Jordi Cervera | www.jordicervera.comFractures of one or more foot bones are mostly a result of accidents, but also due to overloading or pre-existing conditions. Typical symptoms are pain, swelling and limited mobility and/or weight-bearing capacity of the foot. Whether conservative therapy or foot surgery is recommended is decided by the foot specialist after a thorough examination that takes into account the entire foot and body statics.

The foot surgeon Dr Tonio Gottlieb is your competent contact for all questions regarding foot fractures: As a proven expert in his field, he examines and analyses your foot comprehensively. He will make a well-founded diagnosis and recommend a treatment plan tailored to you. Whether it's an initial examination or a second opinion - it's best to make a personal appointment right away!

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What is a fracture?

A 'fracture' is the technical term for a broken bone. The bone is completely or partially severed and the bone fragments may be displaced from their normal anatomical position.

We speak of a foot fracture, a foot fracture or a broken foot when the fracture affects one or more bones of the foot skeleton - from the tarsal to the metatarsal bones to the toes.

How do fractures of the foot occur?

The human bone is extremely stable and elastic at the same time, so that it can withstand high loads. If a fracture nevertheless occurs, this can have three causes:

  • Excessive force in the event of a fall, blow or impact
  • repeated overloading (stress fracture)
  • Weakening of the bone tissue due to disease (pathological fracture)

In which accidents can you break your foot?

In most cases, foot fractures are caused by the application of excessive force. Typical accident scenarios are twisting of the foot on uneven ground or during rapid changes of direction in sports, a hard impact during a fall or jump from a great height (e.g. "snowboarders ankle") and the impact of the toes against a hard edge. Traffic accidents are also a frequent cause of foot fractures.

Dropping heavy objects can also cause a fracture in the foot; prevention with safety shoes is recommended for occupational or other activities with increased risk.

How stress fractures of the foot occur

A fracture can also occur due to repeated overloading of the bone. In healthy bones, this is called a fatigue fracture or a stress or insufficiency fracture.

In the foot area, the metatarsus is particularly affected by fatigue fractures. The term "marching fracture" refers here to a classic cause: the abrupt increase in stress caused by long marches on foot in young recruits. Equally affected are untrained hikers or overambitious jogging beginners whose bone tissue does not have enough time to adapt to the new load intensity as part of the natural regeneration process.

Foot malpositions can also lead to incorrect loading, especially overloading of certain bones and joints, and thus promote fatigue fractures.

What causes a pathological fracture?

If the stability of the bone is greatly reduced, the risk of pathological fractures increases. These are also called spontaneous fractures and describe a bone fracture as a result of a comparatively minor force (minor trauma) that a healthy bone would easily withstand.

Possible causes for such weakening of the bone are:

  • Pre-existing conditions, especially osteoporosis, metastases and tumours, metabolic disorders (diabetes mellitus) and/or hereditary diseases, e.g. brittle bone disease (osteogenesis imperfecta).
  • Malnutrition (vitamin D deficiency)
  • Taking certain medicines (corticosteroids)

What types of fractures can occur in the foot?

In surgery, different types of fractures are distinguished, for example, according to the mechanism of origin, the number of bone fragments or the course of the fracture line. The most important terms are briefly introduced below.

Closed fractures

The 'normal' bone fracture is a closed fracture: here the bone is broken, the overlying skin is not severed. The underlying soft tissue may be largely uninjured in simple fractures, but in more severe injuries there may be extensive muscle, connective tissue and vascular damage.

Open fractures

In an open fracture, there is a skin injury at the fracture site. In simpler cases, the broken bone may 'pierce' the skin; in more severe cases, there is extensive soft tissue injury, up to and including incomplete amputation injury.

The bone is contaminated, i.e. contaminated by pathogens and toxins entering from the outside. Therefore, an open fracture requires special care and the wound must not be closed.

 

Dr Tonio Gottlieb:

“The successful treatment of a foot fracture starts with making a precise diagnosis, i.e. describing the fracture and the underlying cause.”

Whether it's an initial examination or a second opinion - Dr. med. Gottlieb in Berlin examines you with the utmost care and particularly comprehensive medical expertise. As a proven foot specialist, he has extensive expertise and years of experience. It is best to make an appointment today!

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Which fractures occur most frequently in a broken foot?

In principle, a bone fracture can occur in any bone of the foot. However, clinical statistics show several focal points of injury - both in general and depending on age and load.

Fractures of the foot most frequently affect the ankle joint, the metatarsal bones and the tarsal. Fractures of the metatarsals occur most frequently at the outer edge of the foot. The toes are only affected in 5-10% of all foot fractures. Small toe fractures are often multi-fragment fractures.

Most common fractures in childhood

In children and adolescents, the bones are particularly elastic but have vulnerable areas at which the bone grows (epiphyses).

