Foot Fractures

Overview

Your foot has 26 bones, and any of them can break. But the fractures that bring patients to an orthopedic clinic fall into a handful of patterns, each with its own cause, how well it heals, and how likely it is to need surgery. The foot is built in three zones: the heel and back of the foot, which bear most of your weight; the middle of the foot, which forms the arch; and the front of the foot, the long bones and toes you push off with.

Some foot fractures are acute, high-energy injuries. A fall from a ladder that lands heel-first is a calcaneus fracture. A twisting injury to the midfoot with swelling across the top of the foot is a Lisfranc injury, which is easy to miss. Others are overuse injuries: a runner with gradually worsening pain in the ball of the foot has a metatarsal stress fracture, and the specific bone matters because some heal far more readily than others.

What unites all foot fractures is the weight-bearing question. Your foot has to carry you, and a fracture that heals in a position that changes how load distributes across the sole will cause problems for years. Alignment matters in the foot the way it matters in the ankle and knee.

The patterns we treat most often each have their own page with the mechanism, diagnosis, and treatment laid out in detail:

Symptoms

The mechanism usually tells the story. A twist or awkward step with pain along the outer border of your foot is a Jones fracture pattern. Pain that builds during running and eases with rest, focused at the ball of the foot, is a metatarsal stress fracture. A fall from height onto the heels with an immediate inability to bear weight is a calcaneus fracture. Swelling across the top of the midfoot after a twist, especially with bruising on the sole (plantar ecchymosis), is a Lisfranc injury and should not be walked on until it is evaluated.

Whether you can put weight on the foot is often what separates a fracture from a simple sprain, but it is not a reliable test on its own. Stress fractures, Lisfranc injuries, and undisplaced breaks are all easy to walk on at first and easy to miss. Pain after a "sprain" that is not improving at two weeks is reason to come back for repeat or more detailed imaging.

How We Make the Diagnosis

imaging that fits the fracture

Weight-bearing X-rays of the foot are the starting point. With a stress fracture, the first X-rays are often normal, so an MRI is the gold standard because it shows the injury weeks earlier. For a calcaneus fracture, a CT scan is essential to map the joint surface for surgical planning. For a suspected Lisfranc injury, weight-bearing views comparing both feet are critical, since the displacement can hide on an X-ray taken off your feet.

How We Treat It

non-surgical care comes first

Many foot fractures heal without surgery, and the cast or boot is matched to which bone is broken and how it sits. Here is what non-operative care looks like by pattern:

Undisplaced metatarsal shaft fracture. A stiff-soled shoe or a walking boot protects the bone while it knits.
Stress fracture. Activity modification and a graduated return to loading, easing weight back onto the bone as it heals.
Undisplaced calcaneus fracture that does not involve the joint surface. A splint first, then a boot.

When Surgery Is Considered

when the bone won't heal aligned

Surgery is considered when the fracture pattern will not heal into a foot that distributes your weight normally. The threshold depends on which bone is broken and how far it has shifted:

Jones fracture. Screw fixation for athletes and active patients, because the rate of a break that fails to heal (nonunion) is high with non-operative treatment alone. More on Jones fracture fixation →
Displaced calcaneus fracture. Open reduction and internal fixation (ORIF) to restore the subtalar joint surface and the shape of the heel. More on heel bone fracture fixation →
Lisfranc injury. Any displacement across the midfoot joints needs anatomic reduction and fixation to hold the arch in place.
Complete or displaced navicular stress fracture. Screw fixation when the fracture is complete or has not healed with non-operative care.

If non-operative care is not enough, these procedures can address this condition:

Providers Who Treat Foot Fractures

Michael S. Vrana, M.D.

David B. Templin, M.D.

Trent Twitero, M.D.

Frequently Asked

questions we hear in clinic

How can I tell a broken foot from a sprain?

Whether you can put weight on the foot is often what separates a fracture from a simple sprain, but it is not a reliable test on its own. Stress fractures, Lisfranc injuries, and undisplaced breaks are all easy to walk on at first and easy to miss. Pain after a “sprain” that is not improving at two weeks is reason to come back for repeat or more detailed imaging.

Will I need an X-ray, or something more?

Weight-bearing X-rays of the foot are the starting point. With a stress fracture the first X-rays are often normal, so an MRI is the gold standard because it shows the injury weeks earlier. A calcaneus fracture needs a CT scan to map the joint surface, and a suspected Lisfranc injury needs weight-bearing views comparing both feet, since the displacement can hide on an X-ray taken off your feet.

Do all foot fractures need surgery?

No. Many foot fractures heal without surgery. An undisplaced metatarsal shaft fracture goes into a stiff-soled shoe or a walking boot, a stress fracture is managed with activity modification and a graduated return to loading, and an undisplaced calcaneus fracture that does not involve the joint surface is treated in a splint, then a boot.

When is surgery considered?

Surgery is considered when the fracture pattern will not heal into a foot that distributes your weight normally. The threshold depends on which bone is broken and how far it has shifted. A Jones fracture in an athlete is often fixed with a screw because the rate of a break that fails to heal is high without surgery, a displaced calcaneus fracture may need fixation to restore the joint surface and the shape of the heel, and any displacement across the midfoot joints in a Lisfranc injury needs anatomic reduction and fixation.

Why does the specific bone matter so much?

What unites all foot fractures is the weight-bearing question. Your foot has to carry you, and a fracture that heals in a position that changes how load distributes across the sole will cause problems for years. Healing potential also varies enormously between bones, so the specific bone that is broken shapes both how it heals and the threshold for surgery.

Why is a Lisfranc injury easy to miss?

A twisting injury to the midfoot with swelling across the top of the foot is a Lisfranc injury, which is easy to miss. The displacement can hide on an X-ray taken off your feet, which is why weight-bearing views comparing both feet are important. It should not be walked on until it is evaluated.