Diagnosis
The diagnosis of a foot fracture can usually be made by the physician already by questioning the patient after an accident (anamnesis) and the clinical examination. Certain clinical signs of a bone fracture are an axial malposition, abnormal mobility, visible bone fragments in open fractures or crackling and crunching noises (crepitations) that occur when the bone fragments rub together. Uncertain signs of a bone fracture, on the other hand, are pain, swelling, bruising (haematomas), overheating and restricted mobility.
X-ray diagnosis is also necessary when there are certain fracture signs. For this purpose, images are taken in several planes. More complicated fractures can be better recorded with a computer tomography image. If stress fractures or soft tissue injuries are suspected, magnetic resonance imaging may be useful.
Cause
The treatment of fractures of the foot depends strongly on the bone affected, the type and complexity of the fracture and the degree to which the surrounding soft tissue is affected. The treatment of a toe fracture can be conservative or surgical, depending on the findings. In most cases, even comminuted fractures of small toes, a conservative procedure is sufficient.
This therapy is based on the principle of immobilization, which ensures that the bone fragments can grow together again in a regular manner. A special immobilizing bandage is used for this purpose, which is left on the foot for a few weeks. Furthermore, a support can be integrated into the sole of the shoe.
Often the broken toe is attached to the neighboring toe, which increases the support effect. In case of displaced (dislocated) fractures of the toe bones, a device (reduction) must be passed into the correct position before immobilization, which is usually done under local anesthesia (local anesthesia). Swelling of the toes can be improved by cooling and elevating the leg.
Painkillers such as NSAIDs (non-steroidal anti-inflammatory drugs, e.g. ibuprofen or diclofenac) and pain ointments help to relieve the pain of a toe fracture. Surgery is most often performed on the base limb of the big toe. The operation can also be performed under local anesthesia.
First, the fragments are set up (reduced). The fractures are then held together with a wire so that they can grow together (osteosynthesis). The insertion of screws or plates may also be necessary.
In most cases, the inserted foreign material is removed after a few weeks or months. Also in the case of metatarsal fractures, reduction, if necessary, is the first step. The latter are fractures in which the soft tissues above the bone are severed, so that the fracture gap is connected to the outside world via the open wound and germs (contamination) can enter the fracture.
A stable closed fracture can now be immobilised for a few weeks with a plaster cast. If the closed fracture is unstable, the metatarsal fracture is fixed with so-called Kirschner wires. This procedure can be performed percutaneously (through the skin) and does not necessarily require open surgery.
Fractures that cannot be reduced from the outside must always be brought into the normal position by surgery and then fixed. In the case of open fractures, reduction is also performed first, followed by fixation. This often results in severe damage to the soft tissue, so that only a preliminary reduction and antibiosis are performed.
Once the soft tissue has recovered, the therapy follows in the form of final reduction and fixation with an external fixator (external fixation) or Kirschner wires. The wires are usually removed after a few weeks, but can also be left in the foot. Depending on the injury and severity, conventional (non-surgical) and surgical treatment may also be considered for tarsal fractures.
The conventional methods ensure immobilization and adhesion of the bone fragments by means of a plaster cast. The surgical procedures first reduce the fracture and then stabilize it. Afterwards, active movement therapy is very important to restore the mobility and functionality of the foot.