Feet are common site of injuries, especially in young children. The most common mechanism is when a large heavy object falls directly onto the foot. Most of these injuries occur in the metatarsals or in the toes. Fractures can occur in any bone of the foot. The most devastating are fractures of either the calcaneus or talus bone. Many of these fractures require surgery for the best outcomes. In many cases, fractures of the metatarsals and phalanges can be treated with a brief period of immobilization without any surgery needed.
ACUTE FOOT INJURIES
There are 5 metatarsals in the foot, with the 1st metatarsal being in line with the big toe and the 5th metatarsal being in line with the little "pinky" toe. Many injuries occur from crush injuries when something heavy lands directly on the top of the foot. The 2nd-5th metatarsals are firmly attached together, and thus when one is broken, the attachments prevent the bones from separating too far from each other. Because of these attachments, surgery is rarely necessary. Treatment typically consists of either a boot or cast, which is applied anywhere from 3-8 weeks. The longevity and type of mobilization depend upon the age of your child as well as the location and severity of injury.
The "Jones Fracture" is a special fracture that occurs at the base of the 5th metatarsal (closer to the cuboid bone). When a fracture occurs in this area, it is less likely to heal due to the poorer blood supply in the area. Depending upon a multitude of factors, some of these fractures may have a better outcome with surgical fixation. If your child has been diagnosed with one of these fractures and you would like to discuss this fracture with a COA surgeon, please do not hesitate to schedule an appointment today.
PHALANAGEAL (TOE) FRACTURES:
There are 2 phalanges that make up the "big toe" and 3 phalangeal fracture that make up the lesser toes (toes 2-5). They are even more susceptible to fracture than metatarsals. Often times, the toes are either "stubbed", or again, an object may land on the toe, causing it to break. In general, as long as the toe visually look straight, then no surgical treatment is needed. The toe can often be "buddy taped" to the adjacent toe for 2-3 weeks. If the toe visually looks crooked, then it may benefit from being set and then pinned surgically to prevent the toe from becoming crooked again.
A special situation is a fracture patten called a "Seymour's Fracture". In this type of fracture, the nail is injured, and then there is a fracture below the nail. Technically, these are "open" fractures, which means that the bone is exposed to air, and thus, surgery to wash the toe is often recommended. In addition, the tissue of the nail is often stuck in the fracture site, and needs to be removed from the fracture to try and allow the toe to grow normally in the future.
If your child has recently "stubbed" his toe, has an obvious injury to the nail, and has been diagnosed with a fracture of the toe, please contact us today to ensure that the fracture is treated appropriately.