March 23, 2017
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Broken Foot (cont.)

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What are the signs and symptoms of a broken foot?

Broken bones are painful, especially when they are weight bearing. Common signs and symptoms of a broken bone in the foot include:

  • Pain
  • Limping
  • Swelling
  • Bruising
  • Tenderness
  • Walking may be too painful

Other signs and symptoms of a broken foot include:

  • Joint dislocation: If the bones are significantly displaced (the bone alignment has been lost or there is an associated joint dislocation) a deformity of the foot may be apparent.
  • People with existing diseases or conditions: with altered pain sensation due to peripheral neuropathy (persons with diabetes are a classic example), pain may not be present, and the fracture may be missed initially. This also may occur in persons with spinal cord injuries. Bruising, swelling, and deformity may be the only clues to a potential fracture.

What are the signs and symptoms of a broken foot in an infant or toddler?

  • Infants and toddlers may ignore the pain of injury and when they see a health-care professional.
  • They may refuse to bear weight on their leg.
  • The child may sit comfortably on the parent's lap without complaint until asked or made to stand.

When should I call the doctor for foot pain?

  • Most of the bones in the foot will eventually heal with rest, but some fractures may need surgery to repair.
  • Often, it is the mechanism of injury associated with the intensity of pain that makes the patient seek care. It is appropriate to seek medical care if the patient cannot walk normally without a limp.
  • Medical care should be accessed immediately if an injury to the foot also includes a laceration. The term "open fracture", previously named "compound fracture," describes a broken bone that is associated with a break in the skin. Open fractures pose a significant risk for major infection of the bone.
  • Other reasons to seek care include:
    • Numbness or tingling in the toes, which may be an indication of nerve damage
    • A cool and white toot, which may signal artery damage and decreased blood supply to the foot

How can I tell if I have a broken bone in my foot?

A broken foot is diagnosed by the health-care practitioner taking a history of how the injury occurred. The mechanism of injury will give clues as to what type of injury may exist and importantly, what other associated injuries may also be potentially present. It is helpful to know how much time has passed from when the injury occurred to when the patient presents for care. Past medical history is important; those with diabetes or other conditions that suppress the immune system are at greater risk for infection with foot injuries.

Physical examination may include the following:

  • Inspection of the foot for swelling, bruising, deformities and open wounds.
  • Palpation allows the health care professional to feel where the pain is located. This is very helpful if X-rays are taken, since it allows the health care professional to correlate areas of tenderness with the anatomy seen on the X-Ray. (This is particularly important in children whose bones may not have yet calcified. Fractures may be easily missed since they occur through cartilage instead of bone.)
  • An exam of the circulatory system, feeling for pulses, and assessing how quickly blood returns to the tip of a toe after it is pressed and the toe turns white (capillary refill).
  • A neurologic exam, assessing sensation such as light touch and pin prick sensations
  • Motor function, asking the patient to move the injured area. This assists in assessing muscle and tendon function. The ability to move the foot means only that the muscles and tendons work, and does not guarantee bone integrity or stability. The concept that "it can't be broken because I can move it" is not correct.
  • A range of motion exam of the foot may be helpful in assessing ligament stability. However, if the fracture is obvious, the health care practitioner may choose to keep the foot immobilized to prevent further pain.

Imaging

  • X-rays are often taken to evaluate the status of the bones in the foot and to check for fracture. Usually three views are taken to help the health care professional and radiologist adequately view the bones. Special views may be taken if there is concern for a fracture of the calcaneus.
  • X-rays may not be taken for simple toe injuries, since the result may not affect the treatment plan.
  • For some foot fractures, X-rays may not be adequate to visualize the injury. This is often true for metatarsal stress fractures, where bone scans may be used if the history and physical examination suggest a potential fracture, but the plain X-rays are normal.
  • Computerized tomography (CT) may be used to assess fractures of the calcaneus and talus, since it may better be able to illustrate the anatomy of the ankle and midfoot joint and potential associated injuries. Magnetic resonance imaging (MRI) may be used in some cases of foot fractures.
  • The Lisfranc joint describes the connection between the first, second, and third metatarsals and the three cuneiform bones. A Lisfranc fracture dislocation often requires a CT scan to evaluate this region of the foot. While X-rays may hint at the damage in this type of injury, the CT can delineate the numerous bones and joints that may be damaged.
Medically Reviewed by a Doctor on 11/22/2016

Source: MedicineNet.com
http://www.medicinenet.com/broken_foot/article.htm

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