Fractures occurring to the bones of the foot and ankle are among the most common fractures that occur to people. The majority of these fractures occur as a single event, such as a trip or fall. However, repetitive stress on the foot and ankle can also lead to a fracture.
Ankle fractures are common in people of all ages. Younger patients most commonly sustain a broken ankle while playing sports. Older patients are more likely to injure themselves tripping off a curb or falling while walking down stairs.
An ankle fracture refers to a break that occurs to the lower end of the tibia and fibula bones. These 2 bones contact the talus bone in the foot, and comprise the ankle joint. The tibia bone is the larger bone that composes the top and inner side of the ankle joint. The fibula is the smaller, outer bone of the ankle. The fibula, also known as the lateral malleolus, is most commonly fractured. In a more severe fracture, the inner portion of the tibia (known as the medial malleolus) will be fractured in addition to the fibula. In the most severe form of ankle fracture, the lower end of the tibia will be broken as well. This latter fracture is especially serious because it involves the weight-bearing portion of the joint, and injuring this area puts one at extremely high risk of developing arthritis of the ankle joint.
Treatment of an ankle fracture depends on if the bones have been shifted out of place (known as displacement). A fracture with up to 2 mm of displacement usually can be treated with 6 to 8 weeks in a cast. However, if the fracture is more than 2mm displaced, surgical repair is often necessary. This requires placing plates and screws to hold the broken pieces of bone together until they heal.
The metatarsal bones are the long bones of the forefoot that attach to the toes. These are the most commonly fractured bones in the foot, especially the 5th metatarsal, the bone located on the outermost side of the foot. This fracture occurs when the foot and ankle is suddenly twisted inwards. 90% of the time, a metatarsal fracture can be treated with a walking cast for 4-6 weeks, followed by use of a special stiff-soled shoe for an additional 4 weeks. 10% of the time, a metatarsal fracture will need to be surgically repair because the bones are displaced.
The heel bone, known as the calcaneus, can be broken in a fall from a height or from a motor vehicle accident. This is a very serious and complicated type of fracture, because the calcaneus usually breaks into many different fragments, and often requires surgical repair. Even with a less serious calcaneus fracture, there is often residual stiffness in the foot and ankle following this type of break. Recovery from a calcaneus fracture takes 4 to 6 months. Due to the complicated nature of this type of injury, a calcaneus fracture is best treated by an Orthopedic Surgeon with considerable experience treating this type of fracture.
The toe bones in the foot are known as phalanges. The phalanges of the foot are most commonly fractured when kicking the leg of a chair or table while walking barefoot in the house. In a severe fracture, the toe will be angled out of place and will need to be “set” back straight into position (usually done at the ER or in an Orthopedist’s office, or sometimes by the injured person). Despite their small size, toe fractures can me quite painful. Taping the injured toe to the adjacent toe can be helpful to immobilize the toe and allow more comfortable walking. For the first 2 weeks, using a stiff-soled shoe helps to relieve the pain and put less pressure on the broken toe. After 4 to 6 weeks, one can return to normal activities. Phalanx fractures rarely need surgical repair.
Stress fractures can occur under 2 circumstances. The first is when normal amounts of stress are applied to weakened bone. Bone can be weakened by osteoporosis (loss of bone mass), certain disease states, or after prolonged immobilization. Under such circumstances, normal amounts of stress including a moderate amount of walking or light amount of jogging can cause a fracture of one of the foot bones.
The second circumstance where a stress fracture can occur is when an excessive amount of stress is placed on a normal bone. This usually occurs when an athlete is training extremely hard, such as running prolonged distances, or performing repetitive jumping.
The most common stress fracture occurs to the metatarsal bone under either of the above circumstances. With weakened bone, the heel bone can also sustain a stress fracture. With excessive stress on normal bone, the navicular bone (in the middle of the foot) and either of the leg bones (the tibia and fibula) are at risk for stress fractures.