Fractures

Stubbed your toe and it's grown to the size of a grapefruit? Playing basketball and tripped while driving to the hoop? Took a tumble down the stairs carrying laundry? We feel your pain! If you find that you cannot move your toe, foot, or ankle, it's likely you've broken a bone. Fractures are treated in our six offices: Rocky Hill CT, Bristol CT, Newington CT, Glastonbury CT, Middletown CT, and Kensington CT. Our four podiatrists Dr. Jeffrey S. Kahn, Dr. Richard E. Ehle, Dr. Craig M. Kaufman, and Dr. Ayman M. Latif are highly trained in treating fractures of the foot, ankle, and toe. 

Nearly one-fourth of all the bones in your body are in your feet. A broken (fractured) bone in your forefoot or in one of your toes is often painful, but rarely disabling. Most of the time, these injuries heal without operative treatment.

There are two types of foot fractures: stress fractures and general bone fractures. Stress fractures usually occur in the bones of the forefoot extending from the toes to the middle of the foot. Stress fractures are like tiny cracks in the bone surface. They can happen with sudden increases in exercise (such as running or walking for longer distances or times), improper training techniques, or a change in surfaces.

Most other types of fractures extend through the bone, and are called bone fractures. They may be stable, in which there is no shift in bone alignment, or displaced, in which the bone ends no longer line up properly. Bone fractures usually result from trauma, such as dropping a heavy object on your foot, or from a twisting injury. If the fractured bone does not break through the skin, it is called a closed fracture. If the fracture does break through the skin, it is called an open fracture.

Because of the complex structures in the foot, there are some other, more specific types of fractures that can occur. For example, the fifth metatarsal, known as the little or pinky toe, is susceptible to a variety of different fractures. The relationship between the ankle and the foot can be compromised by an ankle-twisting injury, which may tear the tendon that attaches to this bone and pull a small piece of the bone away. A more serious injury in the same area is known as a Jones fracture, which occurs near the base of the bone and disrupts its blood supply. This injury may take longer to heal or require surgery.

Common symptoms for any type of foot fracture includes pain, swelling, and sometimes bruising. Be sure to seek medical attention for any suspected foot fracture.

Ankle Fractures

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 ankle fractureof 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 and accurate and early diagnosis. They sometimes occur simultaneously. 

Symptoms

An ankle fracture is accompanied by one of 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 foot and ankle surgeon.
  • Bruising develops soon after the injury
  • Inability to walk- however, it is possible to walk with less severe break, so never rely on walking as a test of whether a bone has been fractured
  • Change in 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.

Diagnosis

Following an ankle injury it is important to have the ankle evaluated by a foot and ankle surgeon for proper diagnosis and treatment. If you are unable to do so right away, go to the emergency room as soon as possible for a more thorough assessment. 

The affected limb will be examined by the foot and ankle surgeon by touching the specific areas to evaluate the injury. In addition, the surgeon may order x-rays and other imaging studies, as necessary.

Non-surgical Treatment

Treatment of ankle fractures depends on the type and severity of the injury. At first, the foot and ankle surgeon will want you to follow the R.I.C.E. protocol:

  • Rest: Stay off the injured ankle.
  • 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 elastric 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 surgeon 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 foot and ankle surgeon will select the procedure that is appropriate for your injury.

Follow-up Care

It is important to follow your sugeon's instructions after treatment. Failure to do so can lead to infection, deformity, arthritis, and chronic pain. 

Fractures of the Fifth Metatarsal

What Is a Fifth Metatarsal Fracture?

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 fifth toe fracturefractures 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 metatarsal head and neck.

Symptoms 

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

Diagnosis

Anyone who has symptoms of a fifth metatarsal fracture should see a foot and ankle surgeon 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 the 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.

Non-surgical Treatment

Until you are able to see a foot and ankle surgeon, the "R.I.C.E" method of care should be performed. The foor 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. 

When Is Surgery Needed?

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. 

Toe and Metatarsal Fractures

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.

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 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 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 foot and ankle surgeon 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, 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

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
  • Chronice 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 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.

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 repetitve 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 dispalced.
  • Follow-up care. Your foot and ankle surgeon will provide instructions for care following surgical or non-surgical treatment. Physical therapy, exercises, and rehabilitation may be included in a schedule for return from normal activities. 

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