Fractures of the Foot

Nearly one-fourth of all of the bones in your body are in your feet. As your feet provide you with both support and the ability to walk, they are also subjected to a lot of trauma that can cause injuries. There are many different types of fractures that can occur in the feet. A fracture is a break in the bone. The word fracture and break are used interchangably.

Types of Fractures

There are four main types of fractures that can occur in the feet: stress fractures, traumatic fractures, open fractures and closed fractures. Although all of these types of fractures can occur in all age groups, children and adolescents have open growth plates which can require some special considerations.

stress fractures occur frequently in the metatarsal bones that start at the base of your toes and extend to the middle of your foot. Stress fractures are tiny cracks that occur on the surface of the bone. Stress fractures are often caused by increased stress in a particular bone (or bones) in the foot that may be due to increases in a particular training program, improper training techniques or changes in training surfaces. For the non-athlete, stress fractures can be caused by increasing activity and doing too much too quickly without allowing your body to adjust to your new activity level, improper shoe gear during walking or running and changes in the surfaces upon which you are walking. Others who are susceptible to stress fractures are post-menopausal women and athletic teenage women who do not menstruate regularly.

Traumatic fractures are caused by an injury or trauma to a bone or bones in your foot. Examples of this include dropping a heavy object on your foot, a twisting injury (such as a sprained ankle) or 'jamming' a toe or toes against a door, chair or bedpost. When these injuries occur they may be accompanied by a ‘pop’ or 'crack' or just significant pain in the area.

Open fractures (sometimes called ‘compound fractures’) occur when the bone pierces through the skin and is exposed to the environment outside of the body. Closed fractures occur when the bone does not pierce through the skin and stays within the body.

Displaced Fractures and Non Displaced Fractures

Fractures where the ends of the bone are out of alignment with each other and one or both parts of the bone have moved from their original position.

Non displaced fractures are fractures where the bone has broken but the edges of the fractured bone have not moved and are still 'in line' with each other.

Symptoms

The most common symptoms are the following:

  • Pain
  • Swelling
  • Bruising

The ability to walk with a fracture in the foot or ankle is dependent on the type of fracture that is present. If you have a broken toe, you may be able to walk but walking will aggravate the pain. If the pain, swelling, and discoloration continue for more than two or three days, or if pain interferes with walking, something could be seriously wrong. You should see a doctor as soon as possible. If you delay getting treatment, you could develop persistent foot pain and arthritis. You could also change the way you walk (your gait), which could lead to the formation of painful calluses on the bottom of your foot, stress fractures or other injuries.

Diagnosis

Your Weil Foot & Ankle Institute surgeon will examine your foot to pinpoint the central area of tenderness and compare the injured foot to the normal foot. Your Weil Foot & Ankle Surgeon will typically want to know when the pain started, what you were doing at the time and if there was any injury to the foot.

X-rays will typically identify most fractures. Typically x-rays will be taken of both feet to compare the subtle difference that may occur in a fracture from the non-injured foot.

An MRI (or sometimes a bone scan) may occasionally be needed to identify stress fractures. The Weil Foot & Ankle Institute has three extremity MRI's on site at our Des Plaines, Highland Park, and Lincoln Park locations. These extremity MRI's only take about 30 minutes for the study and only requires the patient put their foot into a painless machine avoiding the uncomfortable claustrophobia that some MRI devices create.

In complex injuries where multiple bones are broken, a computed tomography (CT or CAT) scan may be needed to assess your injury further.

Treatment

Treatment for fractures of the foot is dependent on the type of fracture that has occurred.

Toe (Phalanges) Fractures

Toe (phalanges) fractures can occur when an unprotected foot strikes a hard object. If the toe is abnormally bent, one of the bones within the toe may break. The fracture may be displaced or dislocated (out of position). Simple fractures of the four smaller toes heal typically without a cast. Certain measures, including splinting the toe or toes together for stability of the fracture site with tape or nylon fastening (Velcro) to the adjacent toes for several weeks and wearing comfortable shoes can provide comfort and protect the toe. Stiff-soled shoes support the fracture, and wide, soft shoes place less pressure on the swollen toe. If walking in normal shoes is too painful, the doctor can prescribe specially fabricated boots. Depending on the severity of the pain, your Weil Foot & Ankle Surgeon may also prescribe anti-inflammatory and/or pain medication.

Fracture of the Big Toe (Hallux)

Chicago Foot Fracture CareA fracture of the big toe (hallux) tends to be more severe than that of the other toes, causing more intense pain, swelling, and bleeding under the skin. A big toe can break when a person stubs it or drops a heavy object onto it. Fractures of the big toe may require immobilization in a cast or walking boot for several weeks while the fracture heals. Sometimes fractures of the big toe can extend into the joint surface, damaging the cartilage on the inside of the big toe joint(s). If untreated, this may lead to the development of arthritis. Additionally, if these fractures are displaced (out of alignment) surgery may be recommended.

Fractures of the First Metatarsal

Fractures of the first metatarsal (long bone in the middle of the foot that connects with the big toe) are a rare but serious injury as the first metatarsal has a very important role in normal, everyday walking. This fracture is generally the result of a trauma (such as dropping something on the foot, a car accident or a sports injury) or twisting injury to the foot. Treatment for this injury will be determined by the specific cause of injury, the fracture pattern, displacement of the fracture as well as your age and activity level. Non-surgical treatment for this fracture usually involves being immobilized in a cast or walking boot. Surgical correction and stabilization of this fracture may be suggested if the fracture is displaced or severe. In addition, if the bone is out of alignment, you may have a type of fracture called a Lis Franc fracture.

Fractures of the Middle Metatarsals

Chicago Foot Fracture CareFractures of the middle metatarsals (the long bones in the middle of the foot) can occur when heavy objects are dropped on the foot or when a person sustains another injury to the front-middle portion of the foot. Treatment for this injury will be determined by the specific cause of injury, the fracture pattern, displacement of the fracture as well as your age and activity level. Non-surgical treatment for this fracture usually involves being immobilized in a cast or walking boot. Surgical correction and stabilization of this fracture may be suggested if the fracture is displaced, unstable or severe. Additionally, if more than one metatarsal is fractured, you may have a special type of a fracture called a Lis Franc fracture.

Fractures of the Fifth Metatarsal

Chicago Foot Fracture Care
Fracture of the base of the 5th metatarsal.
Fractures of the fifth metatarsal (the long bone on the outside of the foot that extends to the little toe) are common injuries. Generally, these fractures are related to a twisting injury of the foot (similar to twisting, rolling or spraining) your ankle. These fractures can be hard to heal because the blood supply to this bone is poor. This fracture can be treated with a cast and immobilization if the fracture is not extensive or displaced. Fractures that are extensive, displaced, or at the base of the bone may require surgical treatment with screws and pins holding the bone in place while it heals. Left untreated, these fractures can become a serious problem.

Improper Treatment and Consequences

Some people say, "There is nothing you can do for a broken bone in the foot." However, without proper treatment of these fractures:

  • A deformity may occur, limiting motion of the foot or joint
  • Arthritis may develop in the joint
  • You may develop chronic pain

Therefore, it is important to make an appointment with a Weil Foot & Ankle Institute Physician if you suspect that you may have a fracture in the foot.