Fractures in children usually heal more quickly than in adults. However, they may also have specific injury patterns that require special treatment - depending on whether and how the epiphysis is affected. Epiphyseal fractures are sometimes called Aitken I-IV fractures.

Basically, fractures in childhood most often affect the wrists and arms. However, violent falls can also result in a leg fracture. Only 5-13 % of all paediatric fractures (fractures in children) affect the feet; these are mostly ankle injuries (distal tibia fracture) or injuries to the metatarsal bones.

 

Dr Tonio Gottlieb:

“It is particularly important for children and young people who are still growing to see a foot specialist: A foot fracture should be able to heal optimally so that growth and body statics are not permanently disturbed.”

Dr Gottlieb is an expert in the field of foot surgery and always keeps an eye on the developmental processes typical of old age when planning treatment.

Typical fractures in adults

Foot fractures in adults mainly affect the ankle joint, the metatarsal bones and the tarsal. The toes are comparatively less often affected, the little toes twice as often as the big toe.

Fatigue fractures of the metatarsals typically occur in adults who are actively involved in competitive sports, especially e.g. long-distance running, tennis, dancing, football or even long hikes.

Fractures often occurring in old age

In older people, the elasticity of the bones decreases. As a result of hormone-related decalcification, they also become increasingly brittle; in addition, 30 % of women develop clinically relevant osteoporosis after the menopause. This increases the risk of insufficiency and spontaneous fractures, the femoral neck fracture being particularly dangerous. Foot fractures, however, do not affect older people significantly more often.

What symptoms can accompany a fracture of the foot?

An open fracture is clearly recognisable: A foot with an open wound and visible bone requires immediate first aid (sterile wound covering, stabilisation, elevation). The emergency doctor should be called or the emergency room visited as soon as possible.

A closed fracture, the type of bone fracture as it is usually known, manifests itself - depending on the location and extent - through more or less clear symptoms. Fatigue fractures of the metatarsal bones become noticeable only gradually, whereas an ankle fracture leads to acute pain, loss of function of the foot and requires immediate first aid (stabilisation, elevation, cooling). These symptoms can indicate a fracture and should therefore be clarified by a doctor as soon as possible:

    • Pain, especially pressure and exertion pain
    • Swelling
    • Overheating
    • Bruising (haematoma)
    • Lack of mobility or excessive mobility of the fracture site
    • Deformation or malposition of the joint, arch or toe
    • Friction noises at the breaking point
    • Restricted function of the body part

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How is a fracture of the foot diagnosed?

An experienced foot surgeon can often determine the fracture just by looking at and palpating the foot. X-rays are taken to make a definite diagnosis, and in the case of multiple fragment fractures and fractures close to the joint, a CT scan is often also performed.

What are the treatment options for a foot fracture?

After the initial treatment of the broken foot, there are two options to choose from:

      • Conservative treatment: correct alignment of the bone fragments (reduction, if necessary), immobilisation (with plaster shoe or cast, orthosis or buddy taping in the case of toe fracture) and rehabilitation.
      • Surgical treatment (osteosynthesis): Reduction and connection of bone fragments with screws, plates, wires or nails in order to stabilise the bone and support correct bone healing.

Dr Tonio Gottlieb:

“Every foot fracture is individual and requires a cause-oriented treatment plan that is optimally tailored to your needs and circumstances.”

Especially with more complex fractures of the foot bones, it is advisable not to rely on general surgery but to consult a foot specialist: When making a diagnosis and planning treatment, he or she will always keep in mind the overall structure of the foot as well as the body statics resting on it.

Would you like to obtain a well-founded, cause-oriented therapy recommendation? Whether it's an initial examination or a second consultation, Dr med. Gottlieb and his practice team in Berlin will provide you with highly individual and personal advice!

This is why you should always consult a specialist when treating pre-operated feet.

Even if the fracture occurred some time ago, but you are dissatisfied with the result of the treatment, it is worthwhile to seek a competent second opinion from a foot specialist: After a foot operation, the fracture should ideally heal in such a way that the foot is just as mobile and resilient as before. However, this is not always the case, especially with complex fractures.

In many cases, the reason for this is suboptimal treatment of the broken foot in the emergency room or accident and emergency department. There is a lack of both specialised knowledge and surgical practice here, as foot fractures are comparatively rare (most fractures affect the wrist and the long tubular bones of the arms and legs).

A foot surgeon, on the other hand, specialises in the highly complex and small-scale skeletal system of the foot, has extensive specialist knowledge and day-to-day practical experience with foot operations of all kinds. This enables more precise diagnoses as well as exact therapy planning and treatment according to current standards.

You too can put your trust in the specialist: with foot surgeon Dr. Gottlieb, your foot health is in the best hands! Make a personal appointment to get a competent second opinion or to explore the treatment options for pre-operated feet!

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What complications can occur with fractures?

