Although an injury or bone fracture (fracture in medical terms) in the foot occurs relatively frequently in accidents, it is often overlooked at first.
One of the reasons for this is that the foot is often initially neglected in serious traffic accidents, as fractures of the larger bones or injuries to the abdomen or chest are the main focus. This can be explained by the potential life-threatening nature of major injuries to the abdomen or chest, whereas a fracture to the foot is almost never associated with a risk to life.
Nevertheless, a foot fracture also requires thorough examination and attention. After all, the foot has a very complicated structure and all areas of the foot can be fractured. A foot fracture that is not recognized or is recognized too late can lead to permanent damage and a reduction in the ability to walk.
The human foot consists of a large number of different bones. Anatomically, the foot is divided into a forefoot, midfoot and hindfoot.
The forefoot includes
- the toes and
- the balls of the toes
The hindfoot includes
- the heel (heel bone = medically calcaneus) and
- Parts of the ankle joint (ankle bone = medically known as the talus)
The metatarsus is the area in between, the bones are called:
- Metatarsals (metatarsal bones).
© bilderzwerg / Fotolia
In principle, any part of the foot, i.e. any existing foot bone, can break. In medicine, this is called a foot fracture (ICD code: S92). However, there are bones in the foot area that are more susceptible to fractures than others. This is partly due to their location and exposure to force, but also to the different bone structure and calcium salt content.
Around three quarters of fractures in the foot area are forefoot and metatarsal fractures. This is due to the fact that the forefoot and midfoot are less protected than the hindfoot and are more frequently exposed to force. In addition, the force required is less pronounced here than with hindfoot fractures, as the bone structure is less stable. This is because the hindfoot bears the main weight of the body when walking, while the forefoot and midfoot are essential for mobility and balance.
The most common fracture in the forefoot is the toe fracture. However, as the toes are often exposed to direct (heavy object falls on them) and indirect (foot is twisted) force compared to the other foot bones, fractures are not uncommon here.
In the case of the metatarsus, doctors also distinguish between so-called Jones fractures. This is a sudden fracture between the transition from the diaphysis (bone shaft) to the metaphysis (area between the shaft and the end of the joint) in the fifth metatarsal bone. This often happens when walking on tiptoe and the foot twists and bends.
The heel bone (calcaneus) is the most common fracture in the hindfoot, and this is a very serious and severe injury. The talus, which lies between the tibia and the calcaneus, can also be fractured simultaneously or in isolation. This is also a serious fracture which, if not treated properly, can lead to a permanent restriction in the mobility of the foot.
It is also possible to break 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. Due to its size, however, it rarely breaks - for example, when subjected to targeted force.
Foot fractures often occur as a result of traffic accidents or sports accidents.
In addition to such complex injuries, there are also fatigue fractures. They are the result of repeated stress, i.e. continuous and heavy loads on the bones in the foot. This occurs, for example, in soldiers (so-called "marching fracture"). However, intensive sports also 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 lead to a compression, which in turn triggers a fracture of the calcaneus.
An external malleolus fracture is more likely to occur when the foot twists. If, on the other hand, a heavy object falls on the foot, this usually leads to a metatarsal fracture.
Other causes of foot fractures include crushing and unsafe movements in older people, which are associated with injuries. In addition to uneven floors, the greatest sources of danger are steps and the edges of sidewalks.
The symptoms (external signs) of a sudden (acute) foot fracture are usually relatively clear:
- severe swelling
- Pain at rest and especially when walking
- pressure pain
- bruising
- "crackling" when the bone ends move (this can be felt during the examination, but is rarely carried out due to the pain)
- Open wounds over the fracture and
- Visible bone ends (rare)
The symptoms of a (chronic) foot fracture that develops over a long period of time are similar to those of acute fractures, but are usually less pronounced. For this reason, they can often be overlooked or are discovered too late.
© cirquedesprit / Fotolia
Early diagnosis and timely treatment are very important in the event of a foot fracture. They ensure that the foot heals without pain. Otherwise, there is a risk of incorrect healing(pseudoarthrosis) or so-called post-traumatic arthrosis (joint wear and tear).
The first suspected diagnosis is made on the basis of the most important symptoms of a fracture. To confirm this, the next step is an X-ray examination. If the fracture can already be clearly identified here, no further examinations are usually necessary and treatment can be planned.
However, if the examination does not allow a conclusive assessment to be made, a CT scan (computer tomography) is recommended. In the case of serious traffic accidents, this is carried out in the emergency room from the outset (so-called polytrauma CT). However, care should be taken here to ensure that the foot is completely imaged. Otherwise a bony injury to the foot may be overlooked.
In young people, especially women of childbearing age, magnetic resonance imaging (MRI) also provides a reliable imaging diagnosis if the X-ray image is not conclusive. The advantage of MRI is that there is no radiation exposure.
The treatment of the fracture depends on several factors:
- Type of fracture
- damage to the tissue and
- the patient's general state of health
If you suffer from a foot fracture, you will probably prefer conservative treatment without surgery. This is also possible as long as the natural anatomy of the foot is intact. The fracture must not be displaced. If the fracture is only slightly displaced, conservative treatment is usually also possible.
In the case of skin injuries ("open fracture") or severely displaced bone ends that cannot be brought back into the correct position, surgical treatment is usually unavoidable. However, the majority of foot fractures can be treated conservatively.
What does conservative treatment look like for a foot fracture?
First of all, it is important to immobilize and relieve pressure on the foot. You can do this with the help of plaster casts or a traditional splint. Newer aids are tapes or support bandages (soft cast). These measures are applied continuously for around 4-6 weeks.
Cooling pain ointments and cooling pads help to reduce swelling. However, avoid direct cold. Always place a cloth between the source of cold and the foot to avoid damaging the skin and nerves.
What does surgical treatment look like for a broken foot?
In a surgical procedure, the bones are exposed through a skin incision and brought back into the correct position. The ends of the bones are then firmly joined together, usually using screws or plates. This procedure is medically referred to as osteosynthesis, which means restoration and stabilization of the bone structure.
The video shows how ankle surgery can be performed:
However, this is often followed by a further reset with a plaster cast to prevent the metal from breaking. Furthermore, the metal often has to be removed again after a certain period of time, usually after 6-12 months. This requires another, albeit much smaller, surgical procedure (known as metal removal). However, this metal removal can often be performed on an outpatient basis.
The exact duration and progression depend on the type of fracture. The prognosis also depends on whether soft tissue is damaged in addition to the bone. With good conditions, a quick diagnosis and early treatment, a simple fracture of the foot should be completely healed after around eight weeks.
The healing process of a metatarsal fracture is usually associated with a good prognosis. As a rule, healing should proceed without complications. However, this only applies if the fracture is diagnosed early and the foot is consistently relieved.
However, the complication rate for fractures in the hindfoot is relatively high. Depending on the complexity of the injury, there is often a prolonged restriction of mobility, as the foot must not be loaded for a longer period of time.
In summary, it can be said that a fracture can affect many different areas of the foot. The injury mainly occurs during sport and as a result of accidents. X-ray examinations and, if necessary, a computer tomography (CT) scan can usually provide a reliable diagnosis. Subsequent treatment is conservative with supportive aids or surgical with fixing screws or wires.
