Foot and Ankle Fractures

Fractures occurring to the bones of the foot and ankle are amongst the most common Orthopedic injuries. Proper diagnosis of these injuries is critical in determining appropriate treatment and assuring a full recovery.

Ankle fractures

An ankle fracture (break and fracture mean the same thing) refers to a break that occurs to the lower end of the tibia and/or fibula bones. These 2 bones attach to the talus bone in the foot, and comprise the ankle joint. The fibula, also known as the lateral malleolus, is the outer bone on the ankle and is most commonly fractured. Less commonly fractured is the inner portion of the tibia, known as the medial malleolus, which may be fractured in isolation or in addition to the fibula.

Treatment of an ankle fracture depends on if the bones have been shifted out of place, known as displacement. A fracture with up to 2 mm of displacement usually can be treated without surgery, with 6 to 10 weeks in a cast (often a removable cast). However, if the fracture is more than 2mm displaced, or if the break involves the weight-bearing surface of the ankle joint, surgical repair is often necessary. Otherwise, the bones will heal out of position enough to alter the function of the ankle, and risk long-term problems including arthritis. Surgical repair of a broken ankle requires placing plates and screws to hold the broken pieces of bone together until they heal. Following surgical repair, patients are generally placed in a cast, and need to remain non-weight bearing for a period of time.

In general, most people have a full recover following both nonoperatively treated ankle fractures, and those requiring surgery. However, the length of time to full recover may vary, and some people with more severe fractures may be left with permanent ankle stiffness. Also, there is a small risk of developing arthritis, or permanent damage to the joint surface, with a bad fracture.

Metatarsal fractures

The metatarsal bones are the long bones of the forefoot that attach the middle part of the foot to the toes. These are the most commonly fractured bones in the foot, especially the 5th metatarsal, the bone located on the outermost side of the foot. These fractures occur when the foot and ankle is suddenly twisted inwards. 90% of the time, a metatarsal fracture can be treated with a removable walking cast for 4-8 weeks, followed by use of a special stiff-soled shoe for an additional 4 weeks. 10% of the time, a metatarsal fracture will need to be surgically repaired because the bones are displaced, or the break occurs in a small section of the bone that is particularly difficult to heal. In these cases, metal screws (and occasionally a metal plate) are used to stabilize the bones while the fracture heals. Following surgery, a period of non-weight bearing is necessary, followed by a walking cast or specialized shoe.

Heel fractures

The heel bone, known as the calcaneus, can be broken in a fall from a height or from a motor vehicle accident. This is a very serious and complicated type of fracture, because the calcaneus usually breaks into many different fragments, and often requires surgical repair. Even with a less serious calcaneus fracture, there is often permanent stiffness in the foot and ankle following healing. Recovery from a calcaneus fracture includes 2-3 months on crutches following by another 2-3 months in a walking cast. Due to the complicated nature, a calcaneus fracture is best treated by an Orthopedic Surgeon with considerable experience treating this type of injury.

Toe fractures

The toe bones in the foot are known as phalanges. The phalanges of the foot are most commonly fractured when accidently kicking an object, like the leg of a chair or table while walking barefoot in the house. Sometimes, the toe will be angled out of place and will need to be “set” back straight into position (usually done at the ER or in an Orthopedists office, or sometimes by the injured person). Despite their small size, toe fractures can me quite painful. Taping the injured toe to the adjacent toe (known as “buddy-taping” can be helpful to immobilize the toe and allow more comfortable walking. For the first few weeks, using a stiff-soled shoe helps to relieve the pain and put less pressure on the broken toe. After 4 to 6 weeks, one can return to normal activities. Phalanx fractures rarely need surgical repair.

Stress fractures

Stress fractures can occur under 2 circumstances. The first is when normal amounts of stress are applied to weakened bone. Bone can be weakened by osteoporosis (loss of bone mass), certain disease states, or after prolonged immobilization. Under such circumstances, normal amounts of stress including a moderate amount of walking or light amount of jogging can cause a fracture of one of the foot bones.

The second circumstance where a stress fracture can occur is when an excessive amount of stress is placed on a normal bone. This usually occurs when an athlete is training extremely hard, such as running prolonged distances, or performing repetitive jumping.

The most common stress fracture occurs to the metatarsal bone under either of the above circumstances. With weakened bone, the heel bone can also sustain a stress fracture. With excessive stress on normal bone, the navicular bone (in the middle of the foot) and either of the leg bones (the tibia and fibula) are at risk for stress fractures.