Trauma - Foot & Ankle Fractures
An ankle fracture involves any type of break or crack in the tibia, fibula or talus. This can include injury to one or more of the bones that make up the ankle joint. The more bones that are broken, the more complicated and severe the fracture is.
Patients with a broken ankle may experience:
- Inability to walk
- Physical deformity
Treatment for a broken ankle may include wearing a cast or brace, applying ice and taking anti-inflammatory medication. Stable nondisplaced fractures can usually heal using conservative measures within a 6-8 weeks, while more complicated, displaced or unstable ones may require surgery to reposition the broken bone/s and realign the joint.
Pilon fractures occur at the bottom of the tibia around the ankle joint. Frequently, with this type of fracture the fibula is broken as well. Pilon fractures are often high-impact injuries that may result in the destruction of bones at the ankle joint. They may take place after a fall from a great height, automobile crash or skiing accident. Pilon fractures cause extreme pain, bruising and swelling. The injured foot cannot bear weight and may be crooked or misaligned. Medical attention is needed immediately. If the fracture is stable, it may respond to conservative treatment with a cast or splint. However, in the majority of cases, surgery is necessary to realign the bones of the ankle. Usually an External Fixator is initially placed to stabilize the fracture while the soft tissue recovers and then a second surgery is often performed utilizing plates and screws to stabilize and support the bones as they heal.
The talus is a small bone in the ankle, positioned between the heel bone and the tibia and fibula. It acts as a connection between the foot and the leg. A fracture of the talus is often the result of an automobile accident or fall from a height. Talus fractures are very painful, causing swelling, tenderness and an inability to bear weight on that foot.
Treatment for talus fractures is essential because if it does not heal correctly, the foot's mobility may be reduced and chronic pain and arthritis may develop. Some talus fractures can be treated with casting, followed by physical therapy to regain strength and flexibility. In most cases, however, surgery is necessary to realign the injured bones and properly support the joint.
Heel Bone Fractures
A fracture of the calcaneus, or heel bone, is usually the result of an automobile accident or fall from a great height. Its symptoms include pain on the outside of the ankle or under the heel; inability to bear weight and swelling and stiffness. This fracture may be accompanied by back or knee injury due to the amount of force required to break the heel bone.
Midfoot Fractures & the Lisfranc Injury
A fracture of the Lisfranc joint of the midfoot is often caused by dropping something heavy on the top of the foot or by falling after catching the foot in a hole. Symptoms are similar to a sprain and include swelling and pain at the top of the foot, bruising, possible inability to bear weight and pain when moving the foot while the ankle is held steady. If you think you have a sprain and it does not improve with rest and ice after one to two days, you may have a Lisfranc joint fracture and should see a doctor to prevent further injury.
Metatarsals are the long bones of the forefoot. There are many different kinds of fractures that can happen to the bones of the forefoot. They are painful but often heal without the need for surgery. The metatarsals are prone to stress fractures, or cracks in the bone. These are usually related to a recent increase or change in activity. The fifth metatarsal below the small toe may fracture if it is landed on badly or if the ligament of a twisted ankle pulls off a piece of the bone. Symptoms of a metatarsal fracture include pain that gets worse when walking, swelling and sometimes bruising.
Stress fractures are tiny, hairline breaks that are usually caused by repetitive stress. Stress fractures often afflict athletes who, for example, too rapidly increase their running mileage. They can also be caused by an abnormal foot structure, deformities, or osteoporosis. Improper footwear may also lead to stress fractures. Stress fractures should not be ignored. They require proper medical attention to heal correctly.
Symptoms of stress fractures include:
- Pain with or after normal activity
- Pain that goes away when resting and then returns when standing or during activity
- “Pinpoint pain” (pain at the site of the fracture) when touched
- Swelling, but no bruising
There are several bones in each toe, all of which are susceptible to breaking. Toe fractures are typically caused by dropping something on the toe or impact against it. They can also be due to stress fractures resulting from repetitive movements in sports. When a toe is fractured, it may appear bruised or swollen and feel stiff and painful.
Casting is rarely required for a toe fracture. Most often, the injury heals well by using ice packs, keeping the foot elevated and having the toe taped to the next toe to fix it in position and provide support. Typically, taking acetaminophen or ibuprofen is enough to manage any pain.