A Fabricated Foot Fracture Caused by Deliberate Placement of an External Osseous Fragment: A Case Report

Accurate diagnosis of musculoskeletal injuries requires correlation between clinical and radiological findings.Although plain radiographs are essential for fracture assessment, external objects may mimic osseous pathology and lead to misdiagnosis.We present an unusual case of a fabricated foot fracture caused by deliberate placement of an external osseous fragment for secondary gain.A 23-year-old previously healthy man presented with left foot pain and inability to bear weight following a reported low-energy fall at his military base.Initial radiographs demonstrated an apparent osseous fragment adjacent to the first metatarsal, provisionally interpreted as a fracture, and the patient was treated with below-knee cast immobilization.On follow-up, repeat radiographs showed an unexpected change in the fragment's position.Computed tomography demonstrated that the fragment was external to the foot and embedded within the cast material, with no true fracture.During supervised repeat radiography, the patient was observed deliberately positioning the fragment adjacent to the foot and subsequently admitted to fabricating the injury to obtain sick leave.Discrepancies between clinical findings and serial radiographs should prompt careful reassessment and consideration of external artifacts.Recognition of unexpected changes in the position of an apparent fracture fragment may prevent unnecessary immobilization, investigations, and treatment, particularly when secondary gain is suspected.