FOOT FRACTURE |
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General Information
DEFINITION--A complete or incomplete break in bones of the foot. The many bones of the central and front portions of the foot are the most susceptible to fracture.
BODY PARTS INVOLVED
Bones of the foot.
Ankle joint and the many joints of the foot.
Soft tissue surrounding the fracture site, including nerves, tendons, ligaments and blood vessels.
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SIGNS & SYMPTOMS
Severe foot pain at the time of injury.
Swelling of soft tissue surrounding the fracture.
Visible deformity if the fracture is complete and bone fragments separate enough to distort normal foot contours.
Tenderness to the touch.
Numbness and coldness in the foot and toes, if the blood supply is impaired.
CAUSESDirect blow or indirect stress to the bone. Indirect stress may be caused by twisting or violent muscle contraction, such as kicking.
RISK INCREASES WITH
Contact sports, especially football and soccer.
History of bone or joint disease, especially osteoporosis.
Obesity.
Poor nutrition, especially calcium deficiency.
If surgery or anesthesia are needed, surgical risk increases with smoking and use of drugs such as mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers or corticosteroids.
HOW TO PREVENTUse athletic shoes especially designed for the sport in which you are involved.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment to manipulate and set the broken bones.
Hospitalization (sometimes) for anesthesia and surgery to set the fracture.
Self-care during rehabilitation.
Whirlpool, ultrasound or massage (to displace fluid from the injured joint space).
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and physical exam by a doctor.
X-rays of injured areas, including joints above and below the primary injury site.
POSSIBLE COMPLICATIONS
AT THE TIME OF INJURY:
Shock.
Pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels or connective tissues. AFTER TREATMENT OR SURGERY:
Delayed union or non-union of the fracture.
Impaired blood supply to the fracture site.
Avascular necrosis (death of bone cells) due to interruption of the blood supply.
Arrest of normal bone growth in children.
Infection in open fractures (skin broken over fracture site), or at the incision if surgical setting was necessary.
Shortening of the injured bones.
Proneness to repeated foot injury.
Unstable or arthritic joint following repeated injury.
Prolonged healing time if activity is resumed too soon.
Problems caused by casts. See Appendix 2 (Care of Casts).
PROBABLE OUTCOMEIt is impossible to predict exactly how long it will take for any fracture to heal. Variable factors include age, sex and previous state of health and conditioning. The average healing time for this fracture is 6 to 8 weeks. Healing is considered complete when there is no motion at the fracture site and when X-rays show complete bone union.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Keep the person warm with blankets to decrease the possibility of shock.
Use instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
The doctor will probably realign and set the broken bones in the following manner:
HIND-PORTION FRACTURE: Large fragments are repositioned surgically. Otherwise the fracture is treated as a moderate sprain.
CENTRAL-PORTION FRACTURE: These uncommon compression fractures require surgery.
FRONT-PORTION FRACTURE: These are treated like toe fractures (see Toe Fracture).
Manipulation should be done as soon as possible after injury. Six or more hours after the fracture, bleeding and displacement of body fluids may lead to shock. Also, many tissues lose their elasticity and become difficult to return to a normal position.
CONTINUING CARE
Immobilization is usually necessary. If so, a rigid cast covers the entire foot and extends to just below the knee.
After cast removal, use frequent ice massage. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball. Do this for 15 minutes at a time, 3 or 4 times a day, and before workouts or competition.
Apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
MEDICATIONYour doctor may prescribe:
General anesthesia, local anesthesia, or muscle relaxants to make bone manipulation and fixation of bone fragments possible.
Narcotic or synthetic narcotic pain relievers for severe pain.
Stool softeners to prevent constipation due to inactivity.
Acetaminophen (available without prescription) for mild pain after initial treatment.
ACTIVITY
Actively exercise all muscle groups not immobilized. The resulting muscle contractions promote fracture alignment and hasten healing.
Resume normal activities gradually after treatment. Don't drive until healing is complete.
Begin reconditioning the injured area after clearance from your doctor.
DIET
Drink only water before manipulation or surgery to treat the fracture. Solid food in your stomach makes vomiting while under anesthesia more hazardous.
During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin daily rehabilitation exercises when supportive wrapping is no longer needed. Use ice massage for 10 minutes prior to exercise. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have signs or symptoms of a foot fracture.
Any of the following occur after surgery or other treatment:
Increased pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
Swelling above or below the cast.
Change in skin color beyond the cast to blue or gray, particularly under the toenails.
Numbness or complete loss of feeling beyond the fracture site.
Nausea or vomiting.
Constipation.
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