Foot Fractures
Most of us have heard that you cannot walk on a broken foot… However, that is simply not true and you may cause more damage if you leave a fracture untreated!
If you have experienced an injury that affected your foot and have:
- Continued pain
- An inability or difficulty bearing weight on the foot
- Persistent swelling to the area
- Deformity
It is important to schedule an appointment with Dr. Castelein to have the affected area assessed.
Schedule an appointment today with Dr. Bryant Castelein, DPM – Podiatry Specialist
Anatomy of Foot Fractures
Talus Fracture:
The talus is the bone that creates the lower part of the ankle joint and allows the foot to move up and down. This bone is also the main connector between the foot and leg. It aids in transferring weight and pressure across the ankle joint. A talus fracture occurs when one of the bones that forms the ankle breaks, usually caused by a high-energy/impact event (car accident, fall, etc). CT scans are typically necessary when diagnosing a talus fracture. When the talus is fractured, a substantial loss of motion and function is usually noted. The talus is a difficult bone to heal, and if healed improperly, complications such as non-union, arthritis, chronic pain or a decrease in foot mobility.
Calcaneal Fracture:
The calcaneus or heel bone lies at the back of the foot, below the bones of the ankle joint. The calcaneus along with the talus form the subtalar joint, which allows foot movement side-to-side and balancing on uneven ground. A calcaneal fracture can be quite severe, resulting in debaliting deformity. It often occurs from a high energy/impact event (car accident, fall, etc.) when the heel becomes crushed under the body. Dr. Castelein will often recommend a CT scan when diagnosing a calcaneal fracture. Due to the typical severity of this injury, surgery is often needed to reconstruct and restore mobility to the foot. Without restoring proper alignment, calcaneal fractures may result in long-term complications such as pain, swelling, and arthritis.
Navicular Fracture:
The navicular bone is one of the five midfoot bones and assists in making the tarsus of the foot and ankle. This bone helps transfer weight from the ankle to the ball of the foot. The navicular is covered in cartilage and lacks good blood supply which results in this area being more susceptible to damage. Navicular fractures are often caused by repetitive stress (excessive running, twisting, jumping) or traumatic injury. Dr. Castelein will use a CT or MRI scan to determine the prevalence and severity of a navicular fracture.These fractures are at high risk of nonunion and loss of bone tissue and often require surgical intervention.
Cuneiform Fracture:
The cuneiform consists of three bones: medial cuneiform, intermediate cuneiform and lateral cuneiform. These three bones interlock with each other to form a bridge between the navicular and metatarsals. This set of bones provides stability vital to walking and running. Cuneiform fractures are rare and typically involve a very high energy/impact trauma event (car accident, fall from height, etc.). A cuneiform fracture is very rarely seen on its own and may be accompanied by a LisFranc or other fracture. CT scans are often needed to affirm a cuneiform fracture. Depending on severity of fracture, a period of non-weightbearing or surgical repair may be needed.
Metatarsal Fractures:
Toe Fracture:
Even though they are quite small, fractures to the toes can be painful. The big toe is made of two bones and is especially important as one half of your body weight is transferred through it. The smaller toes each have three bones and combined take the other one half of the body’s weight. A broken toe is a common fracture that mostly occurs from dropping something on the foot, stubbing a toe or overuse/repetitive stress. Dr. Castelein uses X-ray to diagnose foot fractures. When needed he can manually reduce the fracture. He also often recommends changing footwear and immobilization to achieve full resolution. In certain instances surgery may be needed.
Cuboid Fracture:
The cuboid bone is a short, square-shaped bone and is found in the midfoot area of the foot. This bone connects the foot to the ankle and provides overall stability to the foot. Fractures of the cuboid are rare and referred to as a “nutcracker” fracture. Causes are usually related to landing from a high jumping point, repetitive ankle sprains or a crush injury to the foot. Utilizing both CT and X-ray for this fracture is imperative in diagnosis. Cuboid fractures often heal without surgical intervention, however accurate diagnosis of the fracture is needed to determine best course of care.
5th Metatarsal Fracture:
X-Ray:
Dr. Castelein will begin the process of diagnosing a foot fracture with an X-ray taken in our office. The image will display the soft tissues and bones of the foot, allowing Dr. Castelein to diagnose the fracture.
CT Scan:
In some cases, certain fractures may need further detail and require a CT scan to be performed. The CT scan takes many X-ray images from multiple angles and creates a combined cross-sectional image of the foot to allow Dr. Castelin to further examine the fracture. Many times a CT can be displayed in a 3D image to give a great picture of the fracture and shape of the bone.
Conservative treatment for foot fractures is considered when the fracture is mild and non-displaced (the bone has not shifted out of place).
RICE Method:
First, Dr. Castelein will recommend the adaptation of the RICE method during the healing time period. This involves rest, ice, compression and elevation. Resting and staying off of the injured foot will assist in recovery; icing the area for 20 minutes at a time will aid in reducing swelling and inflammation; Compressing the injury with a wrap will help with swelling control; and keeping your foot Elevated above your heart will reduce inflammation.
Walking Boot:
Medical walking boots protect the foot while the fracture is healing. The boot acts as a stabilizer and prevents overuse of the injured bone. A walking boot is typically used for a period of six to eight weeks. Typically, you will be able to leave our office with the walking boot in-hand to begin the healing process immediately.
Casting:
In some instances, Dr. Castelein may cast the affected foot to support the fracture. A cast completely immobilizes the foot and ensures no movement is made during healing. The cast will be molded to your foot by Dr. Castelein in our office to ensure the most protection and support. Sometimes, casting is used in combination with a CAM boot for a period of six to eight weeks.
Surgical Treatments for Foot Fractures
When a foot fracture is more severe, displaced, intra-articular fracture or bones that are not healing together properly (non-union), surgery is usually necessary to repair the fracture. The goal of surgery is to align the bone structure to best support the surrounding ligaments, tendons and muscles. Dr. Castelein is board certified to restore bone shape, allow for early range of motion and return to activity quickly. The type of surgery performed is highly dependent upon the type of fracture endured and its severity. Internal fixation is often used to support the bone and allow for healing while external fixation may be needed for complicated fractures.
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