Broken Foot – Fractures, Symptoms, and Treatment for Foot Fractures (Toe Fracture, Stress Fracture, Fatigue Fracture, and More)

Although injuries or bone fractures in the foot occur relatively frequently in accidents, they are often overlooked at first.

One reason for this is that in serious traffic accidents, the foot is often initially neglected, as attention is focused on fractures of the larger bones or injuries to the abdomen or chest. This is because serious injuries to the abdomen or chest can be life-threatening, whereas a foot fracture is almost never life-threatening.

Nevertheless, a foot fracture also requires a thorough examination and attention. After all, the foot has a very complex structure, and any part of it can be fractured. A foot fracture that goes undetected or is diagnosed too late can lead to permanent damage and impaired mobility. 

The human foot consists of a large number of different bones. Anatomically, the foot is divided into the forefoot, midfoot, and hindfoot. 

The forefoot includes:

• the toes and 
• the ball of the foot

The hindfoot includes:

• the heel (calcaneus) and 
• parts of the ankle joint (ankle bone = talus)

The midfoot is the area in between; the bones are called:

• metatarsal bones. 

© bilderzwerg / Fotolia

In principle, any part of the foot—that is, any bone in the foot—can fracture. In medicine, this is called a foot fracture (ICD code: S92). However, some bones in the foot are more susceptible to fractures than others. This is due, on the one hand, to their location and exposure to force, and on the other hand, to differences in bone structure and calcium content.

About three-quarters of fractures in the foot are forefoot and midfoot fractures. This is because the forefoot and midfoot are less protected than the hindfoot and are, so to speak, more frequently exposed to impact. In addition, the force required to cause a fracture is generally lower here than for hindfoot fractures, as the bone structure is less stable. This is because the hindfoot bears the body’s main weight while walking, whereas the forefoot and midfoot are essential for mobility and balance.

The most common fracture in the forefoot is a toe fracture. However, since the toes are frequently exposed to both direct (a heavy object falls on them) and indirect (the foot is twisted) forces compared to the other bones of the foot, fractures in this area are not uncommon.

In the midfoot, medical professionals also distinguish what is known as a Jones fracture. This is a sudden fracture at the junction between the diaphysis (bone shaft) and the metaphysis (the area between the shaft and the joint end) of the fifth metatarsal bone. This often occurs when walking on tiptoes and the foot twists inward and rolls over.

In the hindfoot, the calcaneus (heel bone) is most commonly fractured, which is a very severe and serious injury. The talus (ankle bone), located between the tibia and the calcaneus, may also be fractured, either simultaneously or on its own. This, too, is a serious fracture that, if not treated properly, can lead to permanent loss of mobility in the foot.

It is also possible to fracture the lateral malleolus or the navicular bone. The navicular bone of the foot is a very small bone. It is located between the talus and the cuneiform bones of the first two toes. However, due to its size, it rarely fractures—except perhaps when subjected to a direct, forceful impact.

Foot fractures often result from traffic accidents or sports injuries.

In addition to such complex injuries, there are also stress fractures. These result from repeated stress—that is, prolonged and intense strain on the bones in the foot. This occurs, for example, in soldiers (so-called “marching fractures”). But even high-intensity sports carry the risk of a so-called stress fracture, for example:

• Aerobics
• Running
• Ballet
• Dancing

Acute fractures of the foot are often caused by jumping from a height or falling. These result in a compression injury, which in turn causes a fracture of the calcaneus. A lateral ankle fracture is more likely to occur when the foot twists. If, on the other hand, a heavy object falls on the foot, this usually results in a metatarsal fracture.

Other causes of foot fractures include contusions and unsteady movements in older adults, which can lead to injuries. In addition to uneven floors, the greatest sources of danger are stair steps and curbs.

The symptoms (external signs) of a sudden (acute) foot fracture are usually relatively clear:

• severe swelling
• Pain at rest and especially when stepping on the foot
• Pain on pressure
• Bruising
• A “cracking” sensation when moving the ends of the bones (this can be felt during an examination, but is rarely done due to the pain)
• Open wounds over the fracture site and 
• exposed bone ends (rare)

The symptoms of a foot fracture that develops over a longer period of time (chronic) are similar to those of acute fractures, though they are usually less pronounced. For this reason, they can often be overlooked or detected too late. 

© cirquedesprit / Fotolia

Early diagnosis and timely treatment are very important for a foot fracture. They ensure that the foot heals without pain. Otherwise, there is a risk of malunion (pseudoarthrosis) or so-called post-traumatic osteoarthritis (joint wear).

