In sustentaculum tali fracture management, which cast position is used?

• A. Dorsiflexed and everted
• B. Plantarflexed and inverted
• C. Neutral
• D. Plantarflexed and everted

Answer: (B)

In sustentaculum tali fractures, the goal of casting is to stabilize the medial portion of the hindfoot and minimize forces that could displace the fragment. Placing the foot in plantarflexion helps relax the posterior structures like the Achilles while reducing posteriorly directed pull on the calcaneus, and inversion stabilizes the hindfoot medially, keeping the sustentaculum tali aligned with the talus. This combination promotes an anatomic position for healing and minimizes movement at the fracture site during immobilization. Positions such as dorsiflexion, neutral, or plantarflexion with eversion tend to increase rib destabilization of the medial column or place distracting forces on the fragment, making plantarflexed and inverted the best choice.