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Toe Fracture / Broken Foot

Definition :
Many people experience a broken bone (fracture) at some point in their lives. A broken ankle or broken foot is common. After all, you have 26 bones in each foot and three bones in each ankle joint. And these bones are susceptible to stress, stubbing, twisting and trauma.

The seriousness of a broken ankle or broken foot varies. Breaks in this part of your body can range from less-serious fractures, involving tiny cracks in your bones, to severe, shattering breaks that pierce your skin.

Treatment for a broken ankle or broken foot depends on the exact site and severity of the fracture. A severely broken ankle or broken foot may require surgery to implant wires, plates, rods or screws into the broken bone to maintain proper alignment during healing.

Causes :
The terms "broken ankle" and "broken foot" are used to describe a range of fractures in this area of your body:

Causes of a broken ankle
Your ankle joint is made up of three bones — the shinbone (tibia), the lower leg bone (fibula) and the ankle

bone (talus). One or more of these bones can break during a fall or blow to your ankle. However, the most common type of broken ankle is a fracture in one of the knobby bumps (each called a malleolus) at the lower ends of the tibia and fibula. These bones help support the joint where your ankle bone connects to your heel bone (calcaneus), which allows your foot to rock from side to side. They're often injured when your ankle rolls inward or outward.

Causes of a broken foot
Each foot contains 26 bones. The most common foot fractures involve your toe bones and the long bones of your midfoot that connect to your toes (metatarsal bones). Both of these types of bones can be crushed by a falling object. (8, 11) Toe bones are also commonly broken by stubbing, while metatarsal fractures often occur during a fall or car accident.

Stress fractures
These tiny cracks can develop in the weight-bearing bones of your feet or ankles, such as the metatarsals. Stress fractures are usually caused by repetitive force or overuse, such as running long distances. But they can also occur with normal use of a bone that's been weakened by a condition such as osteoporosis.

Risk Factor :
These factors may put you at risk of a broken ankle or broken foot :

  • Being overweight. Carrying too much weight can make you more susceptible to rolling your ankle or stressing the bones in your feet.
  • Participating in high-impact sports. The stresses, direct blows and twisting injuries that occur in football, hockey, gymnastics, ballet, tennis and soccer are common causes of foot and ankle fractures.
  • Using improper sports equipment. Faulty equipment, such as shoes that are too worn or too stiff, can contribute to stress fractures and falls. Improper training techniques, such as not warming up, also can cause foot and ankle fractures.
  • Working in certain occupations. Certain work environments, such as a construction site, put you at risk of falling from a height or injuring your feet.
  • Keeping your home cluttered or poorly lit. Walking around in a house with too much clutter or too little light may lead to foot or ankle injuries.
  • Having certain conditions. Osteoporosis or poor sensation in your feet (neuropathy) can put you at risk of injuries to your foot and ankle bones.

When to seek medical advice :
Seek medical attention for any foot or ankle injury. Prompt realignment and treatment of any ankle or foot fracture is key to complete healing. However, broken toes often go undiagnosed. And many people mistake an ankle fracture for an ankle sprain — a less serious injury that involves stretching or tearing of ligaments. Many signs and symptoms of an ankle sprain may be similar to those of a fracture, but sprain and fracture injuries require different treatments.

Seek immediate medical care if you see bone protruding through the skin near your injury. This can lead to severe infection, if not treated promptly.

Symptoms :
If you have a broken ankle or broken foot, you may experience these signs and Symptoms:

  • Immediate, throbbing pain
  • Pain that increases with activity and decreases with rest
  • Swelling
  • Bruising
  • Tenderness
  • Deformity
  • Inability to walk or bear weight
  • Cuts, puncture wounds or protrusion of bone fragments

Some people feel or hear a snap at the time of injury and assume that means something has broken. However, a snapping sound or feeling can be a sign of either a fracture or a sprain.

Diagnosis :
If you suspect that you have a broken ankle or broken foot, your doctor will inspect the affected area for tenderness, swelling, deformity or an open wound. You'll also need X-rays to definitively diagnose a fracture and pinpoint the exact location of the break. If the fracture is difficult to see — such as a stress fracture — you may also need a bone scan or other imaging techniques.

