Treatment of Foot and Ankle Fractures
Ankle Fracture
The ankle joint is composed of three bones: the tibia, fibula, and talus which are articulated together. The ends of the fibula and tibia (lower leg bones) form the inner and outer malleolus, which are the bony protrusions of the ankle joint that you can feel and see on either side of the ankle. The joint is protected by a fibrous membrane called a joint capsule, and filled with synovial fluid to enable smooth movement.
Ankle injuries are very common in athletes and in people performing physical work, often resulting in severe pain and impaired mobility. Pain after ankle injuries can either be from a torn ligament and is called ankle sprain or from a broken bone which is called ankle fracture. Ankle fracture is a painful condition where there is a break in one or more bones forming the ankle joint. The ankle joint is stabilized by different ligaments and other soft tissues, which may also be injured during an ankle fracture.
Causes
Ankle fractures occur from excessive rolling and twisting of the ankle, usually occurring from an accident or activities such as jumping or falling causing sudden stress to the joint.
Symptoms
With an ankle fracture, there is immediate swelling and pain around the ankle as well as impaired mobility. In some cases blood may accumulate around the joint, a condition called hemarthrosis. In cases of severe fracture, deformity around the ankle joint is clearly visible where bone may protrude through the skin.
Types of Fractures
Ankle fractures are classified according to the location and type of ankle bone involved. The different types of ankle fractures are:
- Lateral Malleolus fracture in which the lateral malleolus, the outer part of the ankle is fractured.
- Medial Malleolus fracture in which the medial malleolus, the inner part of the ankle, is fractured.
- Posterior Malleolus fracture in which the posterior malleolus, the bony hump of the tibia, is fractured.
- Bimalleolar fractures in which both lateral and medial malleolus bones are fractured
- Trimalleolar fractures in which all three lateral, medial, and posterior bones are fractured.
- Syndesmotic injury, also called a high ankle sprain, is usually not a fracture, but can be treated as a fracture.
Diagnosis
The diagnosis of the ankle injury starts with a physical examination, followed by X-rays and CT scan of the injured area for a detailed view. Usually it is very difficult to differentiate a broken ankle from other conditions such as a sprain, dislocation, or tendon injury without having an X-ray of the injured ankle. In some cases, pressure is applied on the ankle and then special X-rays are taken. This procedure is called a stress test. This test is employed to check the stability of the fracture to decide if surgery is necessary or not. In complex cases, where detail evaluation of the ligaments is required an MRI scan is recommended.
Treatments
Immediately following an ankle injury and prior to seeing a doctor, you should apply ice packs and keep the foot elevated to minimize pain and swelling.
The treatment of ankle fracture depends upon the type and the stability of the fractured bone. Treatment starts with non-surgical methods, and in cases where the fracture is unstable and cannot be realigned, surgical methods are employed.
In non-surgical treatment, the ankle bone is realigned and special splints or a plaster cast is placed around the joint, for at least 2-3 weeks.
With surgical treatment, the fractured bone is accessed by making an incision over the ankle area and then specially designed plates are screwed onto the bone, to realign and stabilize the fractured parts. The incision is then sutured closed and the operated ankle is immobilized with a splint or cast.
Post-Operative Care
After ankle surgery, you will be instructed to avoid putting weight on the ankle by using crutches while walking for at least six weeks.
Physical therapy of the ankle joint will be recommended by the doctor. After 2-3 months of therapy, the patient may be able to perform their normal daily activities.
Risks and Complications
Risks and complications that can occur with ankle fractures include improper casting or improper alignment of the bones which can cause deformities and eventually arthritis. In some cases, pressure exerted on the nerves can cause nerve damage, resulting in severe pain.
Rarely, surgery may result in incomplete healing of the fracture, which requires another surgery to repair.
Ankle fracture is a painful condition where bones forming the ankle joint break from sudden stress. Your doctor can diagnose an ankle fracture by taking X-ray’s and a CT scan of the injured area. Treatment depends on the type of ankle fracture sustained and includes non-surgical methods such as casting as well as surgical methods to repair the fracture.
Foot Fracture
The foot has 26 bones, and can be divided into 3 parts:
The Hindfoot is comprised of two bones, the talus bone which connects to the bones of the lower leg, and the calcaneus bone which forms the heel.
The Midfoot is comprised of the navicular, cuboid, and three cuneiform bones.
The forefoot is made up of five metatarsal bones and 14 toe bones called phalanges.
The hindfoot is separated from the midfoot by the mediotarsal joint and the midfoot is separated from the forefoot by the Lisfranc joint.
Muscles, tendons, and ligaments support the bones and joints of the feet enabling them to withstand the entire body’s weight while walking, running, and jumping. Despite this, trauma and stress can cause fractures in the foot. Extreme force is required to fracture the bones in the hindfoot. The most common type of foot fracture is a stress fracture, which occurs when repeated activities produce small cracks in the bones.
Types of foot fractures
Foot fractures can involve different bones and joints and are classified into several types:
Calcaneal fractures:
This type affects the heel bone and occurs mostly as a result of high-energy collisions. It can cause disabling injuries and if the subtalar joint is involved it is considered a severe fracture.
Talar fractures:
The talus bone helps to transfer weight and forces across the joint. Talus fractures usually occur at the neck or mid portion of the talus.
Navicular fractures:
Navicular fractures are rare and include mostly stress fractures that occur with sports activities, such as running and gymnastics, as a result of repeated loading on the foot.
Lisfranc fractures:
This type of fracture occurs due to excessive loading on the foot, which leads to stretching or tearing of the midfoot ligaments.
Causes
Foot fractures commonly occur as a result of a fall, motor vehicle accident, dropping a heavy object on your foot, or from overuse such as with sports.
Symptoms
The common symptoms of a foot fracture include:
- Pain
- Bruising
- Tenderness
- Swelling
- Deformity
- Inability to bear weight
Diagnosis
Your doctor diagnoses a foot fracture by reviewing your medical history and performing a thorough physical examination of your foot. Imaging tests such as X-rays, MRI, or CT scan may be ordered to confirm the diagnosis.
Navicular fractures can be especially difficult to diagnose without imaging tests.
Treatment
Treatment depends on the type of fracture sustained. For mild fractures, nonsurgical treatment is advised and includes rest, ice, compression, and elevation of the foot. Your doctor may suggest a splint or cast to immobilize the foot. For more severe fractures, surgery will be required to align, reconstruct or fuse the joints. Bone fragments may be held together with plates and screws.
Physical therapy may be recommended to improve range of motion and strengthen the foot muscles. Weightbearing however should be a gradual process with the help of a cane or walking boot.
Summary
Foot fractures are common injuries, making up about 10% of all orthopedic fractures. Foot fractures can be treated with simple conservative therapies or surgery depending on the severity. Timely treatment is important as it can lead to long-term disability and serious complications if not properly treated.