Injuries to the foot or ankle joint can cause many problems. Anyone who has twisted their foot usually wonders whether it could be a broken foot. Most foot fractures are metatarsal fractures because most of the pressure is exerted on the metatarsus.
A metatarsal fracture is a fracture of the metatarsal or toe bones of the foot, which can have various causes. This is usually manifested by pain when the foot is under stress or already at rest.
What indicates a broken foot?
Depending on how badly the foot is broken, and the bones of the foot are removed from their original shape, the fracture causes different degrees of discomfort.
Usually, an intense swelling or bruise is formed at the appropriate place. Besides, pain can occur when the affected bones are strained or when the broken foot is kept still.
If the fracture is severely misaligned, it can no longer be possible for the broken foot to roll off.
Depending on whether an open or closed fracture is present, bleeding skin wounds, and, in the case of a severe malpositioning, parts of the bone may be visible. Abnormal mobility may also be possible.
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Pain with a broken foot
A broken foot can cause very severe pain. However, the actual intensity of the pain depends mostly on the bone that is broken.
A broken toe can be broken at and shortly after the injury, but then it can be no longer a problem. In most cases, you can put full weight on foot without feeling pain. However, if another part of the foot is affected, the intensity of the pain can be much higher and make it impossible for it to occur.
If surgery is necessary for bone healing or if there is an open fracture with injury to the surrounding soft tissues, the pain can be much severer and cause problems for longer.
For pain therapy, the attending physician prescribes the necessary painkillers and prescribes physiotherapy to ensure an optimal course of treatment.
Some ankle fractures can also cause pain in the lower leg, as the rear bone of the lower leg can also be broken due to the large amount of force involved in the injury. Due to the need for immobilization in the foot, particular attention must be paid to pain in the calf, as this can result in deep vein thrombosis of the leg, which is often favored by bed rest.
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How is a fracture treated?
The therapy depends very much on which bones in the foot are broken and to what extent they have suffered a malposition.
Simple fractures of individual metatarsal bones without displacement from the skeleton can usually be treated with a four-week plaster cast and appropriate immobilization. After that, loading is often possible relatively quickly.
As soon as there is a malposition that cannot be corrected by plaster treatment, the bone must be brought back into its original position using an operation.
The surgeon uses either screws or so-called Kirchner wires. This procedure is also called screw osteosynthesis.
Often no massive, open surgery is necessary, but small external skin incisions are sufficient. After the operation, a plaster splint and relief through crutches are still necessary in most cases.
The screws or wires used usually remain in the foot for life and typically cause no discomfort. Severe, open fractures with severe swelling must be decongested before treatment to prevent an increase in pressure within a plaster cast.
To prevent further malpositioning of the foot bones while the soft tissue is decongested, the bones are held in a fixed position with a so-called “external fixator.” Besides, prophylactic antibiotic treatment prevents infections caused by bacteria.
If you are further interested in this topic, please read our next article under the treatment of a bone fracture.
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How long do you need a cast?
If the foot is broken, it must first be immobilized and stabilized with a plaster cast or splint. How long a cast is needed to allow the fracture to heal entirely depends on the type and location of the injury.
If one of the toes is broken, a so-called roof tile bandage is usually applied, which makes movement in the joint impossible and, in various variations, allows neighboring toes to provide mutual stability. Usually, 3-4 weeks are entirely sufficient for this bandage.
In the case of a fracture in the forefoot or midfoot, a plaster shoe must be worn for 6 weeks in most cases. This ensures that the foot itself is stabilized and stiff. However, the ankle joint should still be able to move.
If the heel and the ankle joint are affected by the fracture, the lower leg may also have to be plastered. In this case, it is also necessary to immobilize the ankle joint for at least 6 weeks.
Which doctor should be consulted?
It is best to consult an orthopedic surgeon or an accident surgeon on the day of the accident so that a detailed diagnosis and imaging procedures can be carried out to determine whether and where a fracture is present, or whether only the ligaments or soft tissue are affected.
If the foot is broken, the severity of the fracture must be determined and what type of illness is to be expected. The location of the pain and the course of the accident provides relevant information.