The initial suspected diagnosis is based on the most important symptoms of a fracture. To confirm this, an X-ray examination is performed next. If the fracture is already clearly visible on the X-ray, no further examinations are usually necessary, and treatment can be planned.

However, if the examination does not allow for a definitive assessment, a CT (computed tomography) scan is recommended. In cases of severe traffic accidents, this is performed immediately in the emergency room (known as a polytrauma CT). In such cases, however, care must be taken to ensure that the entire foot is included in the image. Otherwise, a bone injury to the foot may be overlooked.

In young people, especially women of childbearing age, magnetic resonance imaging (MRI) also allows for a reliable diagnostic assessment when the X-ray is inconclusive. The advantage of MRI is that it involves no radiation exposure.

Treatment of the fracture depends on several factors:

• Type of fracture
• Tissue damage, and
• the patient’s overall health

If you have a foot fracture, you will likely prefer conservative treatment without surgery. This is possible as long as the natural anatomy of the foot remains intact. The fracture must not be displaced. If the fracture is only slightly displaced, conservative treatment is usually also possible.

In cases of skin lacerations (“open fracture”) or severely displaced bone ends that cannot be realigned, surgical treatment is generally unavoidable. However, the majority of foot fractures can be treated conservatively.

What does conservative treatment for a foot fracture involve?

First, it is important to immobilize and take weight off the foot. You can do this with a cast or a traditional splint. Newer options include kinesiology tape or support bandages (soft casts). These measures are used continuously for about 4–6 weeks.

Cooling pain ointments and cold packs help reduce swelling. However, avoid direct contact with cold. Always place a cloth between the cold source and the foot to prevent skin and nerve damage.

What does surgical treatment for a foot fracture involve?

During surgery, the bones are exposed through an incision in the skin and realigned. The ends of the bones are then firmly secured together, usually with screws or plates. This procedure is medically referred to as osteosynthesis, which means the restoration and stabilization of the bone structure.

The video shows how ankle surgery is performed:

However, this is often followed by another cast to ensure the metal does not break. Furthermore, the metal often needs to be removed after a certain period of time, usually after 6–12 months. This requires another surgical procedure—though a much smaller one—known as metal removal. Often, however, this metal removal can be performed on an outpatient basis.

The exact duration and course of recovery depend on the type of fracture. Furthermore, the prognosis is significantly influenced by whether soft tissues are damaged in addition to the bone. Under favorable conditions, with a prompt diagnosis and early treatment, a simple foot fracture should be fully healed after about eight weeks.

The healing process for a metatarsal fracture is usually associated with a good prognosis. In such cases, healing generally proceeds without complications. However, this applies only if the fracture is diagnosed early and the foot is consistently kept off the ground.

The complication rate for fractures in the hindfoot, however, is relatively high. Depending on the complexity of the injury, mobility is often restricted for a longer period, as the foot must not bear weight for an extended time.

In summary, a fracture can affect many different areas of the foot. The injury occurs primarily during sports and as a result of accidents. A definitive diagnosis can usually be made through X-rays and, if necessary, a computed tomography (CT) scan. Subsequent treatment is either conservative, using supportive devices, or surgical, involving fixation with screws or wires.

What are the symptoms of a broken foot?
A broken foot is often recognized by severe pain, swelling, tenderness, and bruising. In addition, limited mobility or misalignment may occur. If severe pain occurs after an injury, a suspected bone fracture should be evaluated by a doctor.

How is a foot fracture diagnosed?
The diagnosis is made through medical history, physical examination, and imaging techniques such as X-rays, MRI, or CT scans. In cases of complicated foot fractures, a CT scan may also be necessary to assess the extent of the injury and the displacement of the bone fragments.

Which bones in the foot are most commonly fractured?
The metatarsals, the base of the fifth metatarsal, the toes, and tarsal bones such as the navicular bone are particularly commonly affected. The ankle joint can also be injured if subjected to a strong impact.

How is a broken foot treated?
Treatment depends on the type of fracture and the extent of the injury. Conservative treatment usually involves immobilization with a cast. If bone fragments are displaced or the fracture is complex, surgical treatment may be necessary to stabilize the fracture.

What is a stress fracture in the foot?
A stress fracture is caused by repeated stress rather than a single accident. Stress fractures can occur particularly during sports or among inexperienced hikers. Stress fractures often develop gradually and cause a dull pain in the midfoot.