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Foot & Ankle Trauma


Alpharetta Foot and Ankle Specialists seeks to provide the highest level of care to keep our patients healthy and active on their feet. We always strive to cure our patients with conservative methods first, offering minimally-invasive procedures when needed utilizing the latest technologies in surgery to promote healing, shorten recovery times, and return our patients to activity as soon as possible.


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.

Ankle Arthroscopy

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.

    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.


    Calcaneus Fracture

    The calcaneus, also called the heel bone, is a large bone that forms the foundation of the rear part of the foot. The calcaneus connects with the talus and cuboid bones. The connection between the talus and calcaneus forms the subtalar joint. This joint is important for normal foot function.


    The calcaneus is often compared to a hard boiled egg, because it has a thin, hard shell on the outside and softer, spongy bone on the inside. When the outer shell is broken, the bone tends to collapse and become fragmented. For this reason, calcaneal fractures are severe injuries. Furthermore, if the fracture involves the joints, there is the potential for long-term consequences such as arthritis and chronic pain.

    How do Calcaneal Fractures Occur?

    Most calcaneal fractures are the result of a traumatic event— most commonly, falling from a height, such as a ladder, or being in an automobile accident where the heel is crushed against the floorboard.

    Calcaneal fractures can also occur with other types of injuries, such as an ankle sprain. A smaller number of calcaneal fractures are stress fractures, caused by overuse or repetitive stress on the heel bone.

    Types of Calcaneal Fractures

    Fractures of the calcaneus may or may not involve the subtalar and surrounding joints. Fractures involving the joints (intra-articular fractures) are the most severe calcaneal fractures, and include damage to the cartilage (the connective tissue between two bones). The outlook for recovery depends on how severely the calcaneus was crushed at the time of injury.

    Fractures that don’t involve the joint (extra-articular fractures) include:

    • Those caused by trauma, such as avulsion fractures (in which a piece of bone is pulled off of the calcaneus by the Achilles tendon or a ligament) or crush injuries resulting in multiple fracture fragments.
    • Stress fractures, caused by overuse or mild injury. The severity and treatment of extra-articular fractures depend on their location and size.

    Signs and Symptoms

    Calcaneal fractures produce different signs and symptoms, depending on whether they are traumatic or stress fractures. The signs and symptoms of traumatic fractures may include:

    • Sudden pain in the heel and inability to bear weight on that foot
    • Swelling in the heel area
    • Bruising of the heel and ankle

    The signs and symptoms of stress fractures may include:

    • Generalized pain in the heel area that usually develops slowly (over several days to weeks)
    • Swelling in the heel area

    Diagnosis

    To diagnose and evaluate a calcaneal fracture, the foot and ankle surgeon will ask questions about how the injury occurred, examine the affected foot and ankle, and order x-rays. In addition, advanced imaging tests are commonly required.

    Treatment

    Treatment of calcaneal fractures is dictated by the type of fracture and extent of the injury. The foot and ankle surgeon will discuss with the patient the best treatment— whether surgical or non-surgical— for the fracture. For some fractures, non-surgical treatments may be used.

    These include:

    • Rest, ice, compression, and elevation (R.I.C.E.) Rest

    (staying off the injured foot) is needed to allow the fracture to heal. Ice reduces swelling and pain; apply a bag of ice covered with a thin towel to the affected area.

    Compression

    (wrapping the foot in an elastic bandage or wearing a compression stocking) and elevation (keeping the foot even with or slightly above the heart level) also reduce the swelling.

    • Immobilization. Sometimes the foot is placed in a cast or cast boot to keep the fractured bone from moving. Crutches may be needed to avoid weight-bearing. For traumatic fractures, treatment often involves surgery to reconstruct the joint, or in severe cases, to fuse the joint. The surgeon will choose the best surgical approach for the patient.

    Rehabilitation

    Whether the treatment for a calcaneal fracture has been surgical or non-surgical, physical therapy often plays a key role in regaining strength and restoring function.

    Complications of Calcaneal Fractures

    Calcaneal fractures can be serious injuries that may produce lifelong problems. Arthritis, stiffness, and pain in the joint frequently develop. Sometimes the fractured bone fails to heal in the proper position. Other possible long-term consequences of calcaneal fractures are decreased ankle motion and walking with a limp due to collapse of the heel bone and loss of length in the leg. Patients often require additional surgery and/or long term or permanent use of a brace or an orthotic device (arch support) to help manage these complications.




    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.

    Bunion Removal

    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.

    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.