Broken Foot

Broken foot symptoms are crack sound, misshapen, numbness, tingling, and severe pain at the broken bone.

Broken bones (also called fractures) in the foot are very common. Feet are very vulnerable to slipping and twisting. Our feet and toes lead us around when we walk and are on the receiving end of dropped objects. About one out of every 10 broken bones occurs in the foot.

The foot is divided into three parts: the hindfoot, the midfoot, and the forefoot.

The foot has 26 bones and is divided into three parts: the hindfoot, the midfoot, and the forefoot.

• Hindfoot: There are two bones in the hindfoot—the talus, which is where the foot attaches to the ankle and the rest of the leg, and the calcaneus, which forms the heel.
• Midfoot: Five smaller foot bones called the navicular, cuboid, and three cuneiform bones make up the midfoot.
• Forefoot: The long part of the foot is called the forefoot and contains 19 bones. There is a metatarsal bone for each of the five toes; the big toe is made up of two phalanges, and the other toes each have three phalanges.

In addition, the foot sometimes has small pebble-like bones called sesamoid bones. These bones do not perform any necessary function and are often called accessory bones.

A common symptom of broken bones in the foot is pain and swelling. The foot pain may be so bad that you may not be able to walk. Broken bones in the toes cause less pain, and you may be able to walk with a broken toe.

Other symptoms of a broken foot may include the following:

• Bruising or redness of the foot 
• Inability to bear weight on the foot 
• Deformity of toes (dislocation) 

Depending on the bone that is broken, the type of fracture, and whether it involves another soft tissue injury or sprained foot or ankle, you may be able to walk on a broken foot.

Until you see a doctor for a diagnosis and treatment plan, however, you should not walk on a suspected broken foot, because walking on a broken foot too soon could cause more damage to the foot. The doctor will tell you whether you can walk on a broken foot or not.

Bones break when something happens to crush, bend, twist, or stretch the bone.

• Toes are often broken when someone accidentally kicks something hard.
• Heels are often broken when a person has a high-impact fall or jumps from a height and lands on his or her feet.
• Other bones in the foot sometimes break when they are twisted or sprained.

Most bones break suddenly during an accident, trauma, or immediate injury. Occasionally, small cracks can form in bones over a long period of time from repeated stress on the bones. These are called stress fractures. They occur most commonly in athletes such as dancers, runners, and gymnasts or in soldiers hiking in full marching gear.

Broken bones are more common in children than in adults:

• In adults, bones are stronger than ligaments (which connect bones to other bones) and tendons (which connect bones to muscles). But in children, ligaments and tendons are relatively stronger than bone or cartilage. As a result, injuries that may only cause a sprained foot in an adult may cause a broken bone in a child.
• However, a child's forefoot is generally flexible and very resilient to injuries of any kind. When metatarsal or phalangeal fractures do occur, they may be difficult to recognize because many parts of a growing child's bone do not show up well on X-rays. For this reason, it is sometimes helpful to get X-rays of the child's other, uninjured foot to compare to the hurt foot.

The doctor will ask the patient about the injury and examine the foot. X-rays are often useful in diagnosing broken bones in the foot.

Injured toes usually are treated in the same way whether they are broken or just bruised, so X-rays are optional for these injuries.

Sometimes a doctor's examination is all that is needed to be certain bones in the midfoot are not broken. Doctors use certain guidelines to decide if an X-ray is needed. If none of the following are present, an X-ray is not required:

• Pain when the doctor pushes over the base of the fifth metatarsal bone (outside edge of the foot)
• Pain when the doctor pushes over the navicular bone
• Inability to take four steps with full weight bearing on the injured foot without pain, both immediately after injury and at the time of the examination

Other imaging methods (such as a bone scan, CT scan, MRI, or ultrasound) can be performed to look for unusual or hidden injuries to the bones of the foot, but are rarely needed. These tests generally are not obtained while in the emergency department and usually are ordered only after consultation with a foot surgeon or orthopedist.

It is important to see a doctor if you think you may have broken a bone in your foot. Go to an emergency department or urgent care center where X-rays can be performed.

For less severe injuries, your doctor may want to see you in the office. If you think you have broken your foot, and your doctor is not available by phone or is not calling you back, go to the emergency department to be examined.

Have someone bring you to the doctor or emergency department. Do not attempt to drive with a broken foot.

Go immediately to the nearest emergency department or call 911 if these conditions develop with a suspected broken foot:

• The foot is blue, cold, or numb.
• The foot is misshapen, deformed, or pointing in the wrong direction.
• There is a large cut or open wound near a possible broken bone.
• You have severe pain.
• You feel you need immediate treatment for any other reason.

First aid for foot injuries involves stabilization and elevation of the injured foot.

• Splint: Any splint that keeps the injured foot from moving is effective. Often a pillow wrapped around the foot like a stirrup and then taped or tied with a bandage works well. Do not wrap the foot so tightly that it cuts off the blood supply to the foot. Any splint that causes the foot to hurt worse, turn blue, or makes it more difficult to wiggle the toes should be removed right away.
• Elevation: Elevation of the injured foot reduces swelling and pain. The foot should be at a level higher than the rest of the body. Lie flat with the foot propped up on several pillows.
• Ice: Wrap ice in a towel and apply it to the injured foot to reduce swelling and pain for the first several hours after an injury. Apply ice for 20 minutes at a time every hour while awake after the injury for one day.
• Rest: Do not attempt to walk on an injured foot if walking is painful.
• Medications: Over-the-counter (OTC) pain medications—such as acetaminophen (Tylenol), or nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen (Advil, Motrin) or Aleve (naproxen)—may be taken to reduce pain and swelling.

