A fracture is a broken bone. If not treated properly, a fracture can lead to long term disability. A fracture may be closed (the broken bone does not break through the skin) or open (the skin is broken over the fracture site, and the bone may poke through the skin or be visible in the wound). Additionally, stress fractures, which are common in the foot and ankle, are hairline cracks in a bone. These are caused by repeated stress on a bone. In any type of fracture, the bone may fail to heal or it may heal in a poor alignment. If either occurs, a surgical reconstruction may be necessary.
When a fracture of one of the 30 bones of the foot and ankle occurs, it is essential to obtain a prompt evaluation for proper diagnosis and treatment. With early diagnosis, appropriate treatment, and correct rehabilitation, a painless foot and ankle which functions properly is probable.
Signs of a fracture?
Accidents are the most common cause of fractures and include motor vehicle, slips and falls, and sports injuries. Symptoms and signs of fractures include:
- Difficulty bearing weight
- A "popping" sound or sensation
How is this treated?
Treatment can include surgical or non-operative options. Non-operative treatment usually consists of a period of immobilization in a boot or cast, followed by some type of rehabilitation. Surgical treatment utilizes internal fixation devices, such as screws and plates to immobilize the bones until they heal together. Surgery also usually requires a period of immobilization in a boot or cast, followed by rehabilitation. Both treatment modalities are combined with a period of no weight-bearing with crutches or a walker, or protected weight-bearing as pain allows. Often, the decision on surgical vs. non-surgical treatment is based on the bones involved, the amount of displacement, as well as the age and activity level of the individual.
The goal of treatment is to get the bone to heal in its normal anatomic position. Until medical care is available, do the following if you suspect a fracture:
- Rest the fractured area and immobilize it if possible.
- Ice the injury to reduce blood flow and limit swelling.
- Compress the injured joint with a cloth bandage.
- Elevate the area to minimize swelling.
What are the risks of treatment?
The risks of operative and non-operative treatment include:
- Joint stiffness
- Non-union (the fails to mend together)
- Mal-union (the bone heals misaligned)
With surgery, infection and nerve injuries can also occur, albeit rarely.
How do I prepare for surgery?
Fracture care surgery often is done on an emergency or urgent basis, so preparation is not always possible. However, the following steps should be followed if time permits:
- Complete any pre-operative tests or lab work prescribed by your doctor.
- Arrange to have someone drive you home from the hospital.
- Call the appropriate surgery center to verify your appointment time. If your surgery is being done at Cleveland Clinic, call:
- Main Campus: 216.444.0281
- Beachwood: 216.839.3500
- Strongsville: 440.878.3400
- Marymount: 216.518.3200
- Euclid: 216.692.7750
- Refrain from eating or drinking anything after midnight the night before surgery.
What do I need to do the day of surgery?
- If you currently take any medications, take them the day of your surgery with just a sip of water.
- Refrain from taking diabetic pills or insulin.
- Do not wear any jewelry, body piercings, makeup, nail polish, hairpins or contacts.
- Leave valuables and money at home.
- Wear loose-fitting, comfortable clothing.
What happens during surgery?
Your foot will be initialized in the preoperative area by someone from the surgical team. In the operating room, you will be met by a nursing team and the anesthesia team. You have several anesthetic options:
- General: Completely asleep and breathing through a tube
- Epidural/Spinal: Numb from the waist down, or
- Local: Numbing medicine just above the surgical site
Epidural/Spinal and Local are usually combined with sedative medication so you can rest comfortably during the procedure. Once you are anesthetized, the surgery is initiated.
What happens after surgery?
It is not unusual to experience numbness, tingling, and burning sensations in your foot or ankle. You should elevate your foot above your heart for 48 hours after the procedure, in order to relieve pain and these sensations. If this does not resolve the problem, your cast or surgical dressing may be too tight, and you may need to call your doctor. Avoid prolonged sitting or standing, and refrain from putting weight on the operative site unless given permission by your doctor.
Your doctor will give you pain medication, which may cause nausea or constipation. Eat lightly on the day of surgery.
If you are wearing a cast, do not put anything in the cast and keep the cast clean and dry. If you are itching beneath the cast, take Benadryl and blow cool air down the cast with a hair dryer.
Ask your surgeon for complete post-operative instructions.
How long is the recovery period after surgery?
Depending on the type of fracture, recovery times vary. A minor bone break in a child may take a few weeks to heal, while a serious break in an older person’s bone may require from months to a year to heal.
In an adult, no fractures heal in fewer than 6 weeks, except for an occasional stress fracture. Weight-bearing is typically allowed from 3 to 8 weeks after a fracture. One usually progressively increases their weight-bearing as they wean off their crutches/walker.
Rehab after surgery?
Rehabilitation plays a major role in fracture care. The goals of rehabilitation are to get the joints above and below the fracture moving as soon as the fracture has healed sufficiently. Range of motion and strengthening exercises are prescribed to restore function.
How can I manage at home during recovery?
You should remain in bed with the foot elevated above the heart for the first 24 to 48 hours after surgery. Otherwise, painful swelling will develop. After the initial 72 hours, you should balance your activity between walking with crutches, sitting, and resting. Your first week after surgery should be spent at home. Avoid prolonged sitting or standing and refrain from putting weight on the operative site unless given permission by your doctor.
Your doctor will most likely give you pain medication, which can cause nausea or constipation. Increase your diet slowly, and eat foods, or take laxatives, which usually help.
If you are wearing a cast, do not put anything inside the cast and keep the cast dry. If itching occurs beneath the cast, blowing cool air from a hair dryer may provide relief.
How frequently should I schedule follow up appointments with my doctor following surgery?
Follow-up visits are scheduled by your surgeon.
This information is provided by Cleveland Clinic and is not intended to replace
the medical advice of your doctor or health care provider.
Please consult your health care provider for advice about a specific medical condition.
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