Most people don’t realize, but your foot is chock full of bones. In fact, you have 52 bones between the two feet. Of the 26 bones in each foot, 19 are phalanges (in the toes) or metatarsal bones (the long bones of the midfoot). Fractures (or breaks) of the metatarsal bones and toes are common. But just because they are coommon, doesn’t mean they should be ignored. All fractures in the feet and toes warrant an evaluation by a foot specialist, even if initial treatment has been started in the emergency room.
What Is a Foot Fracture?
A fracture is a break in the bone. This most often involves one of the five metatarsal bones. All fractures in the feet and toes warrant an evaluation by a foot specialist, even if initial treatment has been started in the emergency room. Basically, foot fractures are divided into two categories: stress fractures and traumatic fractures.
Traumatic fractures (also known as acute fractures) are caused by the application of force or trauma. This can be an impact such as a direct blow—like forcefully stubbing your toe. When evaluating traumatic fractures it is important for your doctor to determine whether the broken bone is displaced or nondisplaced. In displaced fractures,the bone is not only broken, but it is also moved out of alignment. In this case, it is said to be dislocated. Treatment of these types of fractures depends on the extend of injury, the amount of displacement, and wether or not the joint surface is involved. Surgery is sometimes required to put the bone back into proper position and stabilize it so it can heal.
You might have a fracture if you notice any of the following:
• You may hear a sound at the time of the break.
• “Pinpoint tenderness”(pain or tenderness at the precise location of injury) at the time the fracture occurs and perhaps for a few hours later. This can be deceiving, because sometimes, the pain goes away after several hours.
• Deviation or mal-alignment (crooked, misshapen or abnormal appearance) of the toe.
• Bruising and swelling that starts to appear within 48 hours of the injury.
• It is absolutely not true that “if you can walk on it, it can’t be broken.” We see people walking into our office with fractures on a regular basis. Because of this, if you suspect you have a fracture, you should get in for an evaluation as soon as possible. We reserve slots for emergency appointments every day so you won’t have to wait to get taken care of.
Stress fractures are very small cracks in the bone. These tiny, hairline breaks are most often caused by repetitive stress. We see this most often in runners and triathletes. The main culprit is a rapid increase in mileage while training for long distance events. Stress fractures are also caused by osteoporosis, abnormal foot structure (such as high arches), or other foot deformities. Wearing the right shoes for your foot type is critical. You must choose the right shoes for your foot type in order to prevent stress fractures. If you suspect a stress fracture, stop running and don’t ignore it. They can worsen if left untreated. You might also be at risk for a pattern of recurring future injury.
You might have a stress fracture if you notice any of the following symptoms:
• Pain either during or after normal activity.
• Pain which goes away while resting, but returns when standing or walking.
• “Pinpoint tenderness” (pain or tenderness right at the site of the suspected fracture) when touched
• Swelling without any bruising
Sprains and fractures can have very similar symptoms. But often with a sprain, a broader area of the foot will ache, rather than just a certain point of tenderness. We can easily diagnose the problem and start you on the appropriate treatment. This will help you get back to your activities as fast as possible. Keep in mind that some sprains and dislocations can be severely disabling. Without the right treatment you can develop crippling arthritis.
Potential Problems of Improper Fracture Treatment
We often see people in the office who will say “I thought that there isn’t anything that can be done for a broken bone in the foot.” This is false. In fact, if a fractured phalanx bone in the toe or a metatarsal bone in the foot is not treated correctly, you can develop serious problems. For example:
• A permanent deformity in the bone alignment and structure can develop and limit the ability to walk on the foot or fit into shoes
• Arthritis is often caused by an untreated fracture that involves a break in the joint surface. In some cases, when the bone isn’t realigned, an angular deformity develops and causes problems.
• Chronic foot pain and long-term difficulties with walking
• Non-union,or failure of the broken bone to heal, can lead to a need for surgery or suffering from chronic pain.
Metatarsal Fracture Treatment
Metatarsal fractures can be caused by repetitive stress (a small amount of force applied over and over for a very long time) or trauma (a whole lot of force applied all at once). The risk for long-term problems after a metatarsal fracture depends on which of the five metatarsal is broken, and where the break occurs. For example, a break in the first metatarsal bone (the one behind the big toe joint) can lead to painful stiffness and arthritis. The big toe is used frequently and the big toe joint carries about half of all of the force on the forefoot when you walk. If you develop arthritis in the big toe joint, it cane become painful to walk, bend, or just stand on the foot. There is another worrisome injury called a Jones fracture, which involves the base of the fifth metatarsal bone (the one behind the little toe joint). Jones fractures are often misdiagnosed as an ankle sprain. A misdiagnosis and lack of proper treatment can lead to serious problems since sprains and fractures are treated differently. Make sure you see an expert.
The best treatment of a metatarsal fracture will depend on the specifics of the fracture, but may include:
• Rest. Sometimes rest is all that is needed to promote healing of a stress fracture of a metatarsal bone.
• Avoid the activity that led to the fracture.
It is important to make sure that you don’t injury the area further. If running caused the fracture, stop running until you get an evaluation. Don’t make it worse. Sometimes you might have to stay off the foot entirely with the help of crutches of a wheelchair in order to allow it to heal.
• Immobilization, casting, or stiff shoe. A cast, stiff shoe or fracture walking boot might be needed to protect and stabilize the fractured bone while it is healing.
• Surgery. Depending upon the extent of the injury, some metatarsal fractures will heal much better with surgery to re-align and stabilize the bone.
• Follow-up treatment. You will receive very particular instructions for treatment after both surgical and non-surgical metatarsal fracture treatment. Physical therapy, strengthening exercises and rehabilitation will help get you back to your athletic activities as quickly as possible.
Dr. Christopher Segler is a nationally recognized foot fracture specialist. He has worn awards from the American College of Foot ad Ankle Surgeons for his research on the accurate diagnosis of foot fractures and ankle fractures. He practices Podiatry in San Francisco and offers house calls to provide second opinion consultations on foot fractures. He can be reached at (415) 308-0833.
