Fracture Care

What is a Foot Fracture?

Trauma and repeated stress can cause fractures in the foot. Extreme force is required to fracture the bones in the hind foot. The most common type of foot fracture is a stress fracture, which occurs when repeated activities produce small cracks in the bones.

What is the Normal Anatomy of the foot?

The foot has 26 bones, and can be divided into 3 parts:

  • The hind foot is comprised of two bones, the talus bone which connects to the bones of the lower leg, and the calcaneus bone which forms the heel.
  • The midfoot is comprised of the navicular, cuboid, and three cuneiform bones.
  • The forefoot is made up of five metatarsal bones and 14 toe bones called phalanges.

The hind foot is separated from the midfoot by the medio tarsal joint and the midfoot is separated from the forefoot by the Lisfranc joint. Muscles, tendons and ligaments support the bones and joints of the feet enabling them to withstand the entire weight of the body while walking, running and jumping.

What are the Types of Foot Fractures?

Foot fractures can involve different bones and joints and are classified into several types:

  • Calcaneal fractures: This affects the heel bone and occurs mostly because of high-energy collisions. It can cause disabling injuries and if the subtalar joint is involved it is considered a severe fracture.
  • Talar fractures: The talus bone helps to transfer weight and forces across the joint. Talus fractures usually occur at the neck or mid portion of the talus.
  • Navicular fractures: Navicular fractures are rare and include mostly stress fractures that occur with sports activities, such as running and gymnastics, because of repeated loading on the foot.
  • Lisfranc fractures: This type of fracture occurs due to excessive loading on the foot, which leads to stretching or tearing of the midfoot ligaments.

What are the Symptoms of Foot Fractures?

The common symptoms of a foot fracture include pain, bruising, tenderness, swelling, deformity and inability to bear weight.

What is the Treatment for Foot Fractures?

Treatment depends on the type of fracture sustained. For mild fractures, non-surgical treatment is advised and includes rest, ice, compression, and elevation of the foot.

Your doctor may suggest a splint or cast to immobilize the foot. For more severe fractures, surgery will be required to align, reconstruct or fuse the joints. Bone fragments may be held together with plates and screws.

Physical therapy may be recommended to improve range of motion and strengthen the foot muscles. Weight-bearing however, should be a gradual process with the help of a cane or walking boot.

What is an Ankle Fracture?

Ankle injuries are very common in athletes and in people performing physical work, often resulting in severe pain and impaired mobility. Pain after ankle injuries can either be from a torn ligament and is called an ankle sprain or from a broken bone which is called an ankle fracture. An ankle fracture is a painful condition where there is a break in one or more bones forming the ankle joint. The ankle joint is stabilized by different ligaments and other soft tissues, which may also be injured during an ankle fracture.

What is Normal Ankle Joint Anatomy?

The ankle joint is composed of three bones: the tibia, fibula and talus, which are articulated together. The ends of the fibula and tibia (lower leg bones) form the inner and outer malleolus, which are the bony protrusions of the ankle joint that you can feel and see on either side of the ankle. The joint is protected by a fibrous membrane called a joint capsule, and filled with synovial fluid to enable smooth movement.

What are the Types of Ankle Fractures?

Ankle fractures are classified according to their location. The different types of ankle fractures are:

  • Lateral Malleolus fracture in which the lateral malleolus, the outer part of the ankle, is fractured.
  • Medial Malleolus fracture in which the medial malleolus, the inner part of the ankle, is fractured.
  • Posterior Malleolus fracture in which the posterior malleolus, the bony hump of the tibia, is fractured.
  • Bimalleolar fractures in which both lateral and medial malleolus bones are fractured.
  • Trimalleolar fractures in which all three lateral, medial, and posterior bones are fractured.
  • Syndesmotic injury, also called a high ankle sprain, is usually not a fracture, but can be treated as a fracture.

What are the Symptoms of an Ankle Fracture?

With an ankle fracture, there is immediate swelling and pain around the ankle as well as impaired mobility. In some cases, blood may accumulate around the joint, a condition called hemarthrosis. In cases of severe fracture, deformity around the ankle joint is clearly visible where bone may protrude through the skin.

What are the Treatment Options for Ankle Fractures?

Immediately following an ankle injury and prior to seeing a doctor, you should apply ice packs and keep the foot elevated to minimize pain and swelling.

The treatment of an ankle fracture depends upon the type and the stability of the fractured bone. Treatment starts with non-surgical methods, and in cases where the fracture is unstable and cannot be realigned, surgical methods are employed.

In non-surgical treatment, the ankle bone is realigned and special splints or a plaster cast is placed around the joint, for at least 2-3 weeks.

With surgical treatment, the fractured bone is accessed by making an incision over the ankle area and then specially designed plates are screwed onto the bone to realign and stabilize the fractured parts. The incision is then sutured closed and the operated ankle is immobilized with a splint or cast.

What is the Postoperative Care for an Ankle Fracture?

After ankle surgery, you will be instructed to avoid putting weight on the ankle by using crutches while walking for at least six weeks.

Physical therapy of the ankle joint will be recommended by the doctor. After 2-3 months of therapy, the patient may be able to perform normal daily activities.

What are the Risks and Complications of an Ankle Fracture?

Risks and complications that can occur with ankle fractures include improper casting or improper alignment of the bones which can cause deformities and eventually arthritis. In some cases, pressure exerted on the nerves can cause nerve damage, resulting in severe pain.

Rarely, surgery may result in incomplete healing of the fracture, which requires another surgery to repair.