Fractures of bones about the foot and ankle

In a generally healthy human foot, fractures which do not involve the joint will heal spontaneously. Help and comfort is often achieved by means of a cast or a splint.

However, the axis of the bone must be preserved thus preserving the normal weight-bearing patterns of the foot. For this reason, fractures of the “long” bones within the foot, the metatarsals, must often be operated on to restore alignment.

If a fracture involves a joint, the joint surface and its cartilage layer may be displaced. If this is the case, the joint will not work properly anymore (even after the fracture has healed!) and it is quite likely that the joint will degenerate prematurely, becoming painful and impairing function.

The foot has 28 bones and more than 30 joints and therefore fractures about the foot very often involve joints. Fortunately, not all of these joints are essential for proper function and therefore exact repair is necessary only for certain bone fractures.

The fractures are always articular fractures and must be analysed carefully with x-rays. A large majority of these fractures must be operated on, by means of precise, minute repositioning of the fracture fragments and then they need to be fixed with implants such as plates and screws to achieve a good final result (“internal fixation”).

Precise and meticulous repair of the joint surfaces also allows active mobility of the joint very soon after such repair while avoiding the premature degeneration mentioned above.

In our practice, so-called malleolar fractures, if seen within the first hours after the accident, can be treated and operations performed on an out-patient basis.

This bone is situated just below the tibia and thus is involved in malleolar fractures.

If fractured itself, this bone should be repaired by means of an operation in all cases, regardless of the location of the fracture.

This bone is located just below the talus and is the bone of the heel. In our opinion, if a fracture of this bone involves one of its 3 joint surfaces, only an internal fixation can provide a solid and functional reconstruction.

The same holds true even in cases of intact joints because the axis and outer shape of the bone is severely altered through the fracture.

Combined talus and calcaneus fractures should always be treated by open reduction and internal fixation.

This bone is located just in front of the talus and is part of the most important joint of the foot.

If this bone is fractured, which is rare, an internal fixation will optimize the final result in most cases.

This bone is located on the external side of the foot, just in front of the calcaneus. As a small “cuboid” bone, it links the lateral metatarsals (for the 4th and 5th toe) to the calcaneus.

If this bony link undergoes deformation due to a fracture, the whole foot is at risk of deformation. In these cases, the fracture is best treated by internal fixation.

These lesions are at least as complex as their name. Known also as “Lisfranc’s” dislocations they are always partly dislocation and partly fracture. What is fractured is basically the “basis” of the metatarsals, especially the second one, which correspond to the axis or the “roof” of the foot.

As we humans have 5 rays which end with 5 digits or toes, these lesions may end in converging or diverging dislocated rays. Thorough early diagnosis is mandatory since mild dislocations might be overlooked.

These fracture-dislocations must be treated by operative minute re-orientation of the metatarsal rays thus achieving an anatomical alignment of all five metatarsal heads.

The bones of the toes are numerous and in cases of fracture do not need systematic internal fixation.

However, if there seems to be a high risk that the toe will not touch the ground after bone healing, it may need some operative alignment.

It is better to light a lamp than to curse the darkness (Lao Tseu)