First aid at home may include RICE (rest, ice, elevation, and compression) and weight bearing as tolerated. If the decision is made to seek medical care, this regimen may still be considered once the patient is discharged from the hospital to go home.
The treatment of a foot fracture depends upon what bone is broken, the mechanism of injury, the underlying medical condition of the patient, and whether the fracture is open (the skin is broken) or closed (the skin is intact).
Broken toes are often treated symptomatically, with the injured toe "buddy taped" to an adjacent normal toe. It may be helpful to place cotton balls or other absorbent material between the toes to prevent dampness and skin injury. A stiff-soled shoe and crutches may be needed to help with walking. Healing should occur with in 4 to 6 weeks.
Fractures of the great toe that are displaced may require surgery to allow better healing. An orthopedic surgeon or podiatrist may choose this option, but often that decision is made electively a few days after the injury.
Open fractures of the toe usually require good wound cleansing to prevent infection. At the same time the health care practitioner will often explore the wound, looking for foreign objects and evaluate the condition of deep structures like tendons, looking for lacerations.
Metatarsal fractures often heal nicely with conservative care, meaning no operation is needed. The foot is wrapped for comfort to decrease swelling and placed in an orthopedic post-op or Reese shoe.
- First metatarsal fractures that are aligned nicely may be treated with a post-op shoe and avoidance of weight bearing. If the fracture is displaced, meaning the bone fragments do not align, an operation to pin or plate the fracture may be considered.
- Second, third, and fourth metatarsal fractures tend to heal nicely with an ace wrap for support and weight bearing as tolerated. Stress fractures usually involve the second and third metatarsals.
- Fifth metatarsal fractures are of two types. If the fracture is at the very base of the bone, then treatment is the same as the other metatarsal fractures.
- Jones fractures of the fifth metatarsal shaft have a non-healing (non-union) rate of up to 50% and often require surgery to fix the fracture.
- Lisfranc fracture dislocation injuries require surgery for repair.
- The treatment of talus fractures depends upon where the fracture occurs.
- The top of the talus is dome-shaped and is part of the ankle joint, fitting into the base of the tibia or shin bone. This fracture may not be easily identified and sometimes can be mistaken for a non-healing ankle sprain. The treatment is rest and avoidance of weight bearing.
- Talar neck fractures often have difficulty healing because of poor blood supply. Surgery may be required if the bone is displaced, otherwise no weight bearing in a cast for 2-3 months may be required.
- A Shepherd fracture involves the posterior, or back part, of the talus and is seen in athletes who dance or kick. The treatment is immobilization in a cast.
- Lateral process fractures of the talus are becoming more common with the increased numbers of snowboarding injuries. Treatment includes no weight bearing in a cast.
- Calcaneus fractures require significant force to occur and are associated with a marked amount of swelling and pain. An orthopedic surgeon or podiatrist is often consulted to decide whether surgery is needed to stabilize the fracture. The health care practitioner will also look for associated injuries of the ankle, knee, hip, and lumbar spine.
Immobilization of the fractured foot will help with pain control. Ibuprofen (Advil, Motrin) can be helpful with pain control by decreasing inflammation in the area. Narcotic pain medication may also be prescribed if needed.
Rest, ice, and elevation will help limit swelling and decrease pain.
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