From the Guidelines
Foot fractures should be treated with immobilization and offloading, using a knee-high device, to reduce mechanical stress and promote healing, as recommended by the most recent guidelines 1.
Treatment Overview
The treatment of foot fractures depends on the location and severity of the fracture. For minor fractures, the RICE protocol (rest, ice, compression, elevation) is recommended initially, along with over-the-counter pain medications like acetaminophen or ibuprofen for pain management.
Immobilization and Offloading
More severe fractures may require immobilization with a cast, walking boot, or rigid shoe for 4-8 weeks. Displaced fractures often need surgical intervention with internal fixation using screws, plates, or pins.
- Immobilization and offloading are crucial to reduce mechanical stress and promote healing, as discussed in the guidelines for active Charcot neuro-osteoarthropathy in persons with diabetes mellitus 1.
- A knee-high device, such as a total contact cast (TCC) or a non-removable knee-high walker, can be used to offload the foot and reduce plantar pressure 1.
Surgical Intervention
Surgical intervention may be necessary for fractures that are severely displaced or comminuted, or for fractures that fail to heal with conservative treatment.
- The goal of surgical reconstruction is to restore a plantigrade foot that is less prone to ulceration, by redistributing plantar pressure throughout the foot 1.
- However, surgical intervention is associated with high complication rates, and the risk-benefit ratio should be carefully considered before intervening surgically 1.
Weight-Bearing Restrictions and Physical Therapy
Weight-bearing restrictions vary by fracture type, ranging from complete non-weight-bearing to partial weight-bearing with assistive devices.
- Physical therapy is typically introduced after the immobilization period to restore strength, flexibility, and function, and to promote proper healing and prevent long-term mobility issues and pain 1.
From the Research
Types of Foot Fractures
- Metatarsal shaft fractures: typically treated with a posterior splint and avoidance of weight-bearing activities, followed by a short leg walking cast or boot for four to six weeks 2
- Proximal fifth metatarsal fractures: treatment varies depending on the location of the fracture, with a fifth metatarsal tuberosity avulsion fracture treated with a compressive dressing and a short leg walking boot, and a Jones fracture requiring at least six to eight weeks in a short leg non-weight-bearing cast 2
- Great toe fractures: treated with a short leg walking boot or cast with toe plate for two to three weeks, followed by a rigid-sole shoe for an additional three to four weeks 2
- Lesser toe fractures: treated with buddy taping and a rigid-sole shoe for four to six weeks 2
Diagnosis and Management
- Diagnosis of foot fractures typically requires radiographic evaluation, although ultrasonography may be just as accurate 2
- Management of foot fractures is determined by the location of the fracture and its effect on balance and weight bearing 2
- Weight-bearing and duration of immobilization are based on the stability of the fracture and the patient's pain level 3
- Many foot fractures can be managed with a short leg cast or boot or a hard-soled shoe 3
Complications
- Common complications of foot fractures include arthritis, infection, malunion or nonunion, and compartment syndrome 3
- Excessive immobilization from continuous use of a cast or splint can lead to chronic pain, joint stiffness, muscle atrophy, or more severe complications 4, 5
- Certain materials and methods of ideal cast and splint application are recommended to prevent morbidity in high-risk patients 5