Common Injuries of The Foot and Ankle

Ankle Fracture


Definition:
A broken ankle is also known as an ankle "fracture." This means that one or more of the bones that make up the ankle joint are separated into pieces. There may be ligaments damaged as well. Simply put, the more bones that are broken, the more unstable the ankle becomes.

A fractured ankle can range from a simple break in one bone, which may not stop you from walking, to several fractures, which forces your ankle out of place and may require that you not put weight on it for three months


Lateral Malleolus Fracture

The lateral malleolus fracture is a fracture of the fibula.
There are different levels at which that the fibula can be fractured. The level of the fracture may direct the treatment.

Nonsurgical Treatment
If the fracture is not out of place or just barely out of place and the ankle is stable, you may not need surgery. Some physicians let patients put weight on their leg right away, while others have them wait for 6 weeks.

Several different methods are used for protecting the fracture, ranging from a high-top tennis shoe to a short leg cast. Treatment may also be based on where the bone is broken.

A "stress" X-ray may be done to see if the ankle is stable. You will have to see your physician regularly to repeat your ankle X-rays to make sure the fragments of your fracture have not moved out of alignment during the healing process.

Surgical Treatment
If the fracture is out of place or your ankle is unstable, your fracture may be treated with surgery. To make your ankle stable, a plate and screws on the side of the bone or a screw or rod inside the bone may be used to re-align the bone fragments and keep them together as they heal.


Medial Malleolous Fracture

Fractures can occur at different levels of the medial malleolus.
Medial malleolar fractures are sometimes isolated but often occur with a fracture of the fibula, posterior malleolus, or an injury to the ankle ligaments, as well.

Nonsurgical Treatment
If the fracture is not out of place or is a very low fracture with very small pieces, it can be treated without surgery.
A stress X-ray may be done to see if the fracture and ankle are stable.

The fracture may be treated with a short leg cast or a removable brace. Usually, you need to avoid putting weight on your leg for approximately 6 weeks.

You will need to see your physician regularly for repeat X-rays to make sure the fracture does not change in position.

Surgical Treatment
If the fracture is out of place or the ankle is "unstable," surgery may be offered.
Occasionally, surgery may be considered even if the fracture is not out of place. This is done to decrease the risk of the fracture not healing (nonunion), and to allow you to start moving the ankle earlier.

Sometimes, the fracture can include "impaction," or indenting of the ankle joint. This can require bone grafting to repair it, in order to lower any later risk of developing arthritis.

Different techniques for surgery can be used. Screws, a plate and screws, or different wiring techniques can all be used, depending on the fracture.


Posterior Malleolus Fracture

A posterior malleolus fracture is a fracture of the back of the "shin bone" at the level of the ankle joint.
This is usually not an isolated injury. Often, the lateral malleolus is also fractured because it shares ligament attachments with the posterior malleolus. There can also be a fracture of the medial malleolus.

Depending on how large the broken piece is, the back of the ankle may be unstable. Some studies have shown that if the piece is bigger than 25% of the ankle joint, the ankle becomes unstable and should be treated with surgery.

A fracture of the posterior malleolus is important to diagnose because the piece is covered by cartilage. Cartilage is the smooth surface that lines the joint. If the broken piece is larger than about 25% of your ankle and is out of place more than a couple of millimeters, the cartilage surface will not heal properly and the surface of the joint will not be smooth. This uneven surface typically leads to increased and uneven pressure on the joint surface, which leads to cartilage damage and the development of arthritis.

Nonsurgical Treatment
If the fracture is not out place and the ankle is stable, it can be treated without surgery.
Treatment may be with a short leg cast or a removable brace. Patients are typically advised not to put any weight on the ankle for 6 weeks.

Surgical Treatment
If the fracture is out of place or if the ankle is unstable, surgery may be offered.
Different surgical options are available for treating posterior malleolar fractures. One option is to have screws placed from the front of the ankle to the back, or vice versa. Another option is to have a plate and screws placed along the back of the shin bone.


Bimalleolar Fracture

"Bi" means two. "Bimalleolar" means that two of the three parts or "malleoli" of the ankle are broken.
A bimalleolar fracture most commonly means that the lateral malleolus and the medial malleolus are broken and the ankle is not stable.

A bimalleolar equivalent fracture means that the ligaments on the inside, or "medial," side of the ankle are injured along with one of the other "malleoli." Malleoli is pleural for malleolus. Usually, this means that the fibula is broken along with injury to the medial ligaments, making the ankle unstable.

