certified by the
Fractures and Tendon Ruptures
and Metatarsal Fractures
structure of your foot is complex, consisting of bones, muscles, tendons,
and other soft tissues. Of the 26 bones in your foot, 19 are toe bones (phalanges)
and metatarsal bones (the long bones in the midfoot). Fractures of the toe and metatarsal bones are common and
require evaluation by a specialist. A
podiatric foot and ankle surgeon should be seen for proper diagnosis and
treatment, even if initial treatment has been received in an emergency
Is a Fracture?
fracture is a break in the bone. Fractures
can be divided into two categories: traumatic fractures and stress
Traumatic fractures (also called acute fractures) are caused by a direct blow or impact like seriously stubbing your toe. Traumatic fractures can be displaced or non-displaced. If the fracture is displaced, the bone is broken in such a way that it has changed in position (dislocated). Treatment of a traumatic fracture depends on the location and extent of the break and whether it is displaced. Surgery is sometimes required. Signs and symptoms of a traumatic fracture include:
Stress fractures are tiny, hairline breaks that are usually caused by repetitive stress. Stress fractures often afflict athletes who, for example, too rapidly increase their running mileage. Or they may be caused by an abnormal foot structure, deformities, or osteoporosis. Improper footwear may also lead to stress fractures. Stress fractures should not be ignored, because they will come back unless properly treated. Symptoms of stress fractures include:
Sprains and fractures have similar symptoms, although sometimes with a sprain, the whole area hurts rather than just one point. Your podiatric surgeon will be able to diagnose which you have and provide appropriate treatment. Certain sprains or dislocations can be severely disabling. Without proper treatment they can lead to crippling arthritis.
of Improper Treatment
Some people say that “the doctor cannot do anything for a broken bone in the foot”. This is usually not true. In fact, if a fractured toe or metatarsal bone is not treated correctly, serious complications may develop. For example:
of Toe Fractures
Fractures of the toe bones are almost always traumatic fractures. Treatment for traumatic fractures depends on the break itself and may include these options:
of Metatarsal Fractures
in the metatarsal bones may be either stress or traumatic fractures.
Certain kinds of fractures of the metatarsal bones present unique
challenges. For example,
sometimes a fracture of the first metatarsal bone (behind the big toe) can
lead to arthritis. Since the
big toe is used so frequently and bears more weight than other toes,
arthritis in that area can make it painful to walk, bend, or even stand.
type of break, called a Jones’ fracture, occurs at the base of the fifth
metatarsal bone (behind the little toe).
It is often misdiagnosed as an ankle sprain, and misdiagnosis can
have serious consequences since sprains and fractures require different
treatments. Your podiatric
surgeon is an expert in correctly identifying these conditions as well as
other problems of the foot.
Treatment of metatarsal fractures depends on the type and extent of the fracture, and may include:
Fractures (breaks) are common in the fifth metatarsal which is the long bone on the outside of the foot that connects to the little toe. Two types of fractures that often occur in the fifth metatarsal are:
Other types of fractures can occur in the fifth metatarsal. Examples include mid-shaft fractures, which usually result from trauma or twisting, and fractures of the metatarsal head and neck.
Avulsion and Jones’ fractures have the same signs and symptoms. These include:
who has symptoms of a fifth metatarsal fracture should see a foot and
ankle surgeon as soon as possible for proper diagnosis and treatment.
To arrive at a diagnosis, the surgeon will ask how the injury
occurred or when the pain started. The foot will be examined, with the doctor gently pressing on
different areas of the foot to determine where there is pain.
surgeon will also order x-rays. Because
a Jones’ fracture sometimes does not show up on initial x-rays,
additional imaging studies may be needed.
When it is not possible to see a foot and ankle surgeon immediately, the “R-I-C-E” method of care should be performed. This involves:
for treatment of an avulsion fracture may include:
for treatment of a Jones’ fracture may include:
The Lisfranc joint is the point at which the metatarsal bones (long bones that lead up to the toes) and the tarsal bones (bones in the arch) connect. The Lisfranc ligament is a tough band of tissue that joins two of these bones. It is important for maintaining proper alignment and strength of this joint.
do Lisfranc Injuries Occur?
to the Lisfranc joint most commonly occur in automobile accident victims,
military personnel, runners, horseback riders, football players, and
participants of other contact sports.
