Foot Fracture

Introduction

The foot has 26 bones, and can be divided into 3 parts:

The Hindfoot is comprised of two bones, the talus bone which connects to the bones of the lower leg, and the calcaneus bone which forms the heel.

The Midfoot is comprised of the navicular, cuboid, and three cuneiform bones.

The forefoot is made up of five metatarsal bones and 14 toe bones called phalanges.

The hindfoot is separated from the midfoot by the mediotarsal joint and the midfoot is separated from the forefoot by the Lisfranc joint.

Muscles, tendons, and ligaments support the bones and joints of the feet enabling them to withstand the entire body’s weight while walking, running, and jumping. Despite this, trauma and stress can cause fractures in the foot. Extreme force is required to fracture the bones in the hindfoot. The most common type of foot fracture is a stress fracture, which occurs when repeated activities produce small cracks in the bones. 

Types of foot fractures

Foot fractures can involve different bones and joints and are classified into several types:

Calcaneal fractures:
This type affects the heel bone and occurs mostly as a result of high-energy collisions. It can cause disabling injuries and if the subtalar joint is involved it is considered a severe fracture. 

Talar fractures: 
The talus bone helps to transfer weight and forces across the joint. Talus fractures usually occur at the neck or mid portion of the talus. 

Navicular fractures:
Navicular fractures are rare and include mostly stress fractures that occur with sports activities, such as running and gymnastics, as a result of repeated loading on the foot. 

Lisfranc fractures:
This type of fracture occurs due to excessive loading on the foot, which leads to stretching or tearing of the midfoot ligaments. 

Causes

Foot fractures commonly occur as a result of a fall, motor vehicle accident, dropping a heavy object on your foot, or from overuse such as with sports.

Symptoms

The common symptoms of a foot fracture include:
Pain
Bruising
Tenderness
Swelling
Deformity
Inability to bear weight

Diagnosis 

Your doctor diagnoses a foot fracture by reviewing your medical history and performing a thorough physical examination of your foot. Imaging tests such as X-rays, MRI, or CT scan may be ordered to confirm the diagnosis.

Navicular fractures can be especially difficult to diagnose without imaging tests. 

Treatment

Treatment depends on the type of fracture sustained. For mild fractures, nonsurgical treatment is advised and includes rest, ice, compression, and elevation of the foot. Your doctor may suggest a splint or cast to immobilize the foot. For more severe fractures, surgery will be required to align, reconstruct or fuse the joints. Bone fragments may be held together with plates and screws.
 
Physical therapy may be recommended to improve range of motion and strengthen the foot muscles. Weightbearing however should be a gradual process with the help of a cane or walking boot. 

Summary

Foot fractures are common injuries, making up about 10% of all orthopedic fractures. Foot fractures can be treated with simple conservative therapies or surgery depending on the severity. Timely treatment is important as it can lead to long-term disability and serious complications if not properly treated.