A "stress test" X-ray may be done to see whether the medial ligaments are injured.

Bimalleolar fractures or bimalleolar equivalent fractures are unstable fractures and can be associated with a dislocation.

Nonsurgical Treatment
These injuries are considered unstable and surgery is usually recommended.
Nonsurgical treatment might be considered if you have significant health problems, where the risk of surgery may be too great, or if you usually do not walk.

A splint is usually used until the swelling goes down. A short leg cast is then typically used. Casts may be changed frequently as the swelling subsides in the ankle.

You will need to see your physician regularly to repeat your X-rays to make sure your ankle remains stable.
Typically, weightbearing will not be allowed on your ankle for 6 weeks. After 6 weeks, the ankle may be protected by a removable brace as it continues to heal.

Surgical Treatment
Usually, surgical treatment is recommended because these fractures make the ankle unstable.
Lateral and medial malleolus fractures are treated with the same surgical techniques as written above for each fracture listed.


Trimalleolar Fracture

"Tri" means three. Trimalleolar fractures means that all three malleoli of the ankle are broken. These are unstable injuries and they can be associated with a dislocation.

Nonsurgical Treatment
These injuries are considered unstable and surgery is usually recommended.
As with bimalleolar ankle fractures, nonsurgical treatment might be considered if you have significant health problems, where the risk of surgery may be too great, or if you usually do not walk.

Nonsurgical treatment is similar to bimalleolar fractures, as listed above.

Surgical Treatment
Each fracture can be treated with the same surgical techniques as written above for each individual fracture.


Syndesmotic Injury

These are also known as "high" ankle sprains when there is no fracture. Depending on how unstable the ankle is without a fracture, these injuries can be treated without surgery. However, these sprains take longer to heal than the normal ankle sprain.

When there are fractures of other bones in the ankle, these are unstable injuries. They do very poorly without surgical treatment.

Certain types of bimalleolar ankle fractures have an associated syndesmotic injury. Your physician may do a "stress test" X-ray to see whether the syndesmosis is injured.

Arthritis of the Foot and Ankle
Arthritis is the leading cause of disability in the United States. It can occur at any age, and literally means "pain within a joint." As a result, arthritis is a term used broadly to refer to a number of different conditions.

Although there is no cure for arthritis, there are many treatment options available. It is important to seek help early so that treatment can begin as soon as possible. With treatment, people with arthritis are able to manage pain, stay active, and live fulfilling lives, often without surgery.

Description:
There are three types of arthritis that may affect your foot and ankle.

A) Osteoarthritis
Osteoarthritis, also known as degenerative or "wear and tear" arthritis, is a common problem for many people after they reach middle age. Over the years, the smooth, gliding surface covering the ends of bones (cartilage) becomes worn and frayed. This results in inflammation, swelling, and pain in the joint.
Osteoarthritis progresses slowly and the pain and stiffness it causes worsens over time.

B) Rheumatoid Arthritis
Unlike osteoarthritis which follows a predictable pattern in certain joints, rheumatoid arthritis is a system-wide disease. It is an inflammatory disease where the patient's own immune system attacks and destroys cartilage.

C) Post-Traumatic Arthritis
Post-traumatic arthritis can develop after an injury to the foot or ankle. This type of arthritis is similar to osteoarthritis and may develop years after a fracture, severe sprain, or ligament injury.

Cause

Osteoarthritis
Many factors increase your risk for developing osteoarthritis. Because the ability of cartilage to heal itself decreases as we age, older people are more likely to develop the disease. Other risk factors include obesity and family history of the disease.

Rheumatoid Arthritis
The exact cause of rheumatoid arthritis is not known. Although it is not an inherited disease, researchers believe that some people have genes that make them more susceptible. There is usually a "trigger," such as an infection or environmental factor, which activates the genes. When the body is exposed to this trigger, the immune system begins to produce substances that attack the joint. This is what may lead to the development of rheumatoid arthritis.

Post-Traumatic Arthritis
Fractures - particularly those that damage the joint surface - and dislocations are the most common injuries that lead to this type of arthritis. An injured joint is about seven times more likely to become arthritic, even if the injury is properly treated. In fact, following injury, your body can secrete hormones that stimulate the death of your cartilage cells.

Anatomy
There are 28 bones and more than 30 joints in the foot. Tough bands of tissue, called ligaments, keep the bones and joints in place. If arthritis develops in one or more of these joints, balance and walking may be affected.

