Foot Fracture
What is the Normal Anatomy of the foot?
The foot has 26 bones that can be classified into 3 sections:
- The hindfoot is comprised of two bones: the talus bone that connects to the bones of the lower leg and the calcaneus bone that 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 hindfoot is separated from the midfoot by the mediotarsal 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 is a Foot Fracture?
Trauma and repeated stress can cause fractures in the foot. Extreme force is required to fracture the bones in the hindfoot. The most common type of foot fracture is a stress fracture that occurs when repeated activities produce small cracks in the bones.
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 most often include 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 Common Causes of Foot Fractures?
Foot fractures commonly occur because of a fall, motor vehicle accident, dropping a heavy object on your foot or from overuse such as with sports.
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.
How are Foot Fractures Diagnosed?
Your doctor diagnoses a foot fracture by reviewing your medical history and performing a thorough physical examination of your foot. Imaging tests such as X-rays, MRI or CT scans may be ordered to confirm the diagnosis. Navicular fractures can be especially difficult to diagnose without imaging tests.
What is the Treatment for Foot Fractures?
The treatment for foot fractures 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.
Ankle Fractures
What is the Normal Ankle Anatomy?
The ankle joint is composed of three bones: the tibia, fibula, and talus, which articulate 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 is an Ankle Fracture?
Ankle injuries are very common in athletes and individuals performing physical work; often resulting in severe pain and impaired mobility. Pain after ankle injuries can either be from a torn ligament (ankle sprain) or broken bone (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 are the Common Causes of Ankle Fractures?
Ankle fractures can occur from excessive rolling and twisting of the ankle - usually from an accident or activities such as jumping or falling, which cause sudden stress to the joint.
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 the case of a severe fracture, deformity around the ankle joint is clearly visible where a bone may protrude out piercing the skin.
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
How is an Ankle Fracture Diagnosed?
The diagnosis of an ankle injury begins with a review of your history and a thorough physical examination. This is followed by X-rays and CT scan of the injured area to obtain a detailed view.
In some cases, pressure is applied on the ankle and then special X-rays are taken. This procedure is called a stress test. This test is ordered to determine the stability of the fracture under stress and decide on the need for surgery. In complex cases where a detailed evaluation of the ligaments is required, an MRI scan is recommended.
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.
For 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 to allow the bones to heal.
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 applying weight on the ankle and advised using crutches while walking for at least six weeks.
Physical therapy of the ankle joint will be recommended by your doctor. After 2-3 months of therapy, you may be able to perform daily normal activities.
What are the Risks and Complications of an Ankle Fracture Treatment?
The risks and complications that can occur with ankle fracture treatment 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 for repair.
