MANUAL MINORS
Foot fractures are injuries that affect one or more of the bones forming the foot’s structure, such as the tarsal bones (calcaneus, talus), metatarsals, or phalanges. These fractures can range from small stress fractures to severe fractures caused by high-energy trauma, such as falls or accidents.
Symptoms include intense localised pain, swelling, deformity (in displaced fractures), and difficulty walking or bearing weight on the affected foot.
Diagnosis
Diagnosis is based on the trauma history, symptoms, and physical examination. Signs include tenderness upon palpation of the affected area, swelling, and in severe cases, deformity or bruising. X-rays are the initial study to confirm the diagnosis, evaluate the type of fracture (displaced or non-displaced), and determine the location. In some cases, such as complex or stress fractures, a CT scan or MRI may be needed for a more detailed assessment.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Ankle sprain | Pain and decreased stability, but no fracture visible on X-ray. |
Plantar fasciitis | Chronic pain in the bottom of the foot, especially when walking or after rest. |
Bone contusion | Pain following direct impact, with no fracture seen on X-ray. |
Stress fracture | Progressive pain with physical activity, generally visible on MRI rather than initial X-rays. |
Foot joint dislocation | Visible deformity and pain, often associated with a fracture on X-ray. |
Emergency Management
In the emergency department, initial management of foot fractures includes immobilising the affected foot with a splint or orthopaedic boot to stabilise bone fragments and prevent displacement. Ice is applied to reduce swelling, and the foot is elevated to improve venous return.
Analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) are administered for pain control. In open or displaced fractures, urgent surgical intervention is required. The neurovascular status of the foot should be evaluated to rule out vascular or nerve injury.
Definitive Treatment
Definitive treatment of foot fractures depends on the location, severity, and type of fracture:
Fracture Location | Conservative Treatment | Surgical Treatment |
|---|---|---|
Calcaneus | Immobilisation and no weight-bearing (6–8 weeks) if non-displaced. | Surgery if displaced or involving the subtalar joint. |
Talus | Strict immobilisation if non-displaced. | Surgery to prevent complications such as avascular necrosis. |
Fifth metatarsal (Jones fracture) | Immobilisation without weight-bearing. | Surgery recommended due to the high risk of non-union. |
Other metatarsals | Orthopaedic boot and weight restriction if non-displaced. | Surgical reduction and fixation in displaced fractures. |
Phalanges (toes) | Buddy taping, partial immobilisation, weight-bearing as tolerated. | Rarely requires surgical treatment. |
Stress fractures | Rest, orthopaedic boot, proper footwear. | Surgery for persistent stress fractures unresponsive to conservative treatment. |
Open or unstable fractures | N/A | Open reduction and internal fixation (ORIF) with plates and screws. |
Rehabilitation
Rehabilitation is essential to restore foot function after a fracture. It includes exercises to improve mobility, strength, and stability. In complex fractures, physical therapy plays a key role in preventing joint stiffness and enhancing balance. Weight-bearing should be reintroduced gradually as the fracture heals. With proper treatment, most foot fractures heal well, although complex fractures may present complications such as deformities, arthritis, or delayed union.
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