Fractures of the Foot and Ankle

A Patient's Guide

Fractures affecting the foot or ankle are common injuries, often resulting from falls, sports activities, or accidents. They involve a break in one or more of the bones. Depending on the severity, they can significantly impact mobility and quality of life. This guide provides an overview of fractures, including their symptoms, signs, diagnostic investigations, and treatment options.

Symptoms and Signs

Fractures can present with a range of symptoms and signs, varying in intensity depending on the severity of the fracture. Recognising these symptoms early can facilitate timely medical intervention and improve outcomes. The primary symptoms and signs of a fracture include:

Pain and tenderness: Acute, sharp pain at the time of injury is the most common symptom. The pain may be localized to the fracture site or may radiate throughout the ankle and foot. The affected area is often tender to the touch, and palpating the site of the fracture can elicit significant discomfort.
Swelling and bruising: Rapid swelling is common, often within minutes of the injury. Swelling is due to soft tissue damage and bleeding into the surrounding tissues. Bruising may appear shortly after the injury or within a few hours. The discoloration is a result of blood leaking from damaged blood vessels into the skin and underlying tissues.
Deformity: In severe fractures, there may be an obvious deformity. This is more common in displaced fractures where the bone fragments are not properly aligned.
Impaired mobility: Most individuals will find it difficult or impossible to bear weight on the affected limb. Attempting to walk can exacerbate pain and cause further injury
Other signs: Some patients may experience numbness or tingling around the injury site, or feel that foot or ankle is unstable to walk on.

Investigations

Accurate diagnosis of a fracture involves a combination of history, physical examination and imaging studies. This is critical for effective treatment planning. Investigations include:

X-rays: Plain radiographs are the standard imaging technique used to diagnose fractures. They provide detailed images of the bones, allowing for identification of the location and type of fracture. Multiple views (front, side, and oblique) are often needed for a comprehensive assessment.
CT Scans: In complex cases or when the fracture extends into a joint, a CT (computed tomography) scan may be recommended. CT scans offer a more detailed, cross-sectional view of the bones and can help in planning surgical interventions.
MRI (Magnetic Resonance Imaging): MRI is useful for assessing soft tissue damage, including ligaments and tendons, which may accompany the fracture. MRI can also help evaluate bone marrow oedema and other subtle injuries not visible on X-rays. It is particularly useful when stress fractures are suspected.

Acute Treatment

Treatment of fractures aims to achieve proper bone healing, restore function, and prevent complications. The choice of treatment depends on the type and severity of the fracture, patient factors, and the presence of any associated injuries.

There is a wide variety of potential treatment and those relevant should be discussed between you and your orthopaedic surgeon.

Non-surgical treatments may include:

Immobilisation in a boot, splint or plaster cast.
RICE (Rest, Ice, Compression, Elevation) protocol.
Painkillers will help reduce pain but some can have side-effects which it is important to be aware of.
Physiotherapy is helpful once the bone begins to heal, to aid restoration of strength, and range of motion.

Surgical treatments may include:

Open reduction to realign the bone fragments and internal fixation with metal plates, screws, wires or nails.
External fixation using a frame In cases of severe fractures with significant soft tissue damage.

Rehabilitation and Recovery

Gradual Weight-Bearing: The timeline for resuming weight-bearing activities varies based on the type of fracture and treatment method. Gradual progression from partial to full weight-bearing is typically guided by your surgeon.

Strengthening Exercises: As healing progresses, specific exercises to strengthen the muscles around the ankle and improve joint stability are introduced. These exercises are tailored to the patient's needs and recovery goals.

Return to Activities: Full recovery and return to normal activities, including sports, may take several months. Adhering to the rehabilitation program and avoiding premature stress on the healing ankle are crucial for preventing re-injury.

Summary

Fractures are a common but potentially serious injury that requires prompt and appropriate treatment. Recognising the symptoms and signs, obtaining accurate diagnostic investigations, and following a comprehensive treatment plan are key to achieving the best possible outcomes. Whether through non-surgical management or surgical intervention, the goal is to restore function, reduce pain, and prevent long-term complications. With proper care and rehabilitation, most individuals can return to their normal activities and enjoy a full recovery.