Posts for category: fractures
Obese patients experience more severe ankle fractures than those with a healthy body mass index, BMI.
The findings, published in the Journal of Foot and Ankle Surgery, show that patients with a BMI of 30 kg/m2 or above were almost twice as likely to have a Weber C fracture than type A or B fractures.
Christy King, of the Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Oakland, CA, says that patients with Weber C fractures routinely have surgery.
On the other hand, Weber A fractures require surgery if there is medial injury, and type B fractures are operated on if there are also complex bimalleolar, trimalleolar, and bimalleolar equivalent fractures.
Researchers reviewed radiographs from 280 patients, 180 female, average age of 52, with ankle fractures. Information of the patient's Weber classification, BMI, gender, age, diabetes, tobacco use, and osteoporosis, were considered.
Half of the patients, 51.4%, had a BMI of 30 kg/m2, and the ankle fractures were broken down thus: 21% of total patients had Weber A fractures, 59% had type B, and 20% had type C fractures. However, obese patients accounted for the majority of fractures: 46% of type A, 50% of type B, and 61% of type C.
The likelihood of Weber C fractures was not influenced by osteoporosis, tobacco use, or bone mineral density.
Previous research indicated that overweight and obese patients typically have a longer recovery than those with a healthy weight. King et al said in their report, "It is important to recognize the potential risks of obesity, including the possibility of a more severe ankle fracture, to help manage the injury in all phases of treatment."
If you believe have a foot problem and do not currently see a podiatrist, call one of our six locations to make an appointment.
Connecticut Foot Care Centers
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The structure of the foot is complex, consisting of bones, muscles, tendons, and other soft tissues. Of the 26 bones in the foot, 19 are toe bones (phalanges) and metatarsal bones (the long bones in the midfoot). Fractures of the toe and metatarsal bones are common and require evaluation by a specialist. A foot and ankle surgeon should be seen for proper diagnosis and treatment, even if initial treatment has been received in an emergency room.
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 be displaced 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.
Stress fractures are tiny, hairline breaks that are usually caused by repetitive stress. Stress fractures often afflict athletes who, for example, too rapidly increase their running mileage. They can also be caused by an abnormal foot structure, foot deformities, or osteoporosis. Improper footwear may also lead to stress fractures. Stress fractures should not be ignored. They require proper medical attention to heal correctly.
Symptoms of stress fractures include:
- Pain with or after normal activity.
- Pain that goes away when resting and then returns when standing or during activity.
- Pinpoint pain (pain at the site of the fracture) when touched.
- Swelling, but no bruising.
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 structure 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.
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.
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 depend 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 activity.
If you believe you have a broken toe and have not seen a podiatrist yet, call one of our six offices to make an appointment.
Connecticut Foot Care Centers
Podiatrists in CT
Fractures (breaks) are common in the fifth metatarsal- the long bone on the outside of the foot that connects to the little toe. Two types of fractures that often occur in the fifth metatarsal are:
- Avulsion fracture. In an avulsion fracture, a small piece of bone is pulled off the main portion of the bone by a tendon or ligament. This type of fracture is the result of an injury in which the ankle rolls. Avulsion fractures are often overlooked when they occur with an ankle sprain.
- Jones fracture. Jones fractures occur in a small area of the fifth metatarsal that receives less blood and is therefore more prone to difficulties in healing. A Jones fracture can be either a stress fracture (a tiny hairline break that occurs over time) or an acute (sudden) break. Jones fractures are caused by overuse, repetitive stress, or trauma. They are less common and more difficult to treat than avulsion fractures.
Other types of fractures can occur in the fifth metatarsal. Examples include mid-shaft fractures, which usually result from trauma or twisting, and fractures of the fifth metatarsal head and neck.
Avulsion and Jones fractures have the same signs and symptoms. These include:
- Pain, swelling, and tenderness on the outside of the foot.
- Difficulty walking.
- Bruising may occur.
Anyone who has symptoms of a fifth metatarsal fracture should see a podiatrist as soon as possible for proper diagnosis and treatment. To arrive at a diagnosis, the surgeon will ask how the injury occurred or when the pain started. The foot will be examined, with the doctor gently pressing on different areas of the foot to determine where there is pain.
The surgeon will also order x-rays. Because a Jones fracture sometimes does not show up on initial x-rays, additional imaging studies may be needed.
Until you are able to see a foot and ankle surgeon, the R.I.C.E. method of care should be performed:
Rest: Stay off the injured foot. 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 foot should be raised slightly above the level of your heart to reduce swelling.
The foot and ankle surgeon may use one of these non-surgical options for treatment of a fifth metatarsal fracture:
- Immobilization. Depending on the severity of the injury, the foot is kept immobile with a cast, cast boot, or stiff-soled shoe. Crutches may also be needed to avoid placing weight on the injured foot.
- Bone stimulation. A pain-free external device is used to speed the healing of some fractures. Bone stimulation, most commonly used for Jones fractures, may be used as part of the treatment or following an inadequate response to immobilization.
If the injury involves a displaced bone, multiple breaks, or has failed to adequately heal, surgery may be required. The foot and ankle surgeon will determine the type of procedure that is best suited to the individual patient.
If you believe you have fractured your fifth metatarsal, contact one of our six offices to make an appointment.
Connecticut Foot Care Centers
Podiatrists in CT