Fractures

 Traumatic Fractures

Traumatic fractures (also called acute fractures) are caused by a direct blow or impact–like seriously stubbing your toe. Traumatic fractures can be displaced or nondisplaced. If the fracture is displaced, the bone is broken in such a way that it has changed in position (dislocated). Treatment of a traumatic fracture depends on the location and extent of the break and whether it is displaced. Surgery is sometimes required. 

What are the symptoms of a traumatic fracture?

• You may hear a sound at the time of the break.
• “Pinpoint pain” (pain at the place of impact) at the time the fracture occurs and perhaps for a few hours later, but often the pain goes away after several hours.
• Deviation (misshapen or abnormal appearance) of the toe.
• Bruising and swelling the next day.
• It is not true that “if you can walk on it, it’s not broken.” Evaluation by the podiatric surgeon is always recommended.

Stress Fractures

Stress fractures are tiny, hairline breaks that are usually caused by repetitive stress. Stress fractures often afflict athletes who, for example, too rapidly increase their running mileage. Or they may be caused by an abnormal foot structure, deformities, or osteoporosis. Improper footwear may also lead to stress fractures. Stress fractures should not be ignored, because they will come back unless properly treated. 

What are the symptoms of stress fractures?

• Pain with or after normal activity
• Pain that goes away when resting and then returns when standing or during activity
• "Pinpoint pain” (pain at the site of the fracture) when touched
• Swelling, but no bruising

Sprains and fractures have similar symptoms, although sometimes with a sprain, the whole area hurts rather than just one point. Your podiatric surgeon will be able to diagnose which you have and provide appropriate treatment. Certain sprains or dislocations can be severely disabling. Without proper treatment, they can lead to crippling arthritis. 

What are the consequences of improper treatments for fractures?

Some people say that “the doctor can’t do anything for a broken bone in the foot.” This is usually not true. In fact, if a fractured toe or metatarsal bone is not treated correctly, serious complications may develop. For example:

• A deformity in the bony architecture which may limit the ability to move the foot or cause difficulty in fitting shoes.
• Arthritis, which may be caused by a fracture in a joint (the juncture where two bones meet), or maybe a result of angular deformities that develop when a displaced fracture is severe or hasn’t been properly corrected.
• Chronic pain and long–term dysfunction.
• Non–union, or failure to heal, can lead to subsequent surgery or chronic pain.

What are the treatments for toe fractures?

Fractures of the toe bones are almost always traumatic fractures. Treatment for traumatic fractures depends on the break itself and may include these options:

• Rest. Sometimes rest is all that is needed to treat a traumatic fracture of the toe.

• Splinting. The toe may be fitted with a splint to keep it in a fixed position.

• Rigid or stiff-soled shoes. Wearing a stiff-soled shoe protects the toe and helps keep it properly positioned.

• “Buddy taping” the fractured toe to another toe is sometimes appropriate, but in other cases, it may be harmful.

• Surgery. If the break is badly displaced or if the joint is affected, surgery may be necessary. Surgery often involves the use of fixation devices, such as pins.

What are the treatments for metatarsal fractures?

Breaks in the metatarsal bones may be either stress or traumatic fractures. Certain kinds of fractures of the metatarsal bones present unique challenges. For example, sometimes a fracture of the first metatarsal bone (behind the big toe) can lead to arthritis. Since the big toe is used so frequently and bears more weight than other toes, arthritis in that area can make it painful to walk, bend, or even stand. 

Another type of break, called a Jones fracture, occurs at the base of the fifth metatarsal bone (behind the little toe). It is often misdiagnosed as an ankle sprain, and misdiagnosis can have serious consequences since sprains and fractures require different treatments. Your podiatric surgeon is an expert in correctly identifying these conditions as well as other problems of the foot.  Rest, avoiding the offending activity, immobilization (cast or rigid shoe), or surgery.