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Foot & Ankle Fractures

What Is an Ankle Fracture?

A fracture is a partial or complete break in a bone.  Fractures in the ankle can range from the less serious avulsion injuries (small pieces of bone that have been pulled off) to severe shattering- type breaks of the tibia, fibula, or both.

Ankle fractures are common injuries that are most often caused by the ankle rolling inward or outward.

Many people mistake an ankle fracture for an ankle sprain, but they are quite different and therefore require an accurate and early diagnosis. They sometimes occur simultaneously.

Symptoms

An ankle fracture is accompanied by one or all of these symptoms:

  • Pain at the site of the fracture, which in some cases can extend from the foot to the knee
  • Significant swelling, which may occur along the length of the leg or may be more localized
  • Blisters may occur over the fracture site. These should be promptly treated by a foot and ankle surgeon.
  • Bruising that develops soon after the injury
  • Inability to walk—however, it is possible to walk with less severe breaks, so never rely on walking as a test of whether a bone has been fractured
  • Change in the appearance of the ankle – it will look different from the other ankle
  • Bone protruding through the skin—a sign that immediate care is needed. Fractures that pierce the skin require immediate attention because they can lead to severe infection and prolonged recovery.

Diagnosis

Following an ankle injury it is important to have the ankle evaluated by a foot and ankle surgeon for proper diagnosis and treatment. If you are unable to do so right away, go to the emergency room and then follow up with a foot and ankle surgeon as soon as possible for a more thorough assessment.

The affected limb will be examined by the foot and ankle surgeon by touching specific areas to evaluate the injury. In addition, the surgeon may order x-rays and other imaging studies, as necessary.

ankle fracture
ankle fracture

Non-Surgical Treatment

Treatment of ankle fractures depends upon the type and severity of the injury. At first, the foot and ankle surgeon will want you to follow the R.I.C.E. protocol:

  • Rest: Stay off the injured ankle. Walking may cause further injury.
  • Ice: Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
  • Compression: An elastic wrap should be used to control swelling.
  • Elevation: The ankle should be raised slightly above the level of your heart to reduce swelling.

Additional treatment options include:

  • Immobilization.Certain fractures are treated by protecting and restricting the ankle and foot in a cast or splint. This allows the bone to heal.
  • Prescription medications.To help relieve the pain, the surgeon may prescribe pain medications or anti- inflammatory drugs.

When is Surgery Needed?

For some ankle fractures, surgery is needed to repair the fracture and other soft tissue related injuries, if present. The foot and ankle surgeon will select the procedure that is appropriate for your injury.

Follow-up Care

It is important to follow your surgeon’s instructions after treatment. Failure to do so can lead to infection, deformity, arthritis, and chronic pain.

What is a Fifth Metatarsal Fracture?

Fractures (breaks) are common in the fifth metatarsal – the long bone on the outside of the foot that connects to the little toe. Two types of fractures that often occur in the fifth metatarsal are:

  • Avulsion fracture. In an avulsion fracture, a small piece of bone is pulled off the main portion of the bone by a tendon or ligament. This type of fracture is the result of an injury in which the ankle rolls. Avulsion fractures are often overlooked when they occur with an ankle sprain.
  • Jones fracture. Jones fractures occur in a small area of the fifth metatarsal that receives less blood and is therefore more prone to difficulties in healing. A Jones fracture can be either a stress fracture (a tiny hairline break that occurs over time) or an acute (sudden) break. Jones fractures are caused by overuse, repetitive stress, or trauma. They are less common and more difficult to treat than avulsion fractures.
metatarsal fracture

Other types of fractures can occur in the fifth metatarsal. Examples include mid-shaft fractures, which usually result from trauma or twisting, and fractures of the metatarsal head and neck.

Symptoms

Avulsion and Jones fractures have the same signs and symptoms. These include:

  • Pain, swelling, and tenderness on the outside of the foot
  • Difficulty walking
  • Bruising may occur

Diagnosis

Anyone who has symptoms of a fifth metatarsal fracture should see a foot and ankle surgeon as soon as possible for proper diagnosis and treatment. To arrive at a diagnosis, the surgeon will ask how the injury occurred or when the pain started. The foot will be examined, with the doctor gently pressing on different areas of the foot to determine where there is pain.

The surgeon will also order x-rays. Because a Jones fracture sometimes does not show up on initial x-rays, additional imaging studies may be needed.

Non-surgical Treatment

Until you are able to see a foot and ankle surgeon, the “R.I.C.E.” method of care should be performed:

  • Rest: Stay off the injured foot. Walking may cause further injury.
  • Ice: Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
  • Compression: An elastic wrap should be used to control swelling.
  • Elevation: The foot should be raised slightly above the level of your heart to reduce swelling.

The foot and ankle surgeon may use one of these non-surgical options for treatment of a fifth metatarsal fracture:

  • Immobilization. Depending on the severity of the injury, the foot is kept immobile with a cast, cast boot, or stiff- soled shoe. Crutches may also be needed to avoid placing weight on the injured foot
  • Bone stimulation. A pain-free external device is used to speed the healing of some fractures. Bone stimulation, most commonly used for Jones fractures, may be used as part of the treatment or following an inadequate response to immobilization.

When is Surgery Needed?

If the injury involves a displaced bone, multiple breaks, or has failed to adequately heal, surgery may be required. The foot and ankle surgeon will determine the type of procedure that is best suited to the individual patient.