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Recovery Guide: Foot Fracture

What Is It?

Fractures of the foot can come in many different forms. More of the most common types of foot fractures are discussed in their own categories (see Lisfranc, Jones stress, and Calcaneal fractures for more details). Almost a quarter of our bones are in our feet and since we use our feet frequently to bear our weight and move, they are constantly exposed to a lot of forces. Sometimes during extreme activities your bones become overworked and are prone to fracture. That is why athletes and dancers, such as ballerinas, are prone to getting foot fractures. Foot fractures also occur due to sudden sharp movements or as a result of a post traumatic accident, such as a fall or a motor vehicle crash. Post-traumatic breaks tend to be more severe since they are the result of high-impact forces. Calcaneal and Lisfranc fractures are a good example of breaks that can occur due to a high-impact injury. Low-impact injuries result in stress fractures, fractures that occur due to exposure and overuse at the same spot over and over again. Stress fractures are the products of overuse and exceeding too rapidly in physical activity. Pain, bruising, and swelling can be an indication of a foot fracture, though clinical evaluation and x-rays will be needed to confirm the presence of a fracture. Read more

Recovery Guide: Calcaneal Fracture

What Is It?

The calcaneus is the bone that makes up your heel. Calcaneal fractures usually occur after a high-energy accident, such as in a motor vehicle crash or a fall from a great height. Because of this calcaneal fractures tend to come with other problems that vary with the extent of the injury. This is usually related to the amount of force that was used to cause the break. The worst case scenario is that the calcaneus shatters resulting in many fragments. This is known as a comminuted fracture (a break that results in three or more fragments). Because calcaneal fractures are usually the result of a high-force impact, there is a chance that the bones can damage soft tissue and puncture the skin as well.

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Breaks of the calcaneus can be very serious since they can affect the subtalar joint; the joint that is comprised of the calcaneus and the talus (the ankle bone). This joint is responsible for the side-to-side motion of your foot.  Therefore, a severe break in the calcaneus can also result in a stiff ankle, limiting movement. In addition, the calcaneus is also where the Achilles tendon joins from the calf muscle. Tendons are connective tissue that connects muscle to bone and allows us to perform our movements. The Achilles tendon allows us to point our foot down when walking and running. It also helps our heel to support our body weight. A fracture in the calcaneus can disrupt the union of the heel and the Achilles tendon, thus destabilizing our foot and ankle. Lastly, since it typically takes a lot of force to break the calcaneus, other bones in the foot and ankle can be broken as well. All of these features can attribute to instability, swelling, and pain. If a fracture is really severe, it might limit or prevent the patient from walking or even weight bearing all together. Read more

Recovery Guide: Jones Fracture

What Is It?

A Jones fracture is a special type of stress fracture (see “Stress Fractures” for detailed information on what defines a stress fracture) that appears at the base of the fifth metatarsal (the long bone on the outside aspect of the foot that connects to the big toe). Patients with Jones fractures will feel pain on the far right of their midfoot. Like with any other stress fracture, patients who are highly active or progress to increased physical activity too rapidly are more likely to obtain a Jones fracture. However, Jones fractures can also occur acutely, as in a sudden break due to injury. What makes Jones fractures stand out is the fact that the break is located in an area where blood supply is limited, making them difficult to heal. Adequate blood supply is essential for healing, since blood supply carries nutrients to the bone that are necessary for healing. Without sufficient blood supply, the fracture risks becoming a nonunion (the bone fails to join together and heal) or it might require an extended period of time to heal. Though a Jones fracture can potentially heal on it’s own, surgical intervention is often necessary. Read more

Recovery Guide: Lisfranc Fracture

What Is It?

A Lisfranc fracture describes a fracture of the midfoot that can range from mild to very serious. Sometimes an injury can occur at the midfoot that does not break any bones. This is known as a Lisfranc injury. The midfoot is comprised of many tiny bones that are held together by ligaments, a type of connective tissue. Ligaments connect the two ends of bones together to form a joint. The ligaments that cross the midfoot connect the midfoot bones to the metatarsals (the long bones that connect to the toe bones). These joints form what is known as the Lisfranc joint complex and spans across the entire midfoot. It is essential for maintaining the shape of the foot and providing it with stability.

