FOOT AND ANKLE TRAUMA

Image Credit: TD Podiatry

Our feet are one of the most multi-dimensional parts of our bodies. The functions of the foot and ankle in the body provide movement, stability and balance. From an anatomical perspective, the anatomy of the foot and ankle is composed of a variety of bones, joints, muscles, tendons and ligaments. With respect to the details, the foot and ankle is comprised of: 26 bones, 33 joints, muscles, tendons, ligaments , blood vessels, nerves, and soft tissue. All of these elements seamlessly flow together to create the foot and ankle system. 

What Are Ankle Fractures? 

As a hinge joint, the ankle joint is formed at the intersection of the tibia, fibula and talus. These are three of the largest bones in the foot and ankle mechanism. The tibia and the fibula form the vertical segments of the joint, while the talus comprises the foot bone. As a hinge joint, the motion activity possible via the joint is that of dorsiflexion and plantarflexion of the foot. Bound by strong tiobiofibular ligaments, the fibula and the tibia form a socket known as a mortise, that the talus fits into. They also are coated in a hyaline cartilage in order to facilitate smooth motion of the joint. 

The ankle as a joint, is quite fragile and with stresses from various activities such as sports, ankle injuries are one of the most common types of injuries in athletes or any persons involved in physically taxing work such as construction or industrial workers. Ankle injuries are quite painful, and they can result in impaired mobility if they are not monitored. When an ankle injury results from a torn ligament, the resultant condition is known as an ankle sprain. When the bone itself is fractured, the injury is known as an ankle fracture. Restoring the integrity of the ankle is critical regardless of the injury. 

What causes Ankle Injury? 

The root cause of ankle fractures is from the extraneous twisting of the ankle caused by vertical or horizontal stresses to the joint. Bone is a strong, yet highly inflexible substance. When struck with the right force however, it will absorb shock and can snap. Motions such as a jump, a blow or a fall can trigger this outcome. 

Symptoms Of An Ankle Fracture 

When an ankle is fractured, the body will actually make an effort to start the healing process. Patients who have ankle fractures experience: 

  1. Intense Pain
  2. Swelling (Almost instantaneous as the healing process begins)
  3. Hemarthrosis – Accumulation of blood around the wounded site 
  4. Impaired Mobility 
  5. Bone protrusion 

During this instance, seek medical attention as soon as possible. Fast action will be taken in order to restore and reset the joint. 

Classification of Ankle Fractures

There are differing types of ankle fractures, depending on the location of the joint that the fracture has taken place. These fractures include: 

  • Syndesmotic injury –  high ankle sprain 
  • Lateral Malleolus fracture – outer ankle fracture
  • Posterior Malleolus fracture – tibial bulb fracture 
  • Trimalleolar fractures – three lateral, medial, and posterior bones are fractured
  • Syndesmotic injury – high ankle sprain
  • Medial Malleolus fracture –  inner ankle fracture 
  • Bimalleolar fractures – lateral and medial malleolus bones fracture

A consultation with your orthopaedic surgeon will be able to quickly identify what the issue is, so that the appropriate plan of action can be taken. 

Diagnosis

As with all medical conditions, treatment cannot begin until there’s a thorough physical examination, that pinpoints what’s happening in the body. Your orthopeadic surgeon will usually utilize diagnostic tools such as X-rays and a CT scan in order to get a view of the site. An X-ray is critical to differentiating whether the injury is a sprain or a fracture. A stress test can also be applied in order to further diagnose the condition, and determine how stable the joint is. 

Treatments

Once the root cause of the ankle injury has been ascertained, the treatment process can then begin. Initially, to minimize the swelling and to soothe pain, ice packs can be applied to the area. If a fracture is stable, non-surgical methods can initially be utilized to restore the wound and realign the joint. The ankle bone is initially realigned and held in place with a plaster cast or splint for a few weeks. 

