Section 5. Bone, Joint, and Muscle Disorders

Chapter 62. Fractures

Topics: Introduction | Foot Fractures | Leg Fractures | Hip Fractures | Fractures of the Pelvis | Fractures of the Spinal Column | Shoulder Fractures | Arm Fractures | Hand Fractures

Foot Fractures

Fractures of the foot bones occur commonly, caused by falls, twisting injuries, or direct impact of the foot against hard objects. Foot fractures cause considerable pain, which is almost always made worse by attempting to walk or put weight on the foot.

Diagnosis is usually made by x-ray. Sometimes computed tomography (CT) or magnetic resonance imaging (MRI) is required. Treatment varies with the bone involved and the type of fracture but generally involves placing the foot and ankle in a cast.

See the figure Foot Fractures.

Toe (phalanges) fractures can occur when an unprotected foot strikes a hard object. If the toe is abnormally bent, it may need to be realigned. Simple fractures of the four smaller toes heal without a cast. Certain measures, including splinting the toe 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.

A 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 that affect the joint of the big toe may require surgery.

The sesamoids are two small round bones located within the flexor tendon under the big toe. These bones may fracture from running, hiking, and sports involving coming down too hard on the ball of the foot (such as basketball and tennis). Using padding or specially constructed orthoses (insoles) for the shoe helps relieve the pain. If pain continues, a sesamoid bone may need to be removed surgically.

A stress fracture of the metatarsals (the bones in the middle of the foot) can occur when a person walks or runs excessively (see Section 5, Chapter 75). Putting full weight on the foot causes increased pain. The affected area on the metatarsal bone is tender to touch. When a developing stress fracture is recognized early, the person can stop activities that aggravate the fracture. In more advanced and severe cases, crutches and a cast are necessary.

An avulsion fracture of the 5th metatarsal (a bone in the outside edge of the middle of the foot) occurs commonly after the foot is injured by turning inward. The outside edge of the foot develops tenderness and a swollen bruise. A cast is not usually necessary but can make walking easier. Crutches may be needed for a few days.

The ankle may fracture when the foot rolls inward or outward during a fall. Small avulsion fractures of the ligament attachments are similar to a severe sprain. This type of fracture is treated with a brace or cast for 3 to 6 weeks and generally heals well. Fractures through the bony bumps (malleoli) on the inside and outside of the ankle are more serious. When the malleoli are broken, standing and walking are very painful. Nondisplaced fractures of the malleoli can be treated with a cast. Displaced fractures require surgical fixation.