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Foot Fractures

Fractures in the toes and forefoot are a fairly common injury. They usually occur as a result of an injury such as dropping something on the toe or accidentally kicking something. They can also occur as a result of repeated stress on the toes such as occurs when running. The good news is that with proper treatment, they rarely require surgery. There are different types of fractures. Open fractures are when the skin over the fracture is broken and the wound extends down to the bone. There is no bone exposed with a closed fracture. Fractures can also be displaced, where the broken pieces of bone are separated and not lined up well, or non-displaced, where the broken pieces of bone have not moved out of their original placement.

 

Each toe is made up of two or three individual bones called phalanges. The great toe has two and the rest of the toes usually have three phalanges. Each toe also has a longer bone in the forefoot called a metatarsal. They all work together so if any of them is fractured, it causes pain which can affect how you walk. It is not unusual for me to see someone in my office who started with pain in one foot, altered their gait due to the pain, and now has pain and an injury in the other foot.

 

I often hear from people that they don't want their possibly fractured toes treated because there is no treatment. While it is true that normally surgery isn't needed for a broken toe, it is important to make sure the fracture is stable to prevent long term deformity and pain. If the fracture affects one of the three joints in the toe, it is especially important to ensure the fractured pieces of bone are in good alignment while it heals. This helps decrease the risk of developing painful arthritis down the road. Any time a fracture affects a joint, there is a risk of developing arthritis afterwards. However, the better the fracture is reduced or aligned, the better the long term outcome will be.

 

There are various ways to hold a fracture stable while it heals. Sometimes it is as simple as splinting the toe. There are devices used to make this very easy and comfortable. Tape can be used but it often becomes irritating over time. Fractures take an average of six to eight weeks to heal, so the toe will need to be splinted for that length of time. Shoe modifications are also often needed to reduce the amount of motion at the fracture while walking. If you have a lot of swelling with the fracture, it may be difficult to get a shoe on, so a surgical shoe is helpful to both provide a rigid sole and reduce painful pressure on the toe. When there is motion at the fracture while it is healing, the bone will form a callus around the fracture. The callus is your bodies way of stabilizing the fracture and keeping it from moving. When a fracture is open or displaced, surgery is necessary. The fracture will be reduced and held in place with screws or wires.

 

Metatarsals are the bones between your toes and the middle of your foot. Metatarsal bones can get stress fractures. Stress fractures occur as a result of repetitive activity or pressure such as running or jumping. They can also occur when there is a sudden increase in your physical activity. They are small cracks in the bone. Even though they are small, they are painful. They are often not seen on x-ray because they are so small. It is sometimes necessary to get an MRI to see the stress fracture. If they are not treated, they can develop into larger fractures.

 

Larger fractures in the metatarsals are also treated both conservatively and surgically depending on what type of fracture is present. A period of non-weight bearing on the affected foot is often necessary to allow the fracture to heal.

 

A commonly fractured metatarsal is the fifth metatarsal. It is the long bone on the outside of your foot. You can feel the base of the bone about halfway down the outside of your foot. These fractures are often the result of a twisting injury. There is a tendon that inserts at the base of the fifth metatarsal and when you walk, it pulls on the base of the bone. In this type of injury, the tendon can pull off a piece of the bone. This is called an “Avulsion Fracture.” Another common type of fracture occurs where the base and the shaft of the bone meet. Horizontal fractures occur at this location and are called “Jones Fractures.” Due to the distribution of the blood supply to this bone, this is an area of poor blood flow making these fractures more prone to difficult healing. For this reason, these fractures require strict non-weight bearing in a cast or surgery to reduce the fracture and hold the fragments steady while it heals. Because of the poor blood supply, Jones Fractures may take longer to heal than other fractures. If a fracture doesn't heal, it is called a “non-union” and may require surgery and other treatments to stimulate bone growth across the fracture.

Author
Dr Katie Evans Dr Katie Evans writes a monthly column in the Hometown Focus. The articles cover a variety of issues concerning the foot and ankle. If you have any recommendations for future articles, email them to rangefootandankle@gmail.com.

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