What are foot fractures?
There are 26 bones in the foot, all of which can be fractured. There are different types of fractures. Sometimes a bone breaks but stays in place (non-displaced). Sometimes a bone breaks into two pieces that move apart from one another (displaced). Other types of fractures include a bone that is broken in multiple places (comminuted) and a bone that breaks through the skin after fracturing (open fracture).
If you injure your foot, your orthopaedic foot and ankle specialist will take X-rays to see if you have a fracture. X-rays will identify
most fractures but some smaller and more subtle fractures may require CT or MRI scans to be seen. Not all fractures require surgery, and your orthopaedic specialist will help determine how your fracture should be treated.
What are the goals of foot fracture surgery?
If you need surgery for your foot fracture, the goals are to restore the fractured bone to its correct position, stabilize the bone in this position, encourage healing, restore function and reduce the risk of future problems such as persistent pain, loss of motion and arthritis.
What signs indicate surgery may be needed?
All foot fractures are different, but generally speaking if a fracture is significantly displaced it is likely to benefit from surgery. This is especially true if a fracture enters a joint and the joint surface is disrupted and displaced. Restoring the alignment and stabilizing the fracture in its anatomic position will decrease the risk of future problems.
In some cases, surgery may be appropriate for non-displaced or minimally displaced fractures if the fracture is likely to be unstable. In such cases surgery can maintain the alignment and encourage healing in the right position.
Even some non-displaced and stable fractures may benefit from surgery. One such fracture, called a Jones fracture, is often treated surgically in active and athletic individuals because it is likely to get them back to their activities more quickly than treating them without surgery.
When should I avoid surgery?
You should avoid surgery if you have significant soft tissue swelling, infection, diabetes, skin or vascular problems, a non-functional extremity due to paralysis or stroke, or multiple medical problems that would increase the risk of anesthetic complications.
General Details of Procedure
Foot fracture surgery involves making an incision in the skin centered over the fractured bone. The bone is then exposed so the orthopaedic surgeon can see the fracture. The fractured bone fragments are realigned as well as possible into their anatomic positions and secured with implants, most of which are metal. Implants used to secure the fracture may include pins, wires, screws and plates. Once the fracture has been stabilized the incision is stitched closed, a sterile dressing is added and the foot is placed into a cast, splint, boot or post-operative shoe.
In some instances, and for some fracture types, the alignment of the fractured bone can be restored with a closed manipulation of the foot under X-ray and may not require a large incision. If good fracture alignment can be achieved with this method, the fracture is then fixed with appropriate implants through one or more small incisions. This is referred to as percutaneous fracture fixation. The advantages of this technique include smaller incisions, reduced trauma to the tissues, reduced disruption of the blood supply to the bone, and less postoperative pain.
The specific techniques of foot fracture surgery vary widely based on the bone that is injured and the fracture pattern. Here are some examples of typical fracture surgeries:
Calcaneus (heel bone): Fractures of the heel bone can involve disruption of the joint between this bone and the ankle bone, also called the talus. Surgery is often needed to restore the anatomy and realign the joint surface. Significant swelling usually comes with this fracture, so it’s best to wait a week or more until the swelling has gone down. The surgical technique involves an L-shaped incision over the heel or some smaller incisions in the same area. The fracture is realigned, concentrating on the joint surface, and fixed with a plate and/or individual pins or screws.
Talus (ankle bone): Fractures of the ankle bone typically divide it into two large fragments referred to as the head and the body. More severe injuries can include dislocations of nearby joints. The typical surgical technique usually involves one or two incisions over the area just below the ankle. If there are dislocations, these are fixed, and the head and body fragments of the ankle bone are restored to their proper alignment. Screws or a plate and screws are used to hold the pieces in place.
Navicular: The navicular is a bone on the inside of the midfoot. A common fracture causes the bone to break into two fragments. The surgical technique involves an incision over the fracture. The fracture is realigned to restore its anatomic position and secured with screws or a plate and screws.
Cuboid: The cuboid is a bone on the outside of the midfoot. Typically a cuboid fracture is due to a compression injury and results in shortening of the outside of the foot. The goal of surgery is to restore the anatomy of the cuboid, and as a result restore the length of the outside of the foot. This may be done with a plate and screws directly applied to the bone or with another method. The hardware can then be removed once the fracture has healed.
Metatarsals: There are five long bones in the foot which serve as bony struts between the toes and the midfoot. Some metatarsal fractures can be treated without surgery, but displaced fractures may benefit from surgery. Sometimes two or more metatarsals can be fractured as a result of a significant injury. The repair involves an incision over the fractured metatarsal. Additional incisions may be necessary for multiple fractures. The fractures are fixed with pins, screws or a plate, or combination.
Phalanges: The bones of the toes are called phalanges. Most phalangeal fractures can be treated without surgery, however displaced fractures that result in deformity of the toes may benefit from surgery. The technique involves placing the toe into anatomic alignment and then using a pin inserted through the tip of the toe to hold the fracture together. The pin can be removed in four to six weeks once the fracture has healed enough.
What happens after surgery?
After surgery your orthopaedic surgeon will place your foot into a cast, splint, boot or postoperative shoe. It is important to keep your foot elevated as much as possible to reduce pain and swelling. In most cases your doctor will also want you to stay off of your foot completely for four weeks to three months or more.
A few weeks after surgery your doctor will see you back in the clinic to check the wound and remove the stitches. Your orthopaedic surgeon may have you begin working on range-of-motion exercises of the ankle, foot and toes. You may also be referred to a physical therapist.
Your doctor will see you at regular intervals and check X-rays to see how well the fracture is healing. Based on your fracture type and this evaluation, your doctor will decide when you can begin to bear weight on the injured foot. He or she may have you begin weightbearing with a special boot and allow you to advance slowly to your normal footwear as symptoms allow. You can expect up to six months of healing before you are able to return to fairly normal function, and up to a year until you have reached maximum improvement.
There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Potential complications of foot fracture surgery include wound breakdown, failure of the fracture to heal (nonunion), fracture healing in a bad position (malunion), loss of fracture alignment prior to healing, implant failure, persistent pain, loss of motion and arthritis.
Orthopedic foot and ankle surgeons are uniquely qualified to identify and treat fractures of the foot and should be your first resource when an injury to the foot is suspected.
Frequently Asked Questions
When can I bear weight on my injured foot?
For some fractures, your doctor may allow you to bear weight immediately after surgery in a cast, boot or postoperative shoe. However, for most fractures your doctor will probably recommend a period of four weeks to three months or more to allow the fracture to heal adequately before allowing you to put weight on your foot.
Will I need physical therapy?
Your doctor will advise you when to work on strength and range of motion of your injured foot. In some cases physical therapy may be recommended. If so, you will work with a therapist who will assist you with specific exercises for your recovery.
When can I return to unrestricted activity?
This varies by fracture type and severity, as well as any injury to the soft tissues of your foot. In most cases you can expect three to six months or more before you return to full activity without restrictions, and up to a year before you reach maximum improvement.
The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find an Orthopaedic Foot & Ankle Surgeon" tool at the top of this page or contact your primary doctor.