Foot Fractures

A foot fracture is a break in one of the 26 bones of the foot. Patterns vary widely, from a simple toe break that heals in a shoe to a complex heel fracture that may need surgery to rebuild the joint surface. Some fractures happen from a single fall, twist, or blow, while stress fractures build up over time from repeated loading, often in runners. Which bone is involved matters, because some locations, such as the base of the fifth metatarsal (the Jones fracture region) and the central third of the navicular, have a limited blood supply and heal less reliably. A broken bone cannot be reversed, but with the right care most foot fractures heal well.

Common symptoms include:

• Pain along the outer border of the foot after a twist or awkward step
• Pain at the ball of the foot that builds during running and eases with rest
• An inability to bear weight after a fall onto the heel
• Swelling across the top of the midfoot, sometimes with bruising on the sole

Weight-bearing X-rays of the foot are the starting point, because loading shows displacement and joint involvement more clearly. With a stress fracture the first X-rays are often normal, so an MRI is used to detect the injury early. A CT scan maps a heel fracture for surgery, and side-by-side weight-bearing views help when a midfoot injury is suspected.

Many foot fractures heal without surgery:

• A stiff-soled shoe or walking boot for an undisplaced metatarsal shaft break
• Activity modification and a graduated return to loading for a stress fracture
• A splint, then a boot, for an undisplaced heel fracture
• Buddy-taping and a stiff-soled shoe for most broken toes

Surgery is considered when the fracture will not heal into a foot that carries weight normally. A Jones fracture in an active patient is often fixed with a screw, a displaced heel fracture may need fixation, and any displacement across the midfoot joints needs reduction and fixation.

For a fuller explanation, including anatomy, diagnosis, and the full range of treatment:

• Stress Fractures of the Foot and Ankle — AAOS OrthoInfo