Foot and ankle fractures and trauma

Fractures we treat

• Ankle fractures, of one or more of the bones that form the ankle joint, from a stable crack to an unstable break with ligament damage.^[1,5]
• Metatarsal fractures, including the fifth metatarsal on the outside of the foot, where the exact location of the break decides whether a boot is enough or surgery is safer.^[6]
• Stress fractures of the metatarsals, heel bone, navicular and ankle, common in runners, soldiers and anyone who ramps up activity quickly.^[3] Our article on stress fractures in runners covers the warning signs.
• Midfoot (Lisfranc) injuries, which can look deceptively mild on the first day and are easy to miss.^[7]
• Toe fractures, which usually heal with buddy-taping and a stiff-soled shoe.

Trauma care

Beyond fractures, foot trauma includes crush injuries, lacerations, nail-bed injuries, dislocations and tendon injuries. The first priorities are the same: check circulation and nerve function, protect the skin, stabilize the injury, and control swelling. Treatment may include splinting or casting, ice and elevation, pain relief, and later rehabilitation, with surgery when the injury needs it.^[1]

How we evaluate it

We examine the foot and ankle for tenderness over specific bones, swelling, deformity, circulation and sensation, and take X-rays at the practice when a fracture is possible.^[8] Stress fractures don’t always show on early X-rays, so MRI or CT is arranged when the history points to one and the X-ray is normal.^[2]

Treatment

• Protection and healing: a walking boot, a cast or a stiff-soled shoe, with weight-bearing guided by the type of fracture.^[1,2]
• Follow-up X-rays to confirm the bones stay aligned as they heal.
• Rehabilitation to restore motion, strength and balance, and a graded return to work and sport.
• Surgery when the bones are displaced, the joint is unstable, or the fracture is in a location that heals poorly without fixation.^[5,6]

For stress fractures, finding and fixing the cause (a jump in training, shoes, low bone density, nutrition, or foot mechanics) matters as much as healing the bone.^[9]

Common questions

I can walk on it. Can it still be broken?

Yes. A simple break in one bone may not stop you from walking.^[1] Tenderness right over a bone, or being unable to take four steps, after an injury is the usual reason to take an X-ray.^[8]

How long does a fracture take to heal?

Most ankle fractures take at least six weeks for early healing and ten to twelve weeks to heal completely; it can take several months more to stop limping and return to sport.^[1] A stress fracture typically takes six to eight weeks, and longer for more serious ones.^[2]

When can I drive?

Not while your right foot is in a cast or boot. After a broken right ankle, most people can probably drive again at around nine to twelve weeks; we’ll tell you when your ankle is ready.^[1]

Are some stress fractures more serious than others?

Yes. Stress fractures at the base of the fifth metatarsal (a Jones fracture) and in the navicular bone heal poorly because of their limited blood supply, and surgery is more often recommended for them.^[2] They need prompt, careful treatment rather than “walking it off.”

When to seek care