fracture
Since fractures can occur any where in the human body there are plenty of reference sites on the internet that discuss the mechanism and treatment of fractures in general.
Having said that, the first foot fracture I would like to mention are stress fractures. They are not limited to the foot, but are very common in the foot. Stress fractures are basically caused by too much repeated pressure on a bone forcing it to break. Women with low estrogen levels and people with metabolic disease are more susceptible to this condition. The most common site for stress fractures is the metatarsal bone.
Notice the x-ray below. The fracture line is easily identified.
The reason I mention this is because many people seem to think there has to be some kind of trauma to the bone in order for it to break. This is not always the case. Over the years I have seem many patients present to the office complaining of pain, redness and swelling in the forefoot and are shocked when I tell them they have a fracture. A typical scenario may have been spending a day walking in the city wearing dress shoes, carrying packages that may have added additional weight to your feet or forced you to walk in a more abnormal manner. However, rarely during the day will you remember any kind of trauma to the foot. You get home, one foot may be a little sorer than the other, but when you wake up the next morning the affected foot is very sore, generally red, and usually swollen in the area. In simple stress fractures where the two broken ends line up next each other and there is virtually little space between the two ends, a surgical shoe, that is a stiff flat-bottomed shoe will suffice, until the bone heals. The good news is that the lion’s share of stress fractures are of this nature The other very common type of fracture seen in the foot is a fracture of one or more of the toes. There is almost always a history or trauma, usually stubbing your toe against the bedpost when going to the bathroom during the middle of the night (hence the name bed-post fracture). In this case the toe will usually be painful, red, bruised and swollen. The reason I even bother to mention toe fractures is that there is a general misconception that there is no treatment for toe fractures. That could not be further from the truth. The toe is very similar to the finger and there certainly is treatment for finger fractures. The severity of the fractured toe determines the treatment. For the vast majority of fractured toes the treatment is simple. The fractured toe has to be taped to the adjacent toe. By doing this you are able to somewhat immobilize the fractured toe so it can heal. If a fracture site is not adequately stabilized the fracture may not heal (some simple fractures will heal on their own). When a fracture does not adequately heal you are left with scar tissue in the fracture site and what is known as a pseudoarthrosis. The significance of this is the fact that the toe may always continue to hurt, thus requiring surgical intervention, or at the very least you will always be the one who can predict when it is about to rain, because the toe will start bothering you, (changes in barometric pressure with irritate the fracture site). I find that once I demonstrate to the patient how to properly tape the toe they are usually able to get their foot into a wide boxy shoe. Dress shoes are out until the bone is healed, even if the toe does not hurt, the dressier the shoe the more it may force a poor alignment of the broken toe. The other misconception that patients have is my ability to look at a foot or toe and tell if it is broken. The only way to know is through an x-ray (sometimes small fractures will not show up and a bone scan or MRI need to be performed to find the break.) When I “guess”, to appease the patient, I am wrong in about fifty percent of the cases. Lastly, in the foot there are two areas that are prone to taking “forever” to heal even in simple fractures. These are the neck of the talus and the base of the fifth metatarsal bone. The diagram below shows the two places where fractures can take longer to heal. The top arrow is the neck of the talus, usually the result of a sudden upward jarring of the foot as seen in car accidents, and the bottom arrow points to the fifth metatarsal base more commonly known as a Jones fracture which can be the result of trauma, a forceful twisting motion or the breaking of bone as a result of the tendon that attaches to the base pulling (avulsing) part of the bone off. As a general rule, if you sprain your ankle and have x-rays of the ankle taken, you should also have x-rays of the fifth metatarsal base taken as well.
The reason for this is that both areas are poorly vascularized meaning the blood supply to these areas is less than the other surrounding bones. Since blood is the vehicle that carries healing nutrients to an area, any site that has diminished blood flow will have longer healing tendencies. I mention this so that if you happen to be suffering from a fracture in one of these sites you should not be alarmed if it takes longer than usual. Many times in addition to the standard treatment of immobilization for a broken bone, these two sites may require a bone stimulator to heal the fracture or even surgery to fix the break. You should by all means discuss this with your doctor.
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