In cases of joint instability, surgical methods must be employed in order to realign the joint. During surgery, your orthopaedic surgeon will make an incision into the area and then reinforce the ankle joints with a series of plates and screws that will strengthen, realign and stabilize the joint. After closure, the ankle is then covered in a cast for the healing. 

Post-operative Care

After an  ankle surgery, limited mobility will be advised for up to six weeks. Once the surgery is completed, the next phases of the process involve at home care. Before the surgery, your orthopaedic surgeon will let you know what items you’ll need to have on hand to ensure that you have the optimum care at home. Limit your driving during the healing process, and arrange for someone to drive you to any critical activities such as for doctor visits and physical therapy. Physical therapy is ideal for healing. With this therapy, normal activity can be resumed after a few months. 

No surgical procedure is perfect, and there are often complications that can arise. Talking to your orthopaedic surgeon about the risks will appease your mind with respect to your treatment and healing. Fortunately, the need for repeat surgeries to repair a fracture is rare. 

Foot Fracture

Within the foot itself, there are three subsections: the hindfoot, midfoot and the forefoot. The entire foot has 26 bones that are dispersed across these segments. The hindfoot consists of the talus and the calcaneous bones. The midfoot consists of the navicular, cuboid, and three cuneiform bones. The forefoot has the most bones with  five metatarsal bones and fourteen phalanges or toe bones. A series of muscles, tendons and ligaments work together to create a stable, flexible system. When stresses are induced to the foot, fractures can occur and these small cracks are known as stress fractures. 

Types of foot fractures

Depending on the location of the bone, the stress fractures can be classified into different categories: 

  • Calcaneal fractures:  heel bone impacted by high impact
  • Talar fractures: stress fractures occurring at the neck or mid portion of the talus.
  • Navicular fractures – stress induced 
  • Lisfranc fractures: torn midfoot ligaments

What are the causes of Foot Fractures?

Foot fractures via a series of high impact stresses to the foot. These stresses include a fall, a heavy object being dropped on the foot or from high impact activities in a sporting activity. 

Symptoms

  1. Intense Pain
  2. Swelling (Almost instantaneous as the healing process begins)
  3. Hemarthrosis – Accumulation of blood around the wounded site 
  4. Impaired Mobility 

Diagnosis

As with all medical conditions, treatment cannot begin until there’s a thorough physical examination, that pinpoints what’s happening in the body. Your orthopeadic surgeon will usually utilize diagnostic tools such as X-rays and a CT scan in order to get a view of the site. An X-ray is critical to classifying your foot fracture. 

Treatment

Treatment depends on the type of fracture identified. Just like the ankle fractures, there are both non-surgical and surgical treatments for a foot fracture. Applying the RICE method:

Rest
Ice
Compression
Elevation of the foot.

In some instances, your orthopaedic surgeon will prescribe a splint or cast to keep the area stable, and to facilitate the healing process. The bones are one of the slowest healing parts of our bodies and they have to be kept immobile for months in order to facilitate the healing process. With the advent of technologies such as stem cells and growth factors, the healing process can be facilitated. Physical therapy can also be applied in order to strengthen and restore mobility to the foot. 

Summary

Stress fractures are small cracks that can occur in the bones of the lower leg and in the feet. Overworked or stressed bones have limited ability to absorb stresses and can deform and even snap when impacted. Intense exercise or impacts from a fall can induce stress fractures. Athletes, and employees that work in highly physically demanding jobs are at the highest risk of developing stress fractures. Statistically, women have been found to develop more stress fractures than men. Treatments can take place via non-surgical or surgical methods, depending on the severity of the condition. 

Reference: 

  1. Foot And Ankle Trauma: http://www.drbrendanricciardo.com.au/orthopaedic-surgeon-perth-mandurah-esperance-wa-foot-and-ankle-trauma.html

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Dr. Gordon Slater

Dr. Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions.

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Dr Gordon Slater is a highly-skilled surgeon specialising in foot and ankle conditions and sports injuries. Dr Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions. MIS  has many advantages including shorter operating times, reduced post-operative pain, reduced risk of infection, minimal scarring and better cosmetic outcomes.

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