Commonly missed peritalar injuries.

Because of the effect on hindfoot kinematics, missed or delayed diagnosis of peritalar injuries often results in impairment. The seemingly innocuous nature of these injuries, subtle radiographic findings, and low incidence limit familiarity, thereby increasing the likelihood of misdiagnosis. Because of delay in diagnosis, salvage arthrodesis may be necessary to restore function to the extremity. Talar head fracture, talar process fracture, subtalar fracture-dislocation, transverse tarsal joint fracture, and transverse tarsal ligamentous disruption with instability are recurrently misdiagnosed. The keys to proper diagnosis of these potentially devastating injuries are the recognition of their existence, their injury patterns, and their radiographic appearance. The threshold for additional imaging studies should be lowered when a patient has pain and physical examination findings are out of proportion to a provisional diagnosis, or when symptoms fail to improve.