Foot Fracture: Overview
The foot is made up of 26 small bones. The tarsus is the name for the seven
bones that make up the hindfoot and the midfoot. The forefoot consists of
the five metatarsals and the 14 phalanges. There are two phalanges in the
big toe and three in each of the remaining toes.
A foot fracture can happen in any foot bone, but metatarsal bone fractures
are the most common.
A foot fracture is caused by trauma to the bone. Trauma includes:
In addition, when a bone is subjected to repeated stress over a long period of time, small cracks can form in the bone. These are called stress fractures, and the bones in the foot are particularly susceptible to this type of fracture.
Risk factors that increase your chances of fracturing your foot include:
Diagnosis
Symptoms of a foot fracture include:
The doctor will ask about your symptoms, physical activity, and how the injury occurred, and will examine the injured area. The doctor will order x-rays of the foot to confirm the diagnosis.
Treatment Options
Treatment will depend on the severity of the injury. Treatment involves:In a less severe foot fracture, the bones can be realigned without surgery. You may only need crutches and flat-bottom shoes to help protect the fracture. A more serious fracture may require a splint or cast to hold the bones in place. You will need to use crutches to help you walk.
In certain severe cases, you will need surgery to realign the bones. The doctor may use a metal plate with screws, screws alone, or pins to hold the bones in place. A cast or splint will be placed on the foot after surgery. You will need to use crutches to help you walk. The doctor will order more x-rays while the bone heals to ensure that the bones have not shifted.
When your doctor decides you are ready, start range-of-motion and strengthening exercises. You may be referred to a physical therapist to assist you with these exercises. Do not return to sports until your foot is fully healed.
Metatarsal bones and the phalanges may heal in 3-6 weeks, but the tarsal bones will take 6-10 weeks to heal.
Prevention
To prevent foot fractures:
How can I prevent a foot fracture?
Upon return to activity following successful treatment of a foot fracture, intensity, and duration of training should be increased gradually. Should pain be experienced, even relatively mild pain, you should reduce the intensity and duration of activity.
Trying new training methods, such as running stadium steps or changing running surfaces, should be done with caution and temporarily avoided if pain persists. Shoes used in training should be in good condition and not showing deterioration of the foot support system.
As many foot fractures occur in athletes who train sporadically, regular exercise of proper duration and intensity may help prevent fractures. If training is suspended for some time, return to training at reduced intensity and duration and gradually work up to your previous levels.
Stretching the muscle and connective tissue of the legs and building strength of leg muscles also reduces the incidence of foot fractures in runners.
Improving sports performance
The key to improving sports performance after recovering from a foot fracture is a proper rehabilitation program, and adhering to some of those same principles after the injury is gone. Pay close attention to the prevention techniques listed above. These will not only keep you in the game, but will also help you perform better and with more confidence.
Rehabilitation exercises
Rehabilitation depends on the severity of the injury. Most rehabilitation for foot fractures includes rest and avoiding activities that stress, strain, or pressure the injury site. During rehabilitation, athletes can maintain cardiovascular fitness through aerobic activities such as cycling or swimming.
Of course, if your fracture requires surgery to put the bone back in place, your rehabilitation will be prescribed by your doctor and may vary depending on the severity of the injury.
Strengthening the muscles around the foot fracture hastens recovery and prevents recurrence of the injury. Athletes with a history of foot fractures should make these exercises part of their pretraining warm-up. Although the exercises are described for the injured-side foot or leg, you should also do them on the uninjured side. This is especially encouraged for athletes with recurring incidents of foot fracture, as the exercises are preventive as well as rehabilitative.
Sit on the floor with the injured-side leg fully extended and the opposite leg bent at the knee so that the sole of the uninjured-side leg is against the inner thigh of the injured-side leg. Keep the extended leg straight while reaching for and grasping the toes of the injured-side foot. If the toes cannot be reached, put a towel around the underside of the injured-side foot and grasp its ends with the extended hand. Hold this position for 5 to 10 seconds. Relax for 5 seconds. Perform this cycle 10 to 15 times, 3 times daily.
Kneel on the floor with toes pointed backward and sitting on heels. Gradually lower your full body weight. Reach backward with the injured side hand and grasp the injured-side toes, pulling them gently upward and hold this position for 5 seconds. Release the grip on the toes and raise some of the body weight from the heels. Rest in this position for 5 seconds. Perform this cycle 5 times, 3 times daily.
Sit erect on a table or bed with the injured-side leg crossed over the opposite leg. Grasp the toes of the injured-side foot with the hand of the same side and the heel of the injured-side foot with the opposite hand. Gently pull the toes toward the shin. Hold this position for 5 seconds, then relax hands and rest for 5 seconds. Perform this cycle 5 times, 3 times daily.
Sit erect on a table or bed with injured-side leg crossed over the opposite leg. Grasp the top of the injured-side foot with the hand of the same side and the toes of the injured-side foot with the opposite hand, with fingers over the top of the injured foot. Gently pull the toes of the injured-side foot toward the ball of the foot in a curling motion and hold this position for 5 seconds. Relax hands and rest for 5 seconds. Repeat this cycle 5 times, 3 times daily.
Strengthening exercises
Try the following exercises for strengthening the muscles of the lower leg and those that control movements of the foot:
Stand with hands resting on a chair back. Slowly elevate to the toes of both feet and hold this position for 10 to 15 seconds. Return to start position and rest for 5 seconds. Perform 20 times, 3 times daily.
After one week, or later if occasional pain is present, perform single toe raises. Stand to the side of a chair with one hand resting on the chair back. Bend the knee on the uninjured side and raise the foot from the floor. Slowly elevate to the toes of the opposite foot. Hold this position for 10 to 15 seconds. Return to start position and rest for 5 seconds. Perform this cycle 20 times, 3 times daily.
Sit on a table with lower legs dangling over the side. Stabilize your body by holding the table edge with both hands. Turn the foot of the injured side upward and inward and hold this position for 5 to 10 seconds. Return to the start position and rest for 5 seconds. Turn the injured side foot upward and outward and hold for 10 seconds. Return to the starting position and rest for 5 seconds. Repeat this sequence 10 times, 3 times daily. Begin with no resistance and gradually add weight to the ankle over time. Add weight in 2.5 pound increments until you reach 10 pounds.
Lie on your side on a table or bed with the injured-side leg uppermost and the uninjured leg bent at the knee with the uninjured side foot under the injured side calf. The injured-side foot should be extended over the end of the table or bed by a few inches. Relax the injured-side foot, then raise the injured-side toe upward and outward and hold this position for 5 seconds. Relax the injured-side foot. Rest for 5 seconds. Repeat this sequence 10 times, 3 times daily. Begin with no resistance and add weight to the forefoot with training time by 2.5 pounds until 10 pounds can be managed.
Alternative exercises
During the period when normal training should be avoided, alternative exercises may be used. These activities should not require any actions that create or intensify pain at the site of injury. They include:
When can I return to my sport or activity?
If the fracture is treated immediately following initial symptoms, athletes can usually return to competition within 4 to 6 weeks.
A foot fracture that is ignored by an athlete until the pain ultimately prevents him or her from competing, may take 8 to 10 weeks to fully heal. In any case, return to full participation in his or her sport must be delayed until all symptoms disappear, not only at rest, but when performing the skills and activities inherent to the sport or activity.
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon, you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your fracture recovers, not by how many days or weeks it has been since your injury occurred.
You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:
