Special Report on Foot Fractures

The structure of your foot is complex, consisting of bones, muscles, tendons, and other soft tissues. Of the 28 bones in your foot, 19 are toe bones (phalanges) and metatarsal bones (the long bones in the midfoot). Fractures of the toe and metatarsal bones (broken toes) are common and require evaluation by a specialist. A foot and ankle surgeon should be seen for proper diagnosis and treatment, even if initial treatment has been received in an emergency room. What is a Fracture? A fracture is a break in the bone. Fractures can be divided into two categories: traumatic fractures and stress fractures. Traumatic Fractures Traumatic fractures (also called acute fractures) are caused by a direct blow or impact -- like seriously stubbing your toe. Traumatic fractures can be displaced or nondisplaced. If the fracture is displaced, the bone is broken in such a way that it has changed in position (dislocated). Treatment of a traumatic fracture depends on the location and extent of the break and whether it is displaced. Surgery is sometimes required. Signs and symptoms of a traumatic fracture include: •You may hear a sound at the time of the break. •"Pinpoint pain" (pain at the place of impact) at the time the fracture occurs and perhaps for a few hours later, but often the pain goes away after several hours. •Deviation (misshapen or abnormal appearance) of the toe. •Bruising and swelling the next day. It is not true that "if you can walk on it, it's not broken." Evaluation by the foot and ankle surgeon is always recommended. Stress Fractures Stress fractures are tiny, hairline breaks that are usually caused by repetitive stress. Stress fractures often afflict athletes who, for example, too rapidly increase their running mileage. Or they may be caused by an abnormal foot structure, deformities, or osteoporosis. Improper footwear may also lead to stress fractures. Stress fractures should not be ignored, because they will come back unless properly treated. Symptoms of stress fractures include: •Pain with or after normal activity •Pain that goes away when resting and then returns when standing or during activity •"Pinpoint pain" (pain at the site of the fracture) when touched •Swelling, but no bruising Is it a Fracture or a Sprain? Sprains and fractures have similar symptoms, although sometimes with a sprain, the whole area hurts rather than just one point. Your foot and ankle surgeon will be able to diagnose which you have and provide appropriate treatment. Certain sprains or dislocations can be severely disabling. Without proper treatment they can lead to crippling arthritis. Consequences of Improper Treatment Some people say that "the doctor can't do anything for a broken bone in the foot." This is usually not true. In fact, if a fractured toe or metatarsal bone is not treated correctly, serious complications may develop. For example: •A deformity in the bony architecture which may limit the ability to move the foot or cause difficulty in fitting shoes. •Arthritis, which may be caused by a fracture in a joint (the juncture where two bones meet), or may be a result of angular deformities that develop when a displaced fracture is severe or hasn't been properly corrected. •Chronic pain and long-term dysfunction. •Non-union, or failure to heal, can lead to subsequent surgery or chronic pain. Treatment of Toe Fractures Fractures of the toe bones are almost always traumatic fractures. Treatment for traumatic fractures depends on the break itself and may include these options: •Rest. Sometimes rest is all that is needed to treat a traumatic fracture of the toe. •Splinting. The toe may be fitted with a splint to keep it in a fixed position. •Rigid or Stiff-Soled Shoe. Wearing a stiff-soled shoe protects the toe and helps keep it properly positioned. •"Buddy Taping." "Buddy taping" the fractured toe to another toe is sometimes appropriate, but in other cases it may be harmful. •Surgery. If the break is badly displaced or if the joint is affected, surgery may be necessary. Surgery often involves the use of fixation devices, such as pins. Treatment of Metatarsal Fractures Breaks in the metatarsal bones may be either stress or traumatic fractures. Certain kinds of fractures of the metatarsal bones present unique challenges. For example, sometimes a fracture of the first metatarsal bone (behind the big toe) can lead to arthritis. Since the big toe is used so frequently and bears more weight than other toes, arthritis in that area can make it painful to walk, bend, or even stand. Another type of break, called a Jones fracture, occurs at the base of the fifth metatarsal bone (behind the little toe). It is often misdiagnosed as an ankle sprain, and misdiagnosis can have serious consequences since sprains and fractures require different treatments. Your foot and ankle surgeon is an expert in correctly identifying these conditions as well as other problems of the foot. Treatment of metatarsal fractures depends on the type and extent of the fracture, and may include: •Rest. Sometimes rest is the only treatment needed to promote healing of a stress or traumatic fracture of a metatarsal bone. •Avoid the Offending Activity. Because stress fractures result from repetitive stress, it is important to avoid the activity that led to the fracture. Crutches or a wheelchair are sometimes required to offload weight from the foot to give it time to heal. •Immobilization, Casting, or Rigid Shoe. A stiff-soled shoe or other form of immobilization may be used to protect the fractured bone while it is healing. •Surgery. Some traumatic fractures of the metatarsal bones require surgery, especially if the break is badly displaced. •Follow-Up Care. Your foot and ankle surgeon will provide instructions for care following surgical or non-surgical treatment. Physical therapy, exercises and rehabilitation may be included in a schedule for return to normal activities. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

New York Mets 2nd Baseman has a Foot Injury

The New York Mets second baseman, Louis Castillo, could end up on the disabled list due to a foot injury. The injury is being reported as a bone bruise of the left foot. What is a bone bruise? Most people think a bone is either broken or not. In order to explain that I want you to think of a dimmer switch on a light. You see, a bone can be either broken or not, just like a light can either be on or off. That said, there are also the dimmer options. Using an MRI (a special medical device that takes images of the bones and soft tissues and feeds the results into a computer) a radiologist can add more options to the mix. Thinking of a spectrum, where one end is normal bone and the other is a broken bone, now we can add bone bruise (also called a stress reaction) and stress fracture.
Despite his desire to play, the treatment for a bone bruise is rest, stiffer shoes and time. If he continues to play on this foot he can end up with a stress fracture (the next phase on the dimmer switch) or ultimately a fracture of his bone. If he does fracture the bone he is looking at 6 weeks of healing time.


Committed to your health,

Dr. Craig Conti
Sarasota Foot Care Center
www.sarasotafootcarecenter.com

What is a Stress Reaction

Previously reported on this blog, I am both a foot doctor in Sarasota, Florida and a New York Giants football fan. The latest out of New York is that Eli Manning has more to worry about than his long suffering plantar fasciitis. Now it has been reported that Eli has a "stress reaction" in a bone called the cuboid bone of his foot.
Well, what is a "stress reaction?" In order to explain that I want you to think of a dimmer switch on a light. You see, a bone can be either broken or not, just like a light can either be on or off. That said, there are also the dimmer options. Using an MRI (a special medical device that takes images of the bones and soft tissues and feeds the results into a computer) a radiologist can add more options to the mix. Thinking of a spectrum, where one end is normal bone and the other is a broken bone, now we can add stress reaction and stress fracture.
Eli has a stress reaction. The treatment for this is rest, stiffer shoes and time. If he continues to play on this foot he can end up with a stress fracture (the next phase on the dimmer switch) or ultimately a fracture of his cuboid bone. If he does fracture the bone he is looking at 6 weeks of healing time, which basically means the season is over for him.
With Eli hurt and the Giants on a 5-game-out-of-6 losing streak the stress is affecting all Giants fans.

Committed to your health,

Dr. Craig Conti
Sarasota Foot Care Center
Sarasotafootcarecenter.com