What Is a Fracture?
A fracture is a break in the bone. Fractures can be divided into two categories: traumatic fractures and stress fractures.
Traumatic fractures (also called acute fractures) are caused by a direct blow or impact, such as seriously stubbing your toe. Traumatic fractures can bedisplaced or non-displaced. If the fracture is displaced, the bone is broken in such a way that it has changed in position (dislocated).
Signs and symptoms of a traumatic fracture include:
- You may hear a sound at the time of the break.
- “Pinpoint pain” (pain at the place of impact) at the time the fracture occurs and perhaps for a few hours later, but often the pain goes away after several hours.
- Crooked or abnormal appearance of the toe.
- Bruising and swelling the next day.
- It is not true that “if you can walk on it, it’s not broken.” Evaluation by a Podiatrist is always recommended.
Consequences of Improper Treatment
Some people say that “the doctor can’t do anything for a broken bone in the foot.” This is usually not true. In fact, if a fractured toe or metatarsal bone is not treated correctly, serious complications may develop. For example:
- A deformity in the bony architecture which may limit the ability to move the foot or cause difficulty in fitting shoes
- Arthritis, which may be caused by a fracture in a joint (the juncture where two bones meet), or may be a result of angular deformities that develop when a displaced fracture is severe or hasn’t been properly corrected
- Chronic pain and deformity
- Non-union, or failure to heal, can lead to subsequent surgery or chronic pain.
Treatment of Toe Fractures
Fractures of the toe bones are almost always traumatic fractures. Treatment for traumatic fractures depends on the break itself and may include these options:
- Rest. Sometimes rest is all that is needed to treat a traumatic fracture of the toe.
- Splinting. The toe may be fitted with a splint to keep it in a fixed position.
- Rigid or stiff-soled shoe. Wearing a stiff-soled shoe protects the toe and helps keep it properly positioned.
- “Buddy taping” the fractured toe to another toe is sometimes appropriate, but in other cases it may be harmful.
- Surgery. If the break is badly displaced or if the joint is affected, surgery may be necessary. Surgery often involves the use of fixation devices, such as pins.
Treatment of Metatarsal Fractures
Breaks in the metatarsal bones may be either stress or traumatic fractures. Certain kinds of fractures of the metatarsal bones present unique challenges.
For example, sometimes a fracture of the first metatarsal bone (behind the big toe) can lead to arthritis. Since the big toe is used so frequently and bears more weight than other toes, arthritis in that area can make it painful to walk, bend, or even stand.
Another type of break, called a Jones fracture, occurs at the base of the fifth metatarsal bone (behind the little toe). It is often misdiagnosed as an ankle sprain, and misdiagnosis can have serious consequences since sprains and fractures require different treatments. Your Podiatrist is an expert in correctly identifying these conditions as well as other problems of the foot.
Treatment of metatarsal fractures depends on the type and extent of the fracture, and may include:
- Rest. Sometimes rest is the only treatment needed to promote healing of a stress or traumatic fracture of a metatarsal bone.
- Avoid the offending activity. Because stress fractures result from repetitive stress, it is important to avoid the activity that led to the fracture. Crutches or a wheelchair are sometimes required to offload weight from the foot to give it time to heal.
- Immobilization, casting, or rigid shoe. A stiff-soled shoe or other form of immobilization may be used to protect the fractured bone while it is healing.
- Surgery. Some traumatic fractures of the metatarsal bones require surgery, especially if the break is badly displaced.
- Follow-up care. Your Podiatrist will provide instructions for care following surgical or non-surgical treatment. Physical therapy, exercises and rehabilitation may be included in a schedule for return to normal activities.
What Is an Ankle Fracture?
A fracture is a partial or complete break in a bone. Fractures in the ankle can range from the less serious avulsion injuries (small pieces of bone that have been pulled off) to severe shattering-type breaks of the tibia, fibula, or both.
Ankle fractures are common injuries that are most often caused by the ankle rolling inward or outward. Many people mistake an ankle fracture for an ankle sprain, but they are quite different and therefore require an accurate and early diagnosis. They sometimes occur simultaneously.
An ankle fracture is accompanied by one or all of these symptoms:
- Pain at the site of the fracture, which in some cases can extend from the foot to the knee
- Significant swelling, which may occur along the length of the leg or may be more localized
- Blisters may occur over the fracture site. These should be promptly treated by a Podiatrist.
- Bruising that develops soon after the injury
- Inability to walk—however, it is possible to walk with less severe breaks, so never rely on walking as a test of whether a bone has been fractured
- Change in the appearance of the ankle – it will look different from the other ankle
- Bone protruding through the skin—a sign that immediate care is needed. Fractures that pierce the skin require immediate attention because they can lead to severe infection and prolonged recovery.
Following an ankle injury it is important to have the ankle evaluated by a Podiatrist for proper diagnosis and treatment. If you are unable to do so right away, go to the emergency room and then follow up with a Podiatrist as soon as possible for a more thorough assessment.
The affected limb will be examined by the Podiatrist by touching specific areas to evaluate the injury. In addition, the Podiatrist may order x-rays and other imaging studies, as necessary.
Treatment of ankle fractures depends upon the type and severity of the injury. At first, the Podiatrist will want you to follow the R.I.C.E. protocol:
- Rest: Stay off the injured ankle. Walking may cause further injury.
- Ice: Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
- Compression: An elastic wrap should be used to control swelling.
- Elevation: The ankle should be raised slightly above the level of your heart to reduce swelling.
Additional treatment options include:
- Immobilization. Certain fractures are treated by protecting and restricting the ankle and foot in a cast or splint. This allows the bone to heal.
- Prescription medications. To help relieve the pain, the Podiatrist may prescribe pain medications or anti-inflammatory drugs.
When is Surgery Needed?
For some ankle fractures, surgery is needed to repair the fracture and other soft tissue related injuries, if present. The Podiatrist will select the procedure that is appropriate for your injury.
It is important to follow your Podiatrist’s instructions after treatment. Failure to do so can lead to infection, deformity, arthritis, and chronic pain.