Foot fractures

What is it about ?

The human foot is made up of 26 bones, which form joints. Together with muscles and tendons, these joints allow the foot to move smoothly. Following an injury (for example after a fall, a sudden contact against an object or a jump from a certain height), it can happen that one or more bones of the foot fracture. These fractures usually prevent proper functioning of the entire foot and are often complicated because they extend to the surface of the joint.

Types of foot fractures

Foot fractures can occur in the following places:

• forefoot (toes);
  • The forefoot consists of the 5 toes and has 14 bones.
• the metatarsus (the middle of the foot);
  • The metatarsal consists of 5 metatarsal bones. These bones are aligned with the toes.
  • The head of the metatarsal bone of the big toe is surmounted by 2 additional small bones (the sesamoid bones), which serve as the insertion point for a few tendons.
  • Fractures that affect the metatarsal bones are often stress fractures. These fractures are caused by repeated overworking of the bone, which eventually breaks.
• the articulation of Lisfranc;
  • This is the joint that connects the metatarsal bones and the tarsus. The tarsus has 7 bones, including the calcaneus and the talus (or talus).
  • Fractures of these bones often go unnoticed. Here are some examples of situations giving rise to these fractures:
    • you are walking in a hole;
    • you step on the brake pedal in an accident;
    • a player steps on your foot during a soccer match.
• the articulation of Chopart;
  • This joint joins the bones of the tarsus.
  • Lesions in this joint are rare and often go unnoticed.
• ankle joint;
  • The talus connects the foot to the lower part of the leg through the ankle joint.
  • The lesions that occur there are often the result of a sprained foot, which causes dislocation of the ankle joint and dislocation of various bones. A fracture can also occur in the talus.
• the heel bone (calcaneus).
  • A fracture of the calcaneus is often caused by falling from a certain height. His healing lasts at least 6 months.

How to recognize them?

Most often, you have had an accident after which you suddenly felt a great pain in your foot. You have difficulty walking, and even pressing on the affected foot. Often the foot swells.

A stress fracture in the metatarsal bones is often the result of prolonged overexertion, for example if you start too quickly a too intensive running program. The pain is mostly felt during, and often also after sports activity.

How is the diagnosis made?

Your doctor will first ask you when and how the pain started in your foot. He will investigate whether there has been an injury or prolonged overexertion of the foot.

A thorough examination of the foot will follow in order to locate the pain with precision. If the doctor suspects a broken foot, he will order an imaging test. He will order an x-ray in most cases and sometimes more specialized exams such as a CT scan or MRI.

What can you do ?

• If your foot is sore, swollen and blue after an accident, it is advisable to raise the leg.
• The application of ice can limit swelling.
• If the pain and swelling further increase and you cannot lean on your foot any longer, see your doctor. He will probably prescribe a x-ray.
• In the meantime, try not to press on the affected foot. Optionally use crutches.

What can your doctor do?

Treatment depends on the location of the fracture in the foot.

Toes

• If you have a broken toe, you will need to wear a shoe that holds the foot well for 1 to 4 weeks, with the injured toe attached to a neighboring toe.
• Depending on the profession you practice, the doctor may also prescribe a work stoppage.
• If the bones are very out of place, your toe may need to be straightened under general anesthesia (fracture reduction).
• Other fractures, such as those that affect the first part of the big toe, often require surgery.

Metatarsal bones

• If you have a broken metatarsal bone, you will need to wear a support bandage for a few weeks. During this time, it is important to put less stress on the joint. You can use crutches.
• If you have multiple fractures in multiple metatarsal bones, you will need to wear a cast for 3 to 4 weeks.
• Displaced fractures must be operated on.

Lisfranc joint

• Any fracture in the Lisfranc joint requires an operation, followed by 6 weeks of immobilization in a cast.

Chopart joint

• Fractures affecting the Chopart joint also require surgery to reattach the bones. After the operation, you will need to wear a cast for 6 to 8 weeks.

Ankle joint

• An ankle fracture associated with a dislocation must be quickly reduced. Bone fragments are attached with screws during surgery. You will then typically need to wear a cast for 8 to 16 weeks.

Heel bone (calcaneus)

• Healing from a broken heel bone takes a long time.
• Treatment may or may not be surgical.

Want to know more?

• The radiography, here, Where to find on this page of Cliniques St Luc UCL
• The scanner, here, Where to find on this page of Cliniques St Luc UCL
• MRI, here, Where to find on this page of Cliniques St Luc UCL

Source

Foreign clinical practice guide ‘Fractures du pied’ (2000), updated on 11.05.2017 and adapted to the Belgian context on 05.03.2019 – ebpracticenet