The joints most commonly affected by arthritis in the lower extremity include:

  • The ankle (tibiotalar joint). The ankle is where the shinbone (tibia) rests on the uppermost bone of the foot (the talus).
  • The three joints of the hindfoot. These three joints include:
  • The subtalar or talocalcaneal joint, where the bottom of the talusconnects to the heel bone (calcaneus);
  • The talonavicular joint, where the talus connects to the inner midfoot bone (navicular); and
  • The calcaneocuboid joint, where the heel bone connects to the outer midfoot bone (cuboid).
  • The midfoot (metatarsocunieform joint). This is where one of the forefoot bones (metatarsals) connects to the smaller midfoot bones (cunieforms).
  • The great toe (first metatarsophalangeal joint). This is where the first metatarsal connects to the great toe bone (phalange).This is also the area where bunions usually develop.

Treatment

Depending on the type, location, and severity of the arthritis, there are many types of treatment available. Nonsurgical Treatment Nonsurgical treatment options include:

  • Pain relievers and anti-inflammatory medications to reduce swelling
  • Shoe inserts (orthotics), such as pads or arch supports
  • Custom-made shoe, such as a stiff-soled shoe with a rocker bottom
  • An ankle-foot orthosis (AFO)
  • A brace or a cane
  • Physical therapy and exercises
  • Weight control or nutritional supplements
  • Medications, such as a steroid medication injected into the joint

Surgical Treatment
If arthritis doesn't respond to nonsurgical treatment, surgical treatment might be considered. The choice of surgery will depend on the type of arthritis, the impact of the disease on the joints, and the location of the arthritis. Sometimes more than one type of surgery will be needed.

Surgery performed for arthritis of the foot and ankle include arthroscopic debridement, arthrodesis (or fusion of the joints), and arthroplasty (replacement of the affected joint).

Arthroscopic Debridement
Arthroscopic surgery may be helpful in the early stages of arthritis.

A flexible, fiberoptic pencil-sized instrument (arthroscope) is inserted into the joint through a series of small incisions through the skin.

The arthroscope is fitted with a small camera and lighting system, as well as various instruments. The camera projects images of the joint on a television monitor. This enables the surgeon to look directly inside the joint and identify the problem areas.

Small instruments at the end of the arthroscope, such as probes, forceps, knives, and shavers, are used to clean the joint area of foreign tissue, inflamed tissue that lines the joint, and bony outgrowths (spurs).

Arthrodesis or Fusion
Arthrodesis fuses the bones of the joint completely, making one continuous bone.

The surgeon uses pins, plates and screws, or rods to hold the bones in the proper position while the joint(s) fuse. If the joints do not fuse (nonunion), this hardware may break.

A bone graft is sometimes needed if there is bone loss. The surgeon may use a graft (a piece of bone, taken from one of the lower leg bones or the wing of the pelvis) to replace the missing bone.

This surgery is typically quite successful. A very small percentage of patients have problems with wound healing. These problems can be addressed by bracing or additional surgery.

The biggest long-term problem with fusion is the development of arthritis at the joints adjacent to those fused. This occurs from increased stresses applied to the adjacent joints.

Arthroplasty or Joint Replacement
In arthroplasty, the damaged ankle joint is replaced with an artificial implant (prosthesis).

Although not as common as as total hip or knee joint replacement, advances in implant design have made ankle replacement a feasible option for many people.

In addition to providing pain relief from arthritis, ankle replacements offer patients better mobility and movement compared to fusion. By allowing motion at the formerly arthritic joint, less stress is transferred to the adjacent joints. Less stress results in reduced occurance of adjacent joint arthritis.

Ankle replacement is most often recommended for patients with:

  • Advanced arthritis of the ankle
  • Destroyed ankle joint surfaces
  • An ankle condition that interferes with daily activities

As in any joint replacement surgery, the ankle implant may loosen over the years or fail. If the implant failure is severe, revision surgery may be necessary.


Surgical Recovery
Foot and ankle surgery can be painful. Pain relievers in the hospital and for a time period after being released from the hospital may help.

It is important to keep your foot elevated above the level of your heart for one to two weeks following surgery.

Your doctor may recommend physical therapy for several months to help you regain strength in your foot or ankle and to restore range of motion. Ordinary daily activities usually can be resumed in three to four months. You may need special shoes or braces.

In most cases, surgery relieves pain and makes it easier to perform daily activities. Full recovery takes four to nine months, depending on the severity of your condition before surgery, and the complexity of your procedure.

