Patient Education

Foot Fracture

Description

Whether the tendency is good or bad, human beings do have a propensity to take a bit of delight in destruction. Knocking over a tall tower of blocks, smashing through the carapace of a scuttling cockroach, watching as a wrecking ball brings down an abandoned office building, all give us the tiniest of thrills. But broken things aren’t always so exciting. In fact, some can as easily cause distress as delight. Broken dishes, broken hearts, broken fingernails-all ignite some degree of angst, some more than others, and broken bones are probably somewhere in the middle of the scale.

Bones really do a lot for us. They help us fight the good fight against gravity (giving structure and support to our bodies), provide anchors for our muscles, and offer us all something to shiver at when people hang skeletons from their trees in late October. So it’s hardly surprising that breaking a bone is often painful and can be extremely disruptive to the function of the foot.

Bone breaks (also known as fractures and cracks) are usually either caused by trauma (a sudden injury like a fall or car accident) or long-term stress to the bone. There are many different types of breaks. They include open fractures (where the bone has broken through the skin) and closed fractures (the skin over the bone remains intact). The break in the bone may be transverse (broken straight across the bone like a snapped twig), oblique (broken at an angle to the bone), spiral (the bone has been twisted apart) and stress fractures (small cracks in the bone). Stress fractures may not be as familiar (or as feared) as fractures caused by trauma, but they still may cause significant problems, particularly in patients with diabetes. Osteoporosis, being overweight, overuse of the foot, poorly fitting or unsupportive shoes, and certain bone disorders may all make one more susceptible to developing these fractures.

While any of the 26 bones in the foot could be broken, a few areas tend to see injury more than others. These include:

  • Toes – Late-night stumbling into the corner of your bookshelf may snap the bones in your toe (so turn on the light or use a flashlight if you need to visit the bathroom the middle of the night). Don’t ever assume that doctors can do nothing for your toe. Some toe breaks may require surgery to get all the pieces back together, or your doctor may need to tape it up to make it heal properly, so be sure your podiatrist has a look at it.
  • Metatarsals – Metatarsals are the long, thin bones that connect your toes to the rest of your foot. Breaks might occur at any point along their length (head, neck, shaft and base), and may occur to any one or all of the five. (Each metatarsal corresponds to and is numbered with the toe it connects to. So the first metatarsal connects to your big toe, and the fifth metatarsal connects to your pinky toe. You can probably work out the other numbers on your own.) Metatarsals are also particularly susceptible to stress fractures when overstrained.
  • Ankle – The ankle is actually made up of several different bones: the tibia (your shin bone), the fibula (the thinner leg bone that runs along next to the tibia-the end of this bone forms the outside of your ankle), and the talus (a foot bone). Any one of these bones can break (or all of them in particularly horrid circumstances), although most breaks tend to occur in the fibula or tibia.
  • Heel – The heel bone (also known as the calcaneus) generally breaks under major stress, such as a car accident or falling from a significant height. Breaks in this area can be particularly devastating, and often require surgery.

Symptoms

Some breaks (particularly those in the ankle) may be mistaken for sprains or other injuries. So, whenever you experience the symptoms of a break, it’s important that you get your foot checked out by a podiatrist in order to determine what’s really going on. Common symptoms of fractures include the following. (By the way, you may experience only some of the symptoms, since not all fractures produce the same symptoms.)

  • Pain (likely to be sudden in the case of fracture caused from trauma, or if from a stress fracture will probably appear with activity and disappear during periods of rest)
  • Tenderness to the touch
  • Swelling
  • Bruising
  • Redness
  • Heat
  • An inability to walk on the foot (stress fractures may not have this symptom)
  • Deformity (the shape of the foot has visibly changed)

A common misconception is that if you can move the bone, it can’t be broken. This is not true, particularly for breaks in the fibula, chip fractures, stress fractures, and broken toes. Get your injury checked by a doctor. It’s better to check and not have a broken bone than not to check and have an untreated fracture.

Diagnosis

Despite having probably knocked over his or her share of block towers as a toddler, your podiatrist takes no delight in broken bones. However, he or she is an expert at diagnosing and fixing them. When you go in to see your foot doctor about your injury, he or she will likely inquire about symptoms you’ve experienced, may make a physical exam of your foot, and (unless he or she has superpowers and can see through your skin) will almost certainly use some sort of imaging technology to find out what’s going on with your bones. X-rays are probably the most commonly used imaging tool in fracture diagnosis, although your podiatrist may also suggest CAT scans or MRIs.

Treatment

Treating a broken bone can be a tricky business, simply because each fracture is different. Depending on the type of fracture and on which bone is broken, treatments may be conservative or can go all the way up to extensive surgery. Whether the treatment is conservative or not, healing broken bones generally revolves around keeping them immobilized so they have a chance to knit back together again. The difference is that conservative treatments immobilize from the outside, while surgery immobilizes from the inside.

Your podiatrist may accomplish external immobilization with a splint, removable boot, or a cast. You’ll likely also find relief from pain by employing the RICE method (Rest, Ice, Compression, and Elevation). Also, whatever you’ve heard, it is not a good idea to soak your broken bone in hot water. Doing so increases blood flow, which will also increase swelling and pain.

However, if the bones aren’t stable, or the break is severe enough (and there are lots of little pieces of bone involved), your podiatrist may suggest surgery to correct the break and avoid arthritis in the future. Surgery may use pins, screws and plates to secure bones in their proper places.

In general, healing from a broken bone usually takes several weeks to several months, although the time needed for healing can vary greatly depending on the type of fracture and your overall health. (Diabetics, for instance, may experience a longer healing time than other patients.) On occasion, bones may not knit back together (non-union), or may knit together incorrectly (mal-union). In such circumstances, your podiatrist can recommend further treatment methods, which may include surgery.

It isn’t always possible to mend broken things (like a very expensive vase, for instance). But the beautiful thing about the body is that, with a little help, it usually does a great job of putting everything back together. So, with enough time and care, your broken bones should be nice and whole once again.