If a foot fracture is suspected, a doctor should be consulted as soon as possible to avoid serious consequential damage. When diagnosing, treating and checking the progress of healing, the attending doctor will always keep in mind the possible complications of a fracture:

      • Joint injuries
      • Injury to adjacent muscles, connective tissue and nerve tracts
      • Injury, blockage or 'squeezing' of adjacent blood vessels (fat embolism, compartment syndrome).
      • Infections of bone and soft tissue (osteomyelitis, wound infection)
      • Necrosis (pathological tissue loss)
      • Nonunion fracture (poorly healed or unhealed fracture with abnormal mobility and persistent friction pain)

Dr Tonio Gottlieb:

“Only well-healed and professionally treated fractures offer the chance to restore the mobility and load-bearing capacity of the foot optimally and bring the associated body statics into line as ideally as possible.”


 

Are fractures in childhood dangerous?

How dangerous a fracture is in childhood depends on which bone is affected, how complex the fracture is and whether it is treated quickly and professionally.

Simple fractures, e.g. a smooth tibia fracture, can be classified as largely harmless if treated properly, because they can be treated well and normally heal without complications and much faster than in adults.

A fracture in the area of the feet, e.g. a transitional fracture of the ankle joint or a metatarsal injury, should always be treated by a specialist: The feet carry the entire body weight and are essential for the body's statics; a poorly healed foot fracture can significantly impair healthy development during the growth phase. This makes it all the more important to have a precise diagnosis and focused treatment by a podiatrist that is tailored to the special features of children's bone structures and growth processes.

How dangerous are foot fractures in old age?

A foot fracture always means an enforced period of rest, and especially in older people, bone fractures also heal more slowly. This is particularly disadvantageous because the motto "a rolling stone gathers no moss" is especially true for senior citizens.

Immobilisation of the foot with a cast or orthosis restricts mobility: Moving around with walking aids carries an increased risk of falling, physical rest in turn promotes the shortening of muscles and tendons. In the case of fracture-related bed confinement, attention should also be paid to decubitus prevention (lack of blood supply to certain parts of the body due to increased pressure over a longer period of time) and mental activation.

Can blood vessels be damaged in a fracture?

In a bone fracture, surrounding blood vessels can be damaged, both by bruising (contusion) and by sharp fracture edges of the bone fragments. In addition, fat droplets can penetrate the blood vessels and block them (fat embolism); furthermore, swelling and haemorrhages can increase the tissue pressure to such an extent that the blood vessels are squeezed (compartment syndrome).

Can nerve damage be caused by fractures?

In the case of fractures with extensive soft tissue injuries, nerve tracts can also be damaged, which can lead to sensory and motoric deficits. A precise individual case diagnosis and cause-oriented therapy is always required here.

Rehabilitation: How long does it take to heal a broken foot?

If you place yourself in the hands of an experienced foot surgeon, even complex fractures can be treated well in most cases. The healing time depends on which bone is affected, how serious the fracture was and which therapy was chosen:

Bone healing generally takes 4-8 weeks. A fracture of the metatarsal bones II-IV in the area of the head is usually healed after 4 weeks, a fracture close to the body at the metatarsal bone V, on the other hand, usually takes 8 weeks. In individual cases, it can take a year or more for the bone to regain its original strength.

After the examination with Dr. Gottlieb, you will always receive a well-founded prognosis; this can only take into account possible complications in the healing process to a limited extent.

How can a fracture be cared for postoperatively?

After foot surgery, the attending doctor will always give you individually adapted behavioural guidelines and tips to support the healing process in the best possible way. Basically important are:

      • Sufficient rest phases, in the first few days also elevated positioning and cooling
      • Appropriate activation for the purpose of muscle training & circulation activation, so that the tissue is optimally supplied with blood.
      • Avoiding smoking - smoking hinders blood circulation, slows wound healing and increases the risk of nonunion.
      • A healthy, balanced diet to ensure that sufficient nutrients are available for new bone formation - especially calcium and vitamin D.

What helps with poorly healed fractures or problems after foot surgery?

The skeletal structure of the foot is highly complex and bears the entire weight of the body. If a fracture heals poorly, this can lead to permanent impairments:

      • Foot pain when walking and/or at rest
      • Lack of mobility of the foot
      • Insufficient resilience of the foot
      • Malpositions and resulting incorrect stresses on the musculoskeletal system

Regardless of whether these problems occur after conservative therapy or after foot surgery, a foot specialist should definitely be consulted in such cases: Dr. Gottlieb has very deep and broad experience, also in the treatment of pre-operated feet. He will examine and advise you personally in order to restore your mobility and increase your well-being.

Whether a broken toe, fatigue fracture in the metatarsus or ankle fracture - with Dr. Gottlieb you are in very competent hands! Rely on the extensive expertise and many years of practical experience of the foot specialist to decide on conservative therapy or foot surgery. Arrange your personal consultation appointment now!