Lisfranc injuries occur as a result of direct or indirect forces to
direct force often involves something heavy falling on the foot.
Indirect force commonly involves twisting the foot.
This can happen, for example, when the foot catches on a stirrup
while falling from a horse.
of Lisfranc Injuries
There are three types of Lisfranc injuries, which sometimes occur together:
The signs and symptoms of a Lisfranc injury may include:
injuries are sometimes mistaken for ankle sprains, making the diagnostic
process very important. To
arrive at a diagnosis, the foot and ankle surgeon will ask how the injury
occurred. The surgeon will
examine the foot and determine the severity of the injury.
and other imaging studies, such as a CT or MRI, may be necessary to fully
evaluate the extent of the injury. The
surgeon may also perform an additional examination while the patient is
under anesthesia to further evaluate a fracture or weakening of the joint
and surrounding bones.
who has symptoms of a Lisfranc injury should see a foot and ankle surgeon
right away. If unable to do
so immediately, it is important to stay off the injured foot, keep it
elevated (at or slightly above hip level), and apply a bag of ice wrapped
in a thin towel to the area every 20 minutes of each waking hour.
These steps will help keep the swelling and pain under control.
Treatment by the foot and ankle surgeon may include one or more of the following, depending on the type and severity of the Lisfranc injury:
foot and ankle surgeon will determine the type of procedure that is best
suited to the individual patient. Some
injuries of this type may require emergency surgery.
of Lisfranc Injuries
can and often do arise following Lisfranc injuries. A possible early complication following the injury is
compartment syndrome, in which pressure builds up within the tissues of
the foot, requiring immediate surgery to prevent tissue damage.
A build-up of pressure could damage the nerves, blood vessels, and
muscles in the foot.
and problems with foot alignment may develop.
In most cases, arthritis develops several months or longer
following a Lisfranc injury, requiring additional treatment.
calcaneus, also called the heel bone, is a large bone that forms the
foundation of the rear part of the foot.
The calcaneus connects with the talus and cuboid bones. The connection between the talus and calcaneus forms the
subtalar joint. This joint is
important for normal foot function.
The calcaneus is often compared to a hard-boiled egg, because it has a thin, hard shell on the outside and softer, spongy bone on the inside. When the outer shell is broken, the bone tends to collapse and become fragmented. For this reason, calcaneal fractures are severe injuries. Furthermore, if the fracture involves the joints, there is the potential for long-term consequences such as arthritis and chronic pain.
do Calcaneal Fractures Occur?
calcaneal fractures are the result of a traumatic event, most commonly
falling from a height, such as a ladder, or being in an automobile
accident where the heel is crushed against the floorboard.
Calcaneal fractures can also occur with other types of injuries,
such as an ankle sprain. A
smaller number of calcaneal fractures are stress fractures, caused by
overuse or repetitive stress on the heel bone.
of Calcaneal Fractures
of the calcaneus may or may not involve the subtalar and surrounding
joints. Fractures involving
the joints (intra-articular fractures) are the most severe calcaneal
fractures, and include damage to the cartilage (the connective tissue
between two bones). The
outlook for recovery depends on how severely the calcaneus was crushed at
the time of injury.
Fractures that do not involve the joint (extra-articular fractures) include:
Calcaneal fractures produce different signs and symptoms, depending on whether they are traumatic or stress fractures. The signs and symptoms of traumatic fractures may include:
The signs and symptoms of stress fractures may include:
diagnose and evaluate a calcaneal fracture, the foot and ankle surgeon
will ask questions about how the injury occurred, examine the affected
foot and ankle, and order x-rays. In
addition, advanced imaging tests are commonly required.
of calcaneal fractures is dictated by the type of fracture and extent of
the injury. The foot and
ankle surgeon will discuss with the patient the best treatment whether
surgical or non-surgical for the fracture.
For some fractures, non-surgical treatments may be used. These include:
traumatic fractures, treatment often involves surgery to reconstruct the
joint, or in severe cases, to fuse the joint.
The surgeon will choose the best surgical approach for the patient.
the treatment for a calcaneal fracture has been surgical or non-surgical,
physical therapy often plays a key role in regaining strength and
of Calcaneal Fractures
fractures can be serious injuries that may produce lifelong problems.
Arthritis, stiffness, and pain in the joint frequently develop.