Fractures of the Heel
It's not easy to break your heel bone (calcaneus). Because it takes a lot of force, such as that sustained in a motor vehicle accident or a fall from a height, you may also incur other injuries as well, particularly to the back.

Nonsurgical Treatment
If the pieces of broken bone have not been pushed out of place by the force of the injury, you may not need surgery:

  • Your foot will need to be elevated above the level of your heart and wrapped in a bulky, compressive dressing to keep the bones from shifting.
  • Ice packs, applied for 20 minutes every hour or two, can help reduce swelling and pain.
  • Your doctor may apply a splint until the swelling goes down, which can take one to three weeks. Then the doctor may give you a removable splint and prescribe some exercises to maintain flexibility and movement.

You won't be able to put any weight on your foot until the bone is completely healed, which takes at least six to eight weeks, and perhaps longer.

Surgical Treatment
If the bones have shifted out of place (a displaced fracture), you will most likely need surgery. A metal plate and small screws are used to hold the bones in place. A bone graft may be used to aid in the healing of the fractures. The incision will be bandaged and a splint applied until it is healed. Then, you'll get a removable splint so that you can begin exercising the joint. You won't be able to put any weight on your foot for approximately 10 weeks after surgery. When you begin walking, you may need to use a cane and wear a special boot. It may take up to a year for the injury to heal completely. Depending on the type of job you have, you may not be able to return to the same type of work. Because of the amount of force needed to break the heel bone initially, even if your fracture heals properly, your foot may never be the same as it was before the injury. You may continue to experience stiffness and you may need to wear a heel pad, lift, or cup as well as special shoes with extra depth in the toe compartment.

Lisfranc (Midfoot) Fracture

Have you ever dropped a heavy box on the top of your foot? Or accidentally stepped in a small hole and fallen, twisting your foot? These two common accidents can result in a Lisfranc fracture-dislocation of the midfoot. This fracture gets its name from the French doctor who first described the injury.

Lisfranc injuries occur at the midfoot, where a cluster of small bones forms an arch on top of the foot between the ankle and the toes. From this cluster, five long bones (metatarsals) extend to the toes. The second metatarsal also extends down into the row of small bones and acts as a stabilizing force. The bones are held in place by connective tissues (ligaments) that stretch both across and down the foot. However, there is no connective tissue holding the first metatarsal to the second metatarsal. A twisting fall can break or shift (dislocate) these bones out of place.

Symptoms
Lisfranc fracture-dislocations are often mistaken for sprains. The top of the foot may be swollen and painful. There may be some bruising. If the injury is severe, you may not be able to put any weight on the foot. Lisfranc injuries are often difficult to see on X-rays. Unrecognized Lisfranc injuries can have serious complications such as joint degeneration and compartment syndrome, a build-up of pressure within muscles that can damage nerve cells and blood vessels. If the standard treatment for a sprain (rest, ice and elevation) doesn't reduce the pain and swelling within a day or two, ask your doctor for a referral to an orthopaedic specialist.

Treatment
Treatment for a Lisfranc injury depends on the severity of the injury. If the bones have not been forced out of position, you will probably have to wear a cast and refrain from putting weight on the foot for about six weeks. When the cast is removed, you may have to wear a rigid arch support. Your orthopaedist will also recommend foot exercises to build strength and help restore full range of motion.

Often, operative treatment is needed to stabilize the bones and hold them in place until healing is complete. Pins, wires or screws may be used. Afterwards, you will have to wear a cast and limit weight-bearing on the foot for six to eight weeks. A walking brace may be prescribed when the fixation devices are removed. You may also have to wear an arch support and a rigid soled shoe until all symptoms have disappeared. In some cases, if arthritis develops in these joints, the bones may have to be fused together.

It is important to follow your doctor's orders and refrain from activities until you are given the go-ahead. If you return to activities too quickly, you may easily suffer another injury, resulting in damage to the blood vessels, the development of painful arthritis and an even longer healing time.

Shinbone Fractures

A broken or fractured shinbone (tibia) is the most common long-bone injury. Several types of fractures can occur, ranging from the hairline stress fractures common in runners to severe open fractures (where the skin is broken) resulting from motor vehicle crashes.

Toddler’s Fracture

A toddler (one to three years of age) can fracture the shinbone when he or she trips over a toy or falls down a stair while learning to walk. These fractures usually do not break the skin, and the bone stays fairly well-aligned. There will be acute pain and possibly some swelling. The toddler may refuse to get up and walk again. The area of the fracture may be very tender.

