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Broken Foot (cont.)

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What can you do for a broken foot (treatment)?

  • First aid at home may include RICE (rest, ice, elevation, and compression). Rest may include the use of crutches to limit weight bearing as tolerated.
  • If the decision is made to seek medical care, this regimen may be continued once the patient is discharged from the hospital to go home.
  • The treatment of a foot fracture depends upon what bone is broken, the mechanism of injury, the underlying medical condition of the patient, and whether the fracture is open (the skin is broken) or closed (the skin is intact).
  • Broken toes are often treated symptomatically, with the injured toe "buddy taped" to an adjacent normal toe. It may be helpful to place cotton balls or other absorbent material between the toes to prevent dampness and skin injury. A stiff-soled shoe and crutches may be needed to help with walking. Healing should occur within 4 to 6 weeks.
  • Fractures of the great toe that are displaced may require surgery to allow better healing. An orthopedic surgeon or podiatrist (foot specialist) may choose this option, but often that decision is made electively a few days after the injury.
  • Open fractures of the toe usually require good wound cleansing to prevent infection. At the same time the health care practitioner will often explore the wound, looking for foreign objects and evaluate the condition of deep structures like tendons, looking for lacerations.
  • Metatarsal fractures often heal nicely with conservative care, meaning no operation is needed. The foot is wrapped for comfort to decrease swelling and placed in an orthopedic post-op or Reese shoe. Cast boots also may be considered.
    • First metatarsal fractures that are aligned nicely may be treated with a post-op shoe with no weight bearing. If the fracture is displaced, meaning the bone fragments do not align, an operation to pin or plate the fracture may be considered.
    • Second, third, and fourth metatarsal fractures tend to heal nicely with an ace wrap for support and weight bearing as tolerated.
    • Stress fractures usually involve the second and third metatarsals, and are called "March fractures." March fractures were initially recognized in military recruits who were required to quickly increase the amount they walked. Splints , casts, or walking boots may be considered for pain control.
    • Fifth metatarsal fractures are of two types. Avulsion fracture at the very base of the bone are treated in the same way as the other metatarsal fractures.
    • Jones fractures of the fifth metatarsal shaft have a non-healing (non-union) rate of up to 50% and often require surgery to fix the fracture.
    • Lisfranc fracture dislocation injuries require surgery for repair.
    • The treatment of talus fractures depends upon where in the bone the fracture occurs.
    • The top of the talus is dome-shaped and is part of the ankle joint, fitting into the base of the tibia or shin bone. This fracture may not be easily identified and sometimes can be mistaken for a non-healing ankle sprain. The treatment is rest and avoidance of weight bearing.
    • Talar neck fractures often have difficulty healing because of poor blood supply. Surgery may be required if the bone is displaced, otherwise no weight bearing in a cast for 2-3 months may be required.
    • A Shepherd fracture involves the posterior, or back part, of the talus and is seen in athletes who dance or kick. The treatment is immobilization in a cast.
    • Lateral process fractures of the talus are becoming more common with increasing numbers of snowboarding injuries. Treatment includes no weight bearing in a cast.
    • Calcaneus fractures require significant force to occur and are associated with a marked amount of swelling and pain. An orthopedic surgeon or podiatrist is often consulted emergently to decide whether surgery is needed to stabilize the fracture. CT scan may be needed to assess the extent of the fracture, and whether the fracture line enters the joint. The health-care professional also may look for associated injuries of the ankle, knee, hip, and lumbar spine.

Immobilization of the fractured foot will help with pain control. Ibuprofen (Advil, Motrin) can be helpful with pain control by decreasing inflammation in the area. Narcotic pain medication may also be prescribed if needed.

Rest, ice, and elevation will help limit swelling and decrease pain.

What is the healing and recovery time for a broken foot?

Recovery and healing time for a broken foot depends upon the type of fracture and the bones broken.

What are the complications of a broken foot?

As with any injury, complications may occur.

  • Broken bones may fail to heal, causing a non-union that may require surgery to repair.
  • If the fracture line enters a joint surface, arthritis may develop, even if the joint surface has been aligned by surgery.
  • Open fractures may be complicated by infection and damage to underlying structures like tendons, arteries, and nerves.
  • Though it is uncommon, crush injuries to the foot may cause significant swelling in the tight spaces of the foot, leading to compartment syndrome. Should the pressure in one of these compartments rise above the patient's blood pressure, decreasing blood flow to the area of foot beyond the injury. This is a surgical emergency and fasciotomies, incisions into the foot compartments, are performed to allow space for the swelling to occur, relieve the pressure, and restore blood supply to the foot.

Can a broken foot be prevented?

  • The foot is placed under considerable stress on a daily basis, absorbing the pounding of walking, running, and jumping. Poorly-constructed and -cushioned shoes and obesity help contribute to stress fractures and general instability of the foot.
  • High-impact sports that include twisting and direct blows to the feet increase the risk of fracture. Appropriate protective equipment will help decrease the risk of injury.
  • Certain occupations increase the risk of foot injury. These include the construction trades in which weights may be dropped on a foot, or falls from height may occur.
  • People with osteoporosis or peripheral neuropathy may have increased risk of foot injury. For these people, it is important to decrease the clutter around the house to prevent injury from falling. It is also helpful to limit the number of throw rugs in a home that can cause a person to trip and fall.

REFERENCE:

Gravlee, J.R., MD. "Toe fractures in adults." UpToDate. Updated: Sep 26, 2016.
<http://www.uptodate.com/contents/toe-fractures-in-adults>

Boutis, K. MD. "Metatarsal and toe fractures in children." UpToDate. Updated: Sep 23, 2016.
<http://www.uptodate.com/contents/metatarsal-and-toe-fractures-in-children>

Boutis, K. MD. "Foot fractures (other than metatarsal or phalangeal) in children. UpToDate. Updated: Jul 21, 2015.
<http://www.uptodate.com/contents/foot-fractures-other-than-metatarsal-or-phalangeal-in-children>


Medically Reviewed by a Doctor on 11/22/2016

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

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