A thorough evaluation and X-ray of your injury also helps your doctor classify your fracture into one of the following categories, which helps determine your Treatment:

  • Closed fracture. The bone is broken, but the surrounding skin remains intact. In general, a closed fracture is the least severe type of fracture.
  • Open or compound fracture. The bone is broken, and the skin is pierced or cut by the broken bone. An open fracture is a serious condition that requires immediate, aggressive treatment to decrease your chance of an infection.
  • Displaced fracture. In this fracture, the bone fragments on either side of the break are out of line. A displaced fracture may require surgery to align the bones properly.

Complications :
Complications of a broken ankle or broken foot are rare, but may include :

  • Nerve or blood vessel damage. Trauma to the foot or ankle can injure adjacent nerves and blood vessels. Seek immediate attention if you notice any numbness or circulation problems.
  • Bone infection (osteomyelitis). If you have an open fracture, your bone may be exposed to fungi and bacteria that cause infection.
  • Compartment syndrome. This neuromuscular condition causes pain, swelling and sometimes disability in affected muscles of the legs or arms. Compartment syndrome usually occurs in high-impact injuries, such as a car or motorcycle accident.
  • Arthritis. Fractures that extend into the joint can cause arthritis years later. If your ankle or foot starts to hurt long after a break, see your doctor for an evaluation.
  • Persistent pain. You may experience ongoing pain in the affected area even after your broken bone has healed. Your doctor can evaluate persistent pain to see if a rehabilitation program can help.
  • Poor healing. Smoking cigarettes is a risk factor for poor healing of fractures.

Treatment:
Initial treatment for a broken ankle or broken foot often begins in an emergency room or urgent-care clinic. Here, doctors typically evaluate your injury and immobilize your foot or ankle with a splint. If you have a displaced fracture, your doctor may need to manipulate the pieces back into their proper positions before applying a splint — a process called reduction. Depending on the amount of pain and swelling you have, you may need a muscle relaxant, a sedative or even a general anesthetic before this procedure.

If you have a closed fracture, you'll probably be sent home with the splint and directions to rest and ice the injury until you see your regular doctor or an orthopedic specialist for further treatment in a few days. If you have a more serious fracture, you may be admitted to the hospital for immediate attention. Treatment for a broken ankle or broken foot depends on the site and severity of the injury, but typically involves the following components:

Immobilization
Restricting the movement of a broken bone in your foot or ankle is critical to healing. This may be as simple as taping your broken toe to the neighboring toe — a technique called buddy-taping. Or it may involve splints, walking boots, leg braces or casts for several weeks or months, depending on your injury. You may also receive crutches and strict instructions on the amount of time you're allowed to spend walking or standing on the affected leg.

Surgery
Immobilization heals most broken bones. However, you may need surgery to implant internal fixation devices, such as wires, plates, nails or screws, to maintain proper position of your bones during healing. Surgery may be recommended if you have the following injuries :

  • Multiple fractures
  • An unstable or displaced fracture
  • Loose bone fragments that could enter a joint
  • Damage to the surrounding ligaments
  • Fractures that extend into a joint

Some internal fixation materials are removed after your bone heals. Others may be left in place, while some are made of materials that are absorbed into your body. Complications are rare, but can include wound-healing difficulties, infection and lack of bone healing.

Medications
To reduce pain and inflammation, your doctor may recommend an over-the-counter pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others). If you're experiencing a lot of pain, you may need an opioid medication, such as codeine.

Rehabilitation
After your cast or splint is removed, you'll probably need to loosen up stiff muscles and ligaments in your ankles and feet. A home exercise program of stretching, strengthening and range of motion exercises can help you ease back into your regular routine. Your doctor can suggest the best exercises for your particular injury or refer you to a therapist who can help.

Prevention:
These basic sports and safety tips may help prevent a broken ankle or broken foot :

  • Wear proper shoes. Use hiking shoes on rough terrain. Wear steel-toed boots in your work environment, if necessary. Choose appropriate athletic shoes for your sport. And never go barefoot on paved streets or sidewalks.
  • Replace athletic shoes regularly. Discard sneakers as soon as the tread or heel wears out or if the shoes are wearing unevenly.
  • Start slowly. That applies to a new fitness program and each individual workout.
  • Cross-train. Alternating activities can prevent stress fractures. Rotate running with swimming or biking.
  • Build bone strength. Calcium-rich foods, such as milk, yogurt and cheese, really can do your body good.
  • Clean up spills immediately. Slippery floors can cause dangerous falls.
  • Use night lights. Many broken toes are the result of nighttime stumbling.
 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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