It may be difficult to see this type of fracture on an X-ray, and your physician may request a bone scan to verify the diagnosis. These fractures heal quickly and can be treated with only a short leg weightbearing cast.

Growth Plate Fractures

Growth plate fractures are more common in older children and adolescents. These injuries occur near the ends of the bones at the ankle or knee. Bones do not grow from the center out, but from these growth plate areas. A fracture can disrupt the bone's development, leading to unequal limb length.

Growth plate fractures need to be identified early and watched carefully until the child reaches skeletal maturity to ensure that there is no shortening of the limb. The orthopaedic surgeon may need to use internal fixation devices, such as screws or nails, to stabilize the bone.

Stress Fractures

Stress fractures are overuse injuries that occur when fatigued muscles can no longer absorb shock and transfer the load to the bone. More than 50 percent of all stress fractures occur in the lower leg. Stress fractures can develop gradually, with swelling and pain during activity.

The most important treatment for stress fractures is rest. It takes six to eight weeks for most stress fractures to heal. During that time, the individual should not participate in the activity that caused the fracture, but can participate in other pain-free activities.

Closed Fractures

In a closed fracture, the skin is not broken. Closed fractures may be classified in several different ways, depending on the force of the injury, the stability of the bone, and the type and location of the break. The mechanism of the injury, such as a direct blow to the bone or an indirect twisting injury, can also cause soft-tissue damage.

Many stable closed fractures can be aligned without surgery, immobilized in a cast, and later supported by a fracture brace until healing is complete. However, if there is severe soft-tissue injury or if the fracture is grossly unstable, the orthopaedic surgeon may not be able to manipulate the bone into alignment and surgical treatment may be necessary. Surgical treatment may also be needed if the bone is fragmented into three or more pieces.

Open Fractures

Because the shinbone is so close to the skin surface, a high-energy direct force may push the bone through the skin, resulting in an open fracture. All open fractures have an increased risk of infection and require surgical exploration and treatment. Open fractures are also often associated with trauma elsewhere in the body.

The use of small-diameter, interlocking nails to stabilize the fracture can result in less deformity, improved limb function, and shorter healing times. External fixators, such as a frame constructed around the leg, may also be used for the more severe, contaminated fractures, although these generally have higher rates of infection, poor alignment, or nonunion. In severe cases, amputation may be necessary.

Stress Fractures of the Foot and Ankle

A stress fracture is a small crack in a bone. They often develop from overuse, such as from high-impact sports like distance running or basketball. When muscles are overtired (fatigued), they are no longer able to absorb the shock of repeated impacts. When this happens, the muscles transfer the stress to the bones, creating a small crack or fracture.

Most stress fractures occur in the weight-bearing bones of the foot and lower leg. The most common sites are the second and third metatarsals of the foot. Stress fractures are also common in the heel (calcaneus), the outer bone of the lower leg (fibula), and the navicular, a bone on the top of the midfoot.

Treatment
Treatment depends on the location of the stress fracture. Most stress fractures will heal if you reduce your level of activity and wear protective footwear for 2 to 4 weeks.

Your doctor may recommend that you wear a stiff-soled shoe, a wooden-soled sandal, or a removable short-leg fracture brace shoe. Athletes should switch to activities that place less stress on the foot and leg. Swimming and bicycle riding are good alternative activities.

Stress fractures in the fifth metatarsal bone (on the outer side of the foot) or in the navicular or talus bones take longer to heal, perhaps as long as 6 to 8 weeks. Your doctor may apply a cast to your foot or recommend that you use crutches until the bone heals. In some patients, surgery may be needed to ensure proper healing.

Fracture of the Talus

The talus (TAY-lus) is a small bone that sits between the heel bone (calcaneus) and the two bones of the lower leg (tibia and fibula). It has an odd humped shape, somewhat like a turtle. The bones of the lower leg "ride" on top and around the sides to form the ankle joint. Where the talus meets the bones of the foot, it forms the subtalar joint, which is important for walking on uneven ground. The talus is an important connector between the foot and the leg and body, helping to transfer weight and pressure forces across the ankle joint.

Most injuries to the talus result from motor vehicle accidents, although falls from heights also can injure the talus. These injuries are often associated with injuries to the lower back. An increasing number of talar fractures result from snowboarding, which uses a soft boot that is not rigid enough to prevent ankle injuries.

Treatment:
A talar fracture that is left untreated or that doesn't heal properly will create problems for you later. Your foot function will be impaired, you will develop arthritis and chronic pain, and the bone may collapse.