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Unfortunately, with so many little pieces it makes the foot prone to injury. Lisfranc injuries can be caused by low-energy impacts, resulting from something as simple as a twist in the foot. The injury therefore, can result in fractures, tears in the ligaments, or both. This can cause the bones to displace and the joints to be dislocated. If left untreated, a flat foot deformity can develop as well as arthritis and other medical conditions. Read more

Recovery Guide: Stress Fracture

What Is It?

Stress fractures are typically non-displaced breaks in bone that occur through overuse of physical activity. Fractures are brought on by high energy and low energy injuries. High energy breaks are termed traumatic fractures and occur through a significant amount of force. Stress fractures are low energy breaks and occur through rapid exposure to low energy forces. Thus, a break can form when the same site is exposed over and over again to the same amounts of force. These types of fractures are common in athletes who increase the intensity, severity, and frequency of their activity (such as running). In a nut shell, stress fractures are an injury of overuse. Sometimes transitioning to higher level activities too soon or running on improper terrain can also lead to a stress fracture. This is one of the reasons why healthcare and exercise specialists recommend progressing steadily to more active workout routines and running on soft terrain like a treadmill. Though stress fractures are typically attributed to overuse, other underlying medical conditions can contribute. Conditions that weaken the bone such as osteoporosis or malnutrition can make individuals more prone to obtaining a stress fracture.

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Stress fractures in the foot and ankle are common since we are on our feet all the time. The metatarsals (second and third metatarsals most commonly), the calcaneus (heel bone), and navicular (one of the main bones of the midfoot that connect to the ankle bone) are the most common bones that obtain a stress fracture. Stress fractures in the tibia (long bone of the lower leg), fibula (smaller long bone of the leg that runs along the tibia), and talus (ankle bone) also run the risk of acquiring a stress fracture. It could be difficult to tell if you have a stress fracture since signs can be subtle. Pain can rise with activity, but dissipate with rest. Pain levels can also increase over time depending on how active and aggressive individuals are in their daily routines. Swelling, bruising and some tenderness may also appear. The only real way to rule out a stress fracture is to visit a doctor and have an x-ray or MRI taken. MRI’s are stronger then x-rays, but are often not needed to confirm a diagnosis.

Treatment Options

Fortunately, most stress fractures do not require surgery and can heal on their own. However, recovery times depend on the location of the breaks since some bones can take longer to heal then others. The goal is to reduce activity and to protect the break. Doctor’s will most likely prescribe protective footwear such as an orthotic boot, shoe or a brace, and occasionally require a knee scooter. The length of wearing such footwear can take anywhere from 4-6 weeks. Your level of activity will also be decreased. Runners for example will most likely need to reduce activity to biking or another workout that does require placing pressure on the foot. A stress fracture can take about 1 to 2 months to heal so you would most likely be advised not to return to your typical active routine until at least after two months. Again, this all depends on the bone broken. The navicular, talus, and fifth metatarsal bones take the longest to heal so patients with these types of stress fractures may have a longer recovery period.

Prognosis

It is important to listen to your doctor and only progress back to active duty once the stress fracture is fully healed. Even after a stress fracture is healed it’s important to make a gradual progression in activity to prevent the risk of re-fracture. Low impact exercises are key as well as comfortable and supportive footwear. If surgery is needed, it’s typically because the break has not healed after conservative methods. A surgeon will most likely have to fasten the bones together using internal fixation such as screws, plate or nails.

Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with orthopedic surgeons. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.

Sources

1.)   http://www.hss.edu/condition-list_foot-ankle.asp

2.)   http://www.footeducation.com/foot-and-ankle-conditions

3.)   http://orthoinfo.aaos.org/menus/foot.cfm

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Recovery Guide: Ankle Fracture

What Is It?

