a young couple treating the man's ankle injury
May 17, 2019 | by The Polyclinic

By: Sarah Burns DPM, FACFAS and Daniel Lowinger DPM, FACFAS

Evaluating Acute Foot Trauma

Broken or fractured toes are the most common type of foot trauma, followed by metatarsal fractures. Significantly displaced or bent fractures should be evaluated to determine the need for surgical reduction, which sets the bones back into place. Fifth metatarsal fractures are variable and sometimes difficult to treat.

Depending on where the broken bone is in the foot, typical treatment could involve weight-bearing in a cast boot, non-weight bearing activity or surgery.

Seeking Specialized Care for Lisfranc Ligament Rupture

One of the most commonly missed diagnoses in foot and ankle trauma is a Lisfranc ligament rupture. This injury is associated with tenderness at the top of the foot between the first and second metatarsal base, pain with stress of the midfoot joints in any direction, and significant swelling and often bruising at the dorsal midfoot. This injury requires specialized care, often surgery. Surgical repair of a ruptured Lisfranc ligament is recommended for most active healthy patients and should be performed as soon as possible after the injury.

This injury can have long-term painful side effects, such as post-traumatic osteoarthritis, if treatment is neglected. First metatarsal fractures and multiple metatarsal fractures should always be evaluated by a foot and ankle surgeon. Midfoot stability may be compromised.

Diagnosing Achilles Tendon Ruptures

Achilles Tendon Ruptures are rarely missed and feel like “someone hit me in the back of the ankle with a baseball bat.” They may occur in an older, more sedentary person who may rupture just walking in the home because of chronic degeneration of the tendon or fluoroquinolone antibiotic use. These patients may describe feeling a sudden sense of weakness, or difficulty walking. Like Achilles tendon ruptures, physical exam, ultrasound, or MRI may assist in diagnosis.

Treating Ankle Sprains

Ankle sprains can present in many forms. General guidelines for initial treatment managed by a medical provider include:

  • Immobilize in a cast boot with or without crutches and refer to foot and ankle if bruising, inability to bear weight, history of multiple sprains on the same ankle.
  • If significant swelling occurs, use cast-boot immobilization for at least two weeks. A cast boot is recommended at night while sleeping as well. A night splint may be substituted.
  • If there’s minimal swelling and you’re able to bear weight, bracing and physical therapy may be appropriate.

Follow-up treatment: if swelling improves and you’re able to bear weight comfortably, it’s okay to transition to bracing and physical therapy. Continuation of the night splint may be helpful for an additional two weeks if swelling and pain are not improving, or if complaints of weakness refer to foot and ankle.

Avoiding Long-Term Problems

Incomplete healing of the ligaments may result in long-term instability and pain. These concerns may be evaluated by stress X-ray and MRI and if conservative treatment fails or is thought to be ineffective, treatments may include injection, arthroscopy, or ligament repair.

Contact Us for Care

If you have questions about ankle and foot injuries, call The Polyclinic Podiatry Department at 206-860-4457 for expert diagnosis and comprehensive treatment.

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