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What are fractures?

Foot and ankle fractures, or breaks in the bone, come in many different varieties: ankle fracture,  heel bone fracturemetatarsal fracture5th metatarsal fracturepilon fractureLisfranc fracture and snowboarder’s fracture, to name just a few.

Overusing the bones can cause stress fractures and these occur frequently in runners or others pursuing sports involving repetitive strain.

What causes ankle fractures?

An ankle fracture is characterised by a break in one or more of the three ankle bones: the tibia, fibula and talus. The two ankle joints: the ankle joint (the point at which the tibia, fibula and talus meet) and the syndesmosis joint (located between the tibia and fibula) may also be affected. Ankle fractures are a familiar injury which can result in instability, if not treated properly, leading to the probability of further problems.

The reason for the frequency of ankle fractures is that the ankle bears your entire bodyweight and endures additional strain when running, jumping or participating in sport.

Ankle fracture

Heel bone (Calcaneum) fracture

The heel bone or calcaneus, lying below the ankle joint, is the biggest tarsal bone. Along with the talus, it makes up the subtalar joint which enables the lateral movement in the hindfoot, essential for balance, particularly on bumpy terrain.

Metatarsal fracture

Each foot contains five metatarsal bones, linking your ankle to your toes, assisting balance when walking or standing and supporting the foot when you move. Metatarsal bone fractures occur frequently and are especially common for footballers.

A fracture is either described as ‘open’, if the skin is broken and the bones protrude, or ‘displaced’ in cases of bone misalignment.

5th metatarsal fracture

The 5th metatarsal bone is connected to the little toe on the foot’s outer edge.

Pilon fracture

A pilon fracture affects the shinbone or tibia, together with the weight-bearing surface of the ankle joint. Often, the fibula is also broken. The word ‘pilon’ is French for ‘pestle’, the utensil used when crushing, because the bone is frequently crushed or fragmented in a pilon fracture.

Lisfranc fracture

A Lisfranc or midfoot injury occurs when the midfoot bones are broken, or the ligaments that support the midfoot are torn. Sometimes, a Lisfranc injury can be wrongly diagnosed as an ankle sprain. The midfoot’s job is to add stability to the foot, support the arch and facilitate the transfer of energy from the calves to the forefoot when walking. If this area is damaged, it can lead to arthritis and flat foot.

Snowboarder’s fracture

This type of injury occurs when the lateral process of the talus on the outside of the ankle, just above the heel, is fractured. It often occurs the toes are dorsiflexed (brought towards the shin), leading to the talus being locked in place by the surrounding bones. With the foot in this position, and if the ankle is rolled outwards with too much force, the bone will fracture. Sometimes this injury is mistakenly diagnosed as an ankle sprain that hasn’t responded to treatment, despite the apparently normal appearance of your X-rays.

Stress fractures

Stress fractures are one of the most frequent sports injuries, with women suffering from them more often than men. These injuries are small cracks in the bone, triggered by overuse. Fractures occur when fatigued muscles can no longer absorb the shock of an impact created by a repeated movement. Stress fractures often happen in bones that bear the heaviest load, such as the second and third metatarsals in the foot, which are not only thinner than the first metatarsal but also take the brunt of the impact when running or walking. Stress fractures can also affect the heel (calcaneus), the outer bone of the lower leg and ankle or fibula, the talus (in the ankle joint) and the navicular, which is located on top of the midfoot.

Dancers often have stress fractures in the navicular or metatarsal bones. Walkers and runners are more likely to suffer stress fractures in their metatarsal and calcaneal bones.

Stress fractures in the heel area may be related to tibial and femoral neck stress fractures. These fractures higher up the leg are to be treated with extreme caution because, if they turn into a complete fracture or the bones misalign, it can lead to an aggressive form of arthritis. Should the bone in your femoral head die, a total hip replacement will be necessary.

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