Sometimes the fractured bone fails to heal in
the proper position. Other
possible long-term consequences of calcaneal fractures are decreased ankle
motion and walking with a limp due to collapse of the heel bone and loss
of length in the leg. Patients
often require additional surgery and/or long term or permanent use of a
brace or an orthotic device (arch support) to help manage these
fracture is a partial or complete break in a bone.
In the ankle, fractures can range from the less serious avulsion
injuries (small pieces of bone that have been pulled off) to severe
shattering-type breaks of the tibia, fibula, or both.
Ankle fractures are common injuries that are most often caused by the ankle rolling inward or outward. Many people mistake an ankle fracture for an ankle sprain, but they are quite different and therefore require an accurate and early diagnosis. They sometimes occur simultaneously.
ankle fracture is accompanied by one or all of these signs and symptoms:
an ankle injury it is important to have the ankle evaluated by a foot and
ankle surgeon for proper diagnosis and treatment.
If you are unable to do so right away, go to the emergency room and
then follow up with a foot and ankle surgeon as soon as possible for a
more thorough assessment.
you are able to be examined by a doctor, the “R-I-C-E” principle
should be followed. This
foot and ankle surgeon will examine the affected limb, touching specific
areas to evaluate the injury. In addition, the surgeon may order x-rays and other imaging
studies, as necessary.
of ankle fractures depends upon the type and severity of the injury.
is important to follow your surgeon’s instructions after treatment.
Failure to do so can lead to infection, deformity, arthritis, and
tendon is a band of tissue that connects a muscle to a bone.
The Achilles tendon runs down the back of the lower leg and
connects the calf muscle to the heel bone.
Also called the “heel cord”, the Achilles tendon facilitates
walking by helping to raise the heel off the ground.
is an Achilles Tendon Rupture?
Achilles tendon rupture is a complete or partial tear that occurs when the
tendon is stretched beyond its capacity.
Forceful jumping or pivoting, or sudden accelerations of running,
can overstretch the tendon and cause a tear.
An injury to the tendon can also result from falling or tripping.
Achilles tendon ruptures are most often seen in “weekend warriors” who are typically, middle-aged people participating in sports in their spare time. Less commonly, illness or medications, such as steroids or certain antibiotics, may weaken the tendon and contribute to ruptures.
A person with a ruptured Achilles tendon may experience one or more of the following:
These symptoms require prompt medical attention to prevent further damage. Until the patient is able to see a doctor, the “R-I-C-E” method should be used. This involves:
diagnosing an Achilles tendon rupture, the foot and ankle surgeon will ask
questions about how and when the injury occurred and whether the patient
has previously injured the tendon or experienced similar symptoms.
The surgeon will examine the foot and ankle, feeling for a defect
in the tendon that suggests a tear. Range
of motion and muscle strength will be evaluated and compared to the
uninjured foot and ankle. If
the Achilles tendon is ruptured, the patient will
have less strength in pushing down (as on a gas pedal) and will have
difficulty rising on the toes.
diagnosis of an Achilles tendon rupture is typically straightforward and
can be made through this type of examination.
In some cases, however, the surgeon may order an MRI or other
advanced imaging tests.
options for an Achilles tendon rupture include surgical and non-surgical
approaches. The decision of
whether to proceed with surgery or non-surgical treatment is based on the
severity of the rupture and the patient’s health status and activity
treatment, which is generally associated with a higher rate of re-rupture,
is selected for minor ruptures, less active patients, and those with
medical conditions that prevent them from undergoing surgery. Non-surgical treatment involves use of a cast, walking boot,
or brace to restrict motion and allow the torn tendon to heal.
offers important potential benefits.
Besides decreasing the likelihood of re-rupturing the Achilles
tendon, surgery often increases the patient’s push-off strength and
improves muscle function and movement of the ankle.
surgical techniques are available to repair the rupture.
The surgeon will select the procedure best suited to the patient.
Following surgery, the foot and ankle are initially immobilized in
a cast or walking boot. The
surgeon will determine when the patient can begin weightbearing.
Complications such as incision healing difficulties, re-rupture of
the tendon, or nerve pain can arise after surgery.
an Achilles tendon rupture is treated surgically or conservatively,
physical therapy is an important component of the healing process.
Physical therapy involves exercises that strengthen the muscles and
improve the range of motion of the foot and ankle.
Center For Foot &