To the Editor.
—The most commonly missed fracture in the foot after a sprain is a fracture of the lateral process of the calcaneus. This is not mentioned in either group of "rules" that Stiell et al1 have mentioned. Unfortunately, the pain from this avulsion-type fracture occurs right under the anterior portion of the lateral ligamentous complex. If one does not take a routine oblique roentgenogram of the foot, this fracture will be missed. An avulsion-type fracture of the lateral process of the calcaneus is very significant in prognostic value and is also important to consider when treating the sprained ankle. Before dismissing the use of radiography in acute ankle sprains on a routine basis, this commonly missed fracture will need to be addressed by the authors.
Waller JF. Radiography for Ankle Injuries. JAMA. 1993;270(4):454. doi:10.1001/jama.1993.03510040057026