From the Guidelines
For an avulsion fracture in the foot, a posterior splint or a stirrup splint is typically used for initial immobilization. The choice of splint is crucial in managing avulsion fractures, as it provides stability and allows for swelling, which is common in foot injuries [@\1@].
Key Considerations for Splinting
- The posterior splint extends from below the knee to the toes, holding the ankle in a neutral position.
- A stirrup splint wraps around the foot and up both sides of the leg, providing additional support.
- The choice between these splints depends on the specific location of the avulsion fracture, with metatarsal or midfoot avulsions often managed with a posterior splint, while ankle-related avulsions may benefit from a stirrup configuration.
Accompanying Measures for Healing
- Elevation of the foot above heart level to reduce swelling.
- Ice application for 20 minutes every 2-3 hours to promote healing and reduce pain.
- Non-weight bearing status to prevent displacement of the bone fragment and allow the avulsed fragment to heal in proper position.
Importance of Follow-Up
The splint should be worn until follow-up with an orthopedic specialist, typically within 5-7 days, who will determine if continued immobilization or transition to a walking boot is appropriate [@\1@].
From the Research
Avulsion Fracture in Foot: Splint Used
- For a fifth metatarsal tuberosity avulsion fracture, the patient can be treated acutely with a compressive dressing, then transitioned to a short leg walking boot for two weeks, with progressive mobility as tolerated after initial immobilization 1.
- A study comparing the use of a walking boot and a short-leg cast for avulsion fractures of the base of the fifth metatarsal found that patients treated with a walking boot had less pain and better function than those treated with a short-leg cast 2.
- The walking boot allowed patients to return to their pre-injury level of function and pain approximately 3 weeks earlier than those treated with a short-leg cast 2.
- There is no specific evidence in the provided studies regarding the use of splints for avulsion fractures in other areas of the foot, such as the toes or metatarsals.
- However, for great toe fractures, a short leg walking boot or cast with toe plate is used for two to three weeks, then a rigid-sole shoe for an additional three to four weeks 1.
- For lesser toe fractures, buddy taping and a rigid-sole shoe are used for four to six weeks 1.