Immediate first aid treatment for a talar fracture is to apply a well-padded splint around the back of the foot and leg from the toe to the upper calf. Elevate the foot above the level of the heart and apply ice for 20 minutes every hour or two until you can see a doctor. Don't put any weight on the foot.

In rare cases, a talar fracture can be treated without surgery if X-rays show that the bones have not moved out of alignment. You will have to wear a cast for at least six to eight weeks and will not be able to put any weight on the foot during that time. Afterwards, your doctor will give you some exercises to help restore the range of motion and strength to your foot and ankle. Most fractures of the talus require surgery to minimize later complications. The orthopaedic surgeon will realign the bones and use metal screws to hold the pieces in place. If there are small fragments of bone, they may be removed and bone grafts used to restore the structural integrity of the joint.

After the surgery, your foot will be put in a cast for six to eight weeks and you will not be able to put any weight on the foot for at least three months. As the bones begin to heal, your orthopaedist may order X-rays or a magnetic resonance image (MRI) to see whether blood supply to the bone is returning. If the blood supply is disrupted, the bone tissue could die, a condition called avascular necrosis or osteonecrosis. This could cause the bone to collapse. Even if the bones heal properly, you may still experience arthritis in later years. Most of the talus is covered with articular cartilage, which enables bones to move smoothly against each other. If the cartilage is damaged, the bones will rub against each other, resulting in pain and stiffness. Treatments for arthritis include activity modifications, ankle-foot orthoses, joint fusion, bone grafting and ankle replacement.

Toe and Forefoot Fractures

Nearly one-fourth of all the bones in your body are in your feet, which provide you with both support and movement. A broken (fractured) bone in your forefoot (metatarsals) or in one of your toes (phalanges) is often painful but rarely disabling. Most of the time, these injuries heal without operative treatment.

Types of Fractures

Stress fractures frequently occur in the bones of the forefoot that extend from your toes to the middle of your foot. Stress fractures are like tiny cracks in the bone surface. They can occur with sudden increases in training (such as running or walking for longer distances or times), improper training techniques or changes in training surfaces. Most other types of fractures extend through the bone. They may be stable (no shift in bone alignment) or displaced (bone ends no longer line up). These fractures usually result from trauma, such as dropping a heavy object on your foot, or from a twisting injury. If the fractured bone does not break through the skin, it is called a closed fracture.

Several types of fractures occur to the forefoot bone on the side of the little toe (fifth metatarsal). Ballet dancers may break this bone during a misstep or fall from a pointe position. An ankle-twisting injury may tear the tendon that attaches to this bone and pull a small piece of the bone away. A more serious injury in the same area is a Jones fracture, which occurs near the base of the bone and disrupting the blood supply to the bone. This injury may take longer to heal or require surgery.

Treatment
See a doctor as soon as possible if you think that you have a broken bone in your foot or toe. Until your appointment, keep weight off the leg and apply ice to reduce swelling. Use an ice pack or wrap the ice in a towel so it does not come into direct contact with the skin. Apply the ice for no more than 20 minutes at a time. Take an analgesic such as aspirin or ibuprofen to help relieve the pain. Wear a wider shoe with a stiff sole.

Rest is the primary treatment for stress fractures in the foot. Stay away from the activity that triggered the injury, or any activity that causes pain at the fracture site, for three to four weeks. Substitute another activity that puts less pressure on the foot, such as swimming. Gradually, you will be able to return to activity. Your doctor or coach may be able to help you pinpoint the training errors that caused the initial problem so you can avoid a recurrence. The bone ends of a displaced fracture must be realigned and the bone kept immobile until healing takes place. If you have a broken toe, the doctor will "buddy-tape" the broken toe to an adjacent toe, with a gauze pad between the toes to absorb moisture. You should replace the gauze and tape as often as needed. Remove or replace the tape if swelling increases and the toes feel numb or look pale. If you are diabetic or have peripheral neuropathy (numbness of the toes), do not tape the toes together. You may need to wear a rigid flat-bottom orthopaedic shoe for two to three weeks.

If you have a broken bone in your forefoot, you may have to wear a short-leg walking cast, a brace, or a rigid, flat-bottom shoe. It could take six to eight weeks for the bone to heal, depending on the location and extent of the injury. After a week or so, the doctor may request another set of X-rays to ensure that the bones remain properly aligned. As symptoms subside, you can put some weight on the leg. Stop if the pain returns.

Surgery is rarely required to treat fractures in the toes or forefoot. However, when it is necessary, it has a high degree of success.