Treatment

What treatments should I consider?

Nonsurgical Treatment

Most foot fractures recover well without surgery. The common fractures of the toes and metatarsals do not need 100% accurate reduction for your foot to heal and perform normally. In these cases the goals of treatment are to relieve pain, protect the foot against further harm and allow the bones to heal.

Pain medication, rest, elevation, and avoidance of weight bearing are the principle treatment methods. It is not always necessary to apply a cast or splint to the foot as this does not affect the healing process. A splint may be applied to help with pain relief or to protect the foot. These splints may be discontinued after a few days. Crutches are used to allow you to get around without bearing weight on the fracture, until there are signs of healing on x-ray – usually six weeks.

Toe fractures which are in an unacceptable position may need to be reduced before splinting. This can usually be done under local anesthetic. The toe can then be pulled straight and splinted to its neighbor. This is commonly referred to as buddy taping.

Surgery

Unstable foot fractures are likely to lose the correct position and fail to heal (nonunion) or heal with deformity (malunion). The Jones fracture of the 5th Metatarsal is a common example. These fractures may be treated by reducing the fracture fragment back into position by manipulation and holding it there with pins passed through the skin and across the fracture. The foot would be protected by a splint after this procedure and the pin(s) would stay in place until there was evidence of healing on x-ray. This generally takes about six weeks. Pin removal is a minor procedure which is usually done in the office or clinic and does not require an anesthetic.

Surgery is needed for open fractures. The bone and surrounding muscles and tendons are contaminated by bacteria which have entered the wound. All dirt and dead tissue must be removed from the wound and this may mean quite an extensive opening up of the wound to make sure that the tendons that glide over the bone are cleaned up.

Fractures that disrupt important joints such as calcaneus fractures, fractures of the talus and injuries of Lisfranc’s joint are often treated by open reduction and internal fixation (ORIF). The aim is to restore the joint surface to smoothness and minimize future post traumatic arthritis of the joint. Calcaneus fractures can be treated by applying a plate along the outer side of the bone. Many other situations can be treated by fixing the fragments in place with screws.

Where ORIF has been performed, the implants (screws and plates) used to hold the fracture fragments in position are usually left in place. Sometimes protruding screw heads or tips cause symptoms and this prompts hardware removal. Many patients worry about the operation to remove hardware and expect it to be as painful as the original fracture treatment. This is rarely the case because the bone is healed and there is much less collateral damage in the way of swollen tissue and torn muscle. Recovery after hardware removal is usually quite rapid and most people are very pleased to have it done.

Regardless of the amount of intervention, the management plan usually involves close follow up. It is important to know that the fracture is behaving as predicted and the fragments are remaining in an acceptable position. You should make sure that you are able to return for follow up as recommended.