A fracture is the term used to describe a break in the bone. Breaks usually result due to high energy or low energy injuries. A fracture that occurs due to a high energy injury is termed a traumatic fracture and is a result from a significant amount force. Low energy fractures are termed stress fractures and are a result from repeated exposure to low amounts of force. Fractures of the ankle can be a serious problem depending on the level of severity. The ankle joint is a very complex system and disruption of the joint from severe fractures can lead to joint instability. A joint, simply put, is a surface that is comprised of the ends of at least two bones (where the bone come together and meet), cartilage (which cushions our joints), tendons (which connects muscle to bone), and ligaments (which connects bone to bone). All work together to give our joints the ability to move. Any injury that disrupts this unity eliminates the joints ability to function properly. Read more

Recovery Guide: Achilles Tendon Rupture

What Is It?

Tendons are the structures that connect muscle to bone. They are key in giving us the ability to move. The Achilles tendon is the largest tendon in our body and connects to the two muscles that make up our calf. The Achilles tendon extends from this complex, crosses the talus (the ankle bone) and attaches itself to the calcaneus (the heel bone). Together they form a unit that allows the calf muscle to pull the foot down and is essential for our mobility.  Like muscle, tendons are made up of tiny fibers that come together and form a bigger structure (you can imagine it like the weaves of thread that make up a rope). An Achilles tendon rupture occurs when these fibers tear and can result in partial or complete separation of the tendon from the muscle.

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Recovery Guide: Bunionectomy

What Is It?

Bunions are most commonly known as the bony protrusion that occurs at the base of the joint of the big foot. This protuberance is also affiliated with a fluid filled sac resulting from friction and inflammation known as a “bursa”.  Therefore a bunion could imply both. However, a bunion is also associated with a “hallux valgus” deformity, a condition in which the big toe is deviated from it’s normal anatomical position and leans towards the second toe of the foot. As a result the anatomy of the big toe is disrupted and causes great discomfort and pain for the patient, though sometimes bunions can be painless and present the patient with a more cosmetic discomfort. Since the joint flexes with every step that we take, more severe deformity can result in more severe pain. If left untreated the bunion can affect the patient’s ability to walk. Dorsal bunions (bunions on the top aspect of the toe) are also possible and don’t result in valgus of the big toe. These are typically the result of arthritic changes in the joint and are not as frequent. When bunions do occur, they are usually appear on the big toes of both feet. Read more

Recovery Guide: Ankle Arthrodesis (Fusion)

What Is It?

An arthrodesis in the truest sense of the word means a joint fusion, hence why in lay terms an ankle arthrodesis is known as an “ankle fusion.” A joint is comprised up of the ends of two pieces of bone, ligaments (which hold the bones together), tendons (which attaches muscle to the bone), and cartilage (which cushions our joints). In a nutshell, it’s a surface where two bones connect. Joint classification and composition can vary, but this is the simplest description. The two main bones that comprise the ankle joint are the tibia (long bone of the lower leg) and the talus (the ankle bone). Together they form the surface which allows you to pull your foot up or down. The ankle joint however is actually quite complex and other structures help to provide stability while standing and with movement (such as the fibula and ligaments). Read more

Where Can I Buy a Knee Walker?

Let’s face it: you’re not exactly thrilled by the prospect of spending the next eight to twelve weeks wobbling around on crutches.  You’ve already suffered through the pain of an ankle injury or foot surgery – why do you have to be punished with those medieval torture devices?

Never fear, knee walkers are here.  If you’ve never heard of knee walkers before (also known as roll about scooters and seated scooters), get ready to meet your new best friend during your recovery period.  Roll about scooters are unique mobility devices that allow you to isolate your broken foot or ankle, while providing you with a more stable (and pretty cool) way to get around.  Knee walkers look a bit like those scooters that kids are always rolling around on; however, a cushioned seat allows you to kneel onto the pad, using your good foot to push yourself forward. Read more