Treating Foot and Ankle Fractures
Toe, forefoot, and ankle fractures are very common, especially among athletes. Common symptoms of fractures are bruising, discoloration, and pain when weight bearing.
Fractures can be non-displaced (the bone is cracked, but the ends are still together), displaced (the ends of the broken bones have separated), closed (the skin is not broken), or open (the skin is broken and the bone may be visible). Most fractures require treatment by a doctor, but it is especially essential for fractures that are displaced and/or open. We will first examine the foot or ankle for swelling, bruising, tenderness, deformities, wounds, and loss of sensation. In most cases we will also take an X-ray and sometimes get an MRI or CT as well.
To treat a broken toe, often it is sufficient to manipulate the bone back into place and tape it to a neighboring healthy toe. If the broken bone is a metatarsal (one of the long bones between the toes and the middle of the foot), a period of elevation without weight-bearing is prescribed followed by a boot or cast. If multiple metatarsals are broken, surgery is often required to insert pins, plates, or screws to establish stability. Healing for broken toes or forefoot injuries typically takes 6 – 8 weeks.
Treatment for broken ankles varies based on the severity and stability of the joint, and can range from immobilization in a cast to internal fixation as the bones heal. While bones often heal in about six weeks, the ligaments and tendons of the ankle can take much longer. Once the bones have healed, it’s important to follow a program of rehabilitation and physical therapy to regain strength and range of motion. Most people can return to daily activities (excluding sports) within 3 – 4 months, but full recovery can take up to two years. Limping and swelling can occur for several months, and it can take 9 – 12 weeks before you are able to drive again.
Sports Injuries: Stress Fractures & Runners Injuries
Stress fractures are small cracks or severe bruises in bones, typically caused by overuse or repetitive activities. These are especially common in athletes who run or jump, and can usually be attributed to a sudden change in activities such as increasing intensity or frequency, changing the workout surface (treadmill to street), or trying a new exercise. Conditions that cause bone weakness, like osteoporosis, can often cause stress fractures from basic everyday activities. Symptoms of stress fractures include pain that intensifies during activities, swelling, tenderness, and bruising. If left untreated, stress fractures can worsen and result in bones that are completely broken. To diagnose stress fractures, we begin by assessing your medical history and activities and perform an examination of the affected area. We may use imaging tests such as x-rays or MRIs. Treatment begins conservatively with the RICE protocol (Rest, Ice, Compression, Elevation) as well as anti-inflammatory medication, modified activities, protective footwear, or even a cast. In severe cases, the internal fixation technique may be necessary to hold bones in place as they heal. This involves surgery to insert pins, screws, or plates into the foot. Stress fractures typically heal in 6 – 8 weeks.
Turf toe is the common name for a sprain of the big toe where it joins the foot (MTP joint). It occurs when the big toe is hyperextended and leads to pain, limited range of motion, and tenderness. Bruising or discoloration can occur and walking or moving the big toe is painful. Diagnosis includes history of the injury, physical examination and x-rays to check for fractures. An MRI may be ordered for further evaluation. Initial treatment includes a RICE protocol (Rest, Ice, Compression, Elevation) and nonsteroidal anti-inflammatory medications may help reduce the pain and inflammation. Protective footwear, taping, orthotic devices immobilization may be recommended. Surgery may be needed for fractures or severe sprains.
Treating Ankle Sprains & Ankle Instability
When the ligaments supporting the ankle are overstretched or tear, it is called a sprain. While sprains are common, if left untreated they can result in long-term ankle weakness and an increased likelihood of re-injury, arthritis, instability, and chronic pain. Sprains are often caused by an unexpected twist of the foot or ankle while walking on an uneven surface, falling down, or participating in sports. Symptoms include pain, swelling, bruising, tenderness, and instability of the ankle. In severe cases, you may hear a “pop.” To diagnose a sprain, we start with a simple examination including palpation and range-of-motion tests. We’ll likely also use X-rays to rule out a broken bone, and may order MRIs or ultrasounds to determine stability and the extent of the damage and other injuries. Most sprains are treated without surgery. Treatment for mild sprains can take about 2 to 4 weeks and includes resting the joint, protecting it from further damage, and reducing the swelling with ice and/or medication. For moderate sprains, additional steps are needed to restore range of motion, strength, and flexibility. For severe sprains with complete ligament tears and substantial instability, it can take 6 – 12 weeks for the ligament to heal fully and more maintenance exercises will be required, along with crutches, bracing, and a very gradual return to activities. Surgery may be necessary instability occurs and may include reconstruction of the damaged ankle ligaments. The best way to prevent ankle sprains is by increasing the stability of the ankle with exercises that improve muscle strength, balance, and flexibility.