Diagnostics
The diagnosis always begins with a medical consultation with the patient. By describing the course of the accident and the symptoms, the doctor can already make the first suspected diagnosis. This is followed by a physical examination.
However, a clear diagnosis can only be made by X-ray examination. The X-ray examination must always be carried out in two planes, since a fracture can be overlooked in one plane. In rare cases, computed tomography (CT) or magnetic resonance imaging (MRI) must also be used. Magnetic resonance imaging in particular can rule out damage to the tissue in the area of the tarsal bones. Furthermore, it must be examined whether the fracture has caused injury to vessels or nerves.
Classification
The fractures of the tarsal bones are divided into different classes. These classes are determined by the cause of the fracture, the mechanism of origin, the degree of continuity interruption, the course of the fracture line and the number of fracture pieces. A distinction is made between flexural, crack, compression, shear, rotational and comminuted fractures. A further distinction is made between open and closed fractures. An open fracture is one in which part of the bone protrudes from the skin.
Duration
The duration of healing or the time until the foot can be loaded again depends, among other things, on the bone affected by the fracture. If, for example, a fracture of the ankle bone occurs, the foot must be immobilized for eight weeks and no weight must be placed on it. The ankle bone is of extraordinary importance for the function of the foot because it carries the entire body weight with every step.
The treatment always takes place in combination with physiotherapy to maintain the mobility of the foot. If there is a fracture of the smaller tarsal bones, such as the cuboid bone, the healing time is a little shorter. It is usually between six and eight weeks.
Treatment (conservative)
As a rule, when a tarsal bone is broken, a plaster is applied and possibly a splint is worn to aid healing. The plaster must then be worn for several weeks.Depending on the severity of the injury, movement exercises can be performed during the healing process. However, the foot must be completely unloaded so that only movements are performed and no weight is placed on the foot.
In some cases, however, fracture healing should be completed before the foot is exercised. The foot is then immobilised with a plaster cast. After the foot has been immobilized in a cast, a hindfoot relief boot is often used, which relieves the heel area in particular and distributes the weight more evenly over the forefoot.
In the course of time, the rearfoot can then be subjected to more and more stress. This relief is recommended for eight to twelve weeks, depending on the type of fracture. In complicated cases it may be necessary to treat the fracture surgically.
This is the case if the fracture is displaced or if there are bone splinters in the upper ankle joint, for example. Especially fractures of the calcaneus and the ankle bone are often operated on, as exact reduction is particularly important in these cases. In the case of a fracture of the remaining tarsal bones, surgery is only considered in the case of very severe displacement or severe destruction of the bones.
The operation can be performed openly or, as is now almost common, as a minimally invasive procedure via arthroscopy. For the operation, the fracture is stabilized either with drill wires or with screws. In contrast to other bone fractures, the materials are usually not removed again.
If there is a dislocation at the same time, this can also be corrected during the operation. After an operation, the foot is usually immobilized in a plaster cast, but this is not always necessary. Depending on the type of operation, the foot is stable enough after the operation so that specific strengthening exercises can be performed.
However, these are only movements. It is important that no load in the sense of weight is placed on the foot. Therefore, the patient should always use crutches until the final healing process is complete. Similar to the conservative treatment with a plaster cast, the foot must not be subjected to any load for about eight weeks during the surgical variant.
