&nbsp;\n\nOther common tests to screen for ankle fractures are:\n\n<a href=\"https:\/\/www.physiotutors.com\/wiki\/bernese-ankle-rules\/\">Bernese Ankle Rules<\/a>\n\n<a href=\"https:\/\/www.physiotutors.com\/wiki\/low-risk-ankle-rule\/\">Low Risk Ankle Rule for Ankle Fractures in Children<\/a>\n\n<a href=\"https:\/\/www.physiotutors.com\/wiki\/malleolar-zone-algorithm\/\">Malleolar Zone Algorithm for Fractures in Children<\/a>\n\n<a href=\"https:\/\/www.physiotutors.com\/wiki\/ottawa-ankle-rules\/\">Ottawa Ankle Rules<\/a>\n\n&nbsp;\n"}},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"<h4>References<\/h4>"},"column_right":{"content_editor":"<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/15231460\/\" target=\"_blank\" rel=\"noopener\">Dayan, P. S., Vitale, M., Langsam, D. J., Ruzal\u2010Shapiro, C., Novick, M. K., Kuppermann, N., &amp; Miller, S. Z. (2004). Derivation of clinical prediction rules to identify children with fractures after twisting injuries of the ankle.\u00a0<i>Academic emergency medicine<\/i>,\u00a0<i>11<\/i>(7), 736-743.<\/a>\n\n<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28764972\/\" target=\"_blank\" rel=\"noopener\">Barelds, I., Krijnen, W. P., van de Leur, J. P., van der Schans, C. P., &amp; Goddard, R. J. (2017). Diagnostic accuracy of clinical decision rules to exclude fractures in acute ankle injuries: systematic review and meta-analysis.\u00a0<i>The Journal of emergency medicine<\/i>,\u00a0<i>53<\/i>(3), 353-368.<\/a>"}},{"acf_fc_layout":"cta-image-v2","layout":"","background":"transparent","heading":"","content_editor":"<p class=\"subheading\">Like what you\u2019re learning?<\/p>\n<p class=\"heading-two\">BUY THE FULL PHYSIOTUTORS <strong>ASSESSMENT BOOK<\/strong><\/p>\n\n<ul>\n \t<li>600+ Pages e-Book<\/li>\n \t<li>Interactive Content (Direct Video Demonstration, PubMed articles)<\/li>\n \t<li>Statistical Values for all Special Tests from the latest research<\/li>\n \t<li>Available in \ud83c\uddec\ud83c\udde7 \ud83c\udde9\ud83c\uddea \ud83c\uddeb\ud83c\uddf7 \ud83c\uddea\ud83c\uddf8 \ud83c\uddee\ud83c\uddf9 \ud83c\uddf5\ud83c\uddf9 \ud83c\uddf9\ud83c\uddf7<\/li>\n \t<li>And much more!<\/li>\n<\/ul>","button_type":"internal_link","button_label":"Check out our 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