Then the surgeon determines which parts of the foot are affected with the help of a physical examination and, if necessary, an X-ray, CT, or MRI. Finally, his diagnosis determines which treatment method is to be used to treat the injury and which protection should be taken into account.
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Duration of the treatment
In general, the healing time for broken feet depends on various factors. In younger patients, who are still in the growth phase, healing of fractures is usually much faster and less complicated than in older patients.
The bone tissue is temporarily replaced by a tissue called “callus tissue.” This stabilizes the fractured area and grows much faster in younger patients than in older ones. The soft tissue destroyed by the fracture and the degree to which the bones are displaced from their original position also plays a role.
The healing process can be shortened by surgery, as the corresponding bone parts are held together in the desired position by screws or wires.
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Prognosis for a broken foot
The entire healing process after the foot was broken is usually completed after 6-12 months. In most cases, however, a symptom-free state can be reached after 6 weeks, in which the patient can put on weight usually.
Irrespective of whether the fracture was treated using an operation or alone with a plaster cast, a visit to the doctor after 6 weeks is advisable. During this time, it can be checked whether the broken bone parts have been put together correctly and are in the right position to each other again and to what extent the injury has already healed. Also, wires or screws that cause pain can be removed.
Causes of a foot fracture
If the foot is broken, various causes can be considered. The most common cause is probably a sport. Whether while jogging or through falls during suddenly wrong movements, the metatarsal fracture is one of the most common fractures among athletes.
Even strong, direct violence, for example, from an accident, can cause a metatarsal fracture. Unexpected unevenness in the ground can cause the foot to bend outwards (supination trauma) and thus, in addition to the more frequent injuries to the ligamentous apparatus, damage to the metatarsal bones.
Another cause of a metatarsal fracture can be a fatigue/stress fracture. In this case, long-lasting incorrect loading or unaccustomed loads overload the metatarsal bones. Osteoporosis is a risk factor for such a fracture.
In contrast to fractures caused by trauma, patients usually do not remember a direct accident but feel the pain slowly after prolonged stress or, at a later stage, even when standing.
The fracture of the Os Metatarsale V is also unique. Here the foot is broken at the metatarsal of the little toe. The tendon of a long lower leg muscle is attached to this bone. As a result of over-tensioning the muscle by bending it outwards, the foot may be broken at this point due to the tendon tearing off.
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What complications can occur?
A rare but dangerous complication that can occur when the foot is broken can be a so-called “compartment syndrome.”
In this case, hefty bleeding into a space closed by a muscle fascia causes an increase in pressure in the corresponding compartment, which squeezes the supplying nerves and arteries and leads to an undersupply of the foot. This results in an unpleasant feeling of pressure in the foot and numbness.
Such compartment syndrome requires immediate therapeutic measures. After measuring the pressure in the corresponding compartment, it may be necessary to open the muscle fascia directly to allow the pressure to escape.
If the foot is undersupplied for too long, the tissue may die off, which should be prevented by relieving the pressure.
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Is it a midfoot fracture or just bruised?
After a direct but blunt violent impact on the bones of the foot, a bruise (contusion) may occur in addition to a fracture of the bones, which at first appears with similar symptoms to a broken foot.
In contrast to the situation when the foot is broken, however, only the soft tissue is affected by a contusion, and the bones are not damaged. As a result of bleeding into the muscle, the skin over the area affected by force discolors blue, the tissue swells and feels overheated.
Similar to when the foot is broken, severe pain occurs during exertion, so that movement can also be restricted.
In most cases, however, the symptoms subside after some time, and bruises usually go uneventful.
In the case of powerful force or damage to a large artery, which empties into a space closed by a muscle fascia, so that the pressure rises sharply, the complication of compartment syndrome mentioned above can also occur. In this case, the supplying vessels and nerves are pinched off, and the tissue may no longer be able to receive sufficient supply.
Tissue may be destroyed and die if pressure is not relieved quickly enough.
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Prophylaxis of a metatarsal fracture
Preventing the foot from breaking is usually tricky, as it is usually an unforeseeable accident mechanism. However, by taking special care in individual sports or by wearing appropriate protective clothing, a more severe accident can be prevented. The right footwear with a firm sole can also be decisive for stability during a fall.
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