What Is Foot Fracture Surgery?
There are 26 bones in the foot, all of which can be fractured. There are different types of fractures. Sometimes a bone breaks but stays in place (non-displaced). Sometimes a bone breaks into two pieces that move apart from one another (displaced). Other types of fractures include a bone that is broken in multiple places (comminuted) and a bone that breaks through the skin after fracturing (open fracture).
If you injure your foot, your orthopaedic foot and ankle specialist will take X-rays to see if you have a fracture. X-rays will identify most fractures but some smaller and more subtle fractures may require CT or MRI scans to be seen. Not all fractures require surgery, and your foot and ankle orthopaedic surgeon will help determine how your fracture should be treated.
If you need surgery for your foot fracture, the goals are to restore the fractured bone to its correct position, stabilize the bone in this position, encourage healing, restore function and reduce the risk of future problems such as persistent pain, loss of motion, and arthritis.
All foot fractures are different, but generally speaking if a fracture is significantly displaced it is likely to benefit from surgery. This is especially true if a fracture enters a joint and the joint surface is disrupted and displaced. Restoring the alignment and stabilizing the fracture in its correct position will decrease the risk of future problems, such as pain, swelling, deformity, and arthritis.
In some cases, surgery may be appropriate for non-displaced or minimally displaced fractures if the fracture is likely to be unstable. In such cases surgery can maintain the alignment and encourage healing in the right position.
Even some non-displaced and stable fractures may benefit from surgery. One such fracture, called a Jones fracture, often is treated surgically in active and athletic individuals because it is likely to get them back to their activities more quickly than non-surgical treatment.
When the risks of surgery outweigh potential benefits, your foot and ankle orthopedic surgeon may recommend non-surgical treatment. This decision is made based on an understanding of your entire body, which only a medical doctor, like your foot and ankle orthopaedic surgeon, is trained to do. If you have a serious heart condition, for example, your doctor may recommend non-surgical treatment. He or she also may recommend that you see your cardiologist to determine if surgery is safe before proceeding.
Foot fracture surgery involves making an incision in the skin centered over the fractured bone. The bone is then exposed so the orthopaedic surgeon can see the fracture. The fractured bone fragments are realigned as well as possible and secured with implants such as pins, wires, screws and plates. Once the fracture has been stabilized the incision is stitched closed, a sterile bandage is added, and the foot is placed into a cast, splint, boot or post-operative shoe.
With some fractures, the alignment of the fractured bone can be restored with a closed manipulation of the foot under X-ray and may not require a large incision. If good fracture alignment can be achieved with this method, the fracture is fixed with appropriate implants through one or more small incisions. This is called a percutaneous fracture fixation. The advantages of this technique include smaller incisions, reduced trauma to the tissues, reduced disruption of the blood supply to the bone, and less post-op pain.
After surgery your orthopaedic surgeon will place your foot into a cast, splint, boot or post-op shoe. It is important to keep your foot elevated as much as possible to reduce pain and swelling. In most cases your doctor also will want you to stay off of your foot completely for four weeks to up to three months, depending on the injury.
A few weeks after surgery your doctor will check the wound and remove the stitches. Your foot and ankle orthopaedic surgeon may have you begin working on range-of-motion exercises of the ankle, foot and toes. You also may be referred to a physical therapist.
Your doctor will see you at regular intervals and check X-rays to see how well the fracture is healing. Based on your fracture type and this evaluation, your doctor will decide when you can begin to bear weight on the injured foot. He or she may have you begin weightbearing with a special boot and allow you to advance slowly to your normal footwear as symptoms allow. In most cases you can expect 3-6 months or more before you return to full activity without restrictions, and up to a year before you reach maximum improvement.
Risks and Complications
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. To minimize the risk for blood clots, you may be placed on aspirin or a blood thinning medication for several weeks after surgery. Unfortunately, even when on these medications, blood clots can occur post-operatively.
Potential complications of foot fracture surgery include wound breakdown, failure of the fracture to heal (nonunion), fracture healing in a bad position (malunion), loss of fracture alignment prior to healing, implant failure, persistent pain, loss of motion and arthritis.
Foot and ankle orthopaedic surgeons are uniquely qualified to identify and treat fractures of the foot and should be your first resource when an injury to the foot is suspected.
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