Injured toes usually heal well even if they are broken; however, if the toe seems to be deformed or is pointing in the wrong direction, consult a doctor.

• Treatment typically involves splinting the injured toe to the good toe next to it. This is called "buddy taping."
• Some thin padding (usually cotton balls) is placed between the injured and good toe(s) and they are taped securely with a wide medical tape. They should be secure enough to provide support but not so tight as to cut off blood supply to the toes.
• A stiff-soled shoe—such as a flat firm sandal or a rigid flat-bottom shoe from a medical supply store—is also helpful.

Treatment for a broken bone in the foot depends on which bone is broken and how it is broken. Some broken bones in the foot can be treated with crutches and flat-bottom shoes; others require splints, casts, or boots; and still, others require surgery to repair the bones.

Crutches are used to help the injured person walk when the foot is broken.

• When walking using crutches it is important that they fit properly and that you use them correctly. Your doctor should adjust your crutches to fit you and show you how to use them.
• When using crutches, put your weight on your arms and hands. Do not put your weight on your underarms (armpits). This could hurt the nerves in your underarms.
• To avoid falling, use your crutches only on the firm ground.

Your doctor will tell you whether or not you should bear any weight on your injured foot.

• To use crutches in a "non-weight bearing" way, keep the knee of your injured leg bent whenever you walk to prevent the injured foot from ever touching the ground. Do not let it touch even to help with balance.
• To use crutches for "partial weight bearing" or "weight bearing as tolerated," you can let your injured foot touch the ground only when the crutches are also touching the ground so that some of your weight is on your foot and some are on the crutches. Always let your injured leg swing with the crutches. If it hurts when you walk, put more weight on the crutches and less on your injured foot.

Follow-up with your doctor or orthopedist often is needed post-op to make sure foot fractures are healing well. Follow-up is particularly important if pain continues or if you have difficulty walking, in order to ensure proper healing and prevent re-injury.

The outlook for a foot fracture depends on which bone(s) of the foot were fractured, and the severity of the injury. For most simple fractures, the healing process takes about six to eight weeks without surgery. Severe fractures may require surgery and more recovery time.

• Toe fractures are common and generally heal well with little or no therapy. Although the bones may take 6-8 weeks to heal, pain usually improves much earlier. Rarely, very severe fractures, especially of the big toe, may require a cast or surgery.
• Metatarsal fractures usually heal well. The first metatarsal (the one attached to the big toe) sometimes requires a cast or surgery and a prolonged period on crutches, but the middle three metatarsals can usually be treated with a rigid flat-bottom shoe and partial weight bearing. "March fracture" is a metatarsal stress fracture that commonly occurs in joggers and requires the person to stop jogging for four to six weeks.
• The fifth metatarsal (the one attached to the pinkie toe) is the most commonly broken bone in the midfoot. There are two general types of these fractures:
  • One type is the proximal avulsion fracture. These are very common and usually happen at the same time as a sprained ankle. They heal very well with a rigid flat-bottom shoe or elastic bandage and weight bearing as tolerated.
  • The other type is the Jones fracture, which is much less common but does not heal as well. This fracture worsens with time if you keep walking on it, so the non-weight bearing is very important. People with this fracture often develop problems healing that requires surgery.
• Lisfranc fractures are fractures at the joint between the cuneiforms and the metatarsals (mid-foot). These are rare but can be difficult to diagnose and treat. Weight-bearing X-rays (taken while standing on the injured foot) with comparison views of the uninjured foot or CT scans are sometimes needed to diagnose this problem. These fractures sometimes require surgery.
• Navicular fractures are rare and most often represent stress fractures in young athletes. They usually heal well with a rigid flat-bottom shoe and weight bearing as tolerated. Severe fractures through the navicular bone sometimes require surgery.
• Calcaneal (heel bone) fractures often occur in people who fall or jump from a height and land on their feet. These people often have other injuries as well, so they should be examined carefully. The most common fracture of the calcaneus, the intraarticular joint depression fracture, usually requires surgery. Other fractures of the calcaneus can usually be treated with splints or casts and non-weight bearing.
• Talus fractures are difficult to diagnose and treat. Lateral process fractures often occur from snowboarding injuries.
• Posterior process (Shepherd) fractures are found in athletes who dance or kick. The diagnosis of these injuries often cannot be made in the doctor's office or emergency department during the initial visit and require bone scans or other imaging studies if symptoms continue. Treatments vary, but often splints or casts and a period of non-weight bearing are required.

A broken foot may be diagnosed by a general practitioner (family doctor, internist, pediatrician), or an emergency medicine doctor in a hospital. The person with the broken foot may be referred to a podiatrist (foot specialist) or a board-certified orthopedic surgeon (bone and joint specialist) for the care and further treatment of your broken foot depending on the severity of the injury or need for possible surgery.

• Construction workers and others at risk for foot injuries should always wear steel-toed protective boots.
• Always perform sports with well-fitting supportive athletic shoes.
• When riding in a car, do not allow passengers to dangle feet out the window or place feet up on the dashboard.
• Always wear a seatbelt when riding in a car.