Suffer a foot or ankle injury? Skip urgent care and come straight to the specialist

Falls, accidents, and injuries happen when we least expect it.  These incidents can leave you with painful injuries and in need of a fast diagnosis.  When it comes to foot and ankle trauma, myself and my colleagues at Castle Rock Foot & Ankle Care are here to help.  In fact, we make an extra effort to be available quickly when these injuries occur, with same or next-day appointments available specifically for trauma.  This allows our patients to skip the trip to urgent care and come straight to the specialist for definitive diagnosis and expert management.  Below I will review the most common foot and ankle traumatic injuries and their management

1. Ankle Fractures

Fractures of the ankle are most commonly a result of a rotational injury or trauma.  With the ankle joint consisting of the tibia, fibula, and talus, fractures can include a combination of fractures of these bones depending on severity.  Management of these fractures depends on the number of fractures, displacement of the fractures, and overall stability of the joint.  In cases of significant displacement of instability of the joint, operative treatment is indicated for a good clinical outcome, with the fracture being reduced and stabilized.  

2. Foot Fractures

Fractures of the foot comprises a large subset of injuries.  The most common foot fractures are fractures to the metatarsals, or the long bones of the foot.  Similar to fractures of the ankle, management of these fractures varies based on severity of injury, displacement, and location of the fracture.  A specific fracture to note is a fracture to the 5th metatarsal base.  This is a common injury that is associated with sprains of the ankle, as the peroneal tendons provide a distracting force at the metatarsal base and can lead to fracturing.  Location of this fracture can change management.  Blood supply to the base of this bone is not as robust as to other parts of the bone, meaning that in some cases in fractures that are displaced or in a specific location, stabilization with either a screw or plate and screws can be indicated.  These fractures are important to have evaluated, as treatment can vary significantly based on fracture location.  The second fracture sub-type to specifically discuss is fractures to the midfoot.  Often a result of either a twisting mechanism to the midfoot or crush injury, these injuries often consist of several, subtle fractures to the tarsal bone, specifically the metatarsal bases and their corresponding cuneiforms.  These fractures often require further imaging to better evaluate the extent of the fracture.  In some cases, a major ligament in the midfoot called the Lisfranc ligament can also be ruptured in these injuries.  In cases where this occurs, surgical stabilization of this ligament is imperative, as this has a major stabilizing function for the midfoot.

3. Calcaneal Fractures

The heel bone, also referred to as the calcaneus, is often fractured due to falls from height.  The bone is made up of a hard, cortical outer border and a softer, medullary center.  When this bone fractures, it tends to fracture into numerous fragments with a “blow-out” component as the talus that sits above it forcefully impacts down into the bone.  These fractures often require surgical reduction and fixation to re-align the subtalar joint cartilaginous surfaces and restore the shape of the bone.  Another subset of fractures to this bone include avulsion fractures, where the achilles tendon can fracture the back of the bone in what is referred to as a “beak” fracture or avulsion fracture.  These also require surgical stabilization, as the achilles provides a strong distracting force across the fracture.

4. Foot and ankle ligamentous and tendinous injuries

Not all foot and ankle trauma involves fracturing a bone.  Commonly, ligamentous or tendinous injuries occur via traumatic mechanisms.  The first to discuss is a rupture of the achilles tendon.  Often occurring in middle-aged males, this injury can be a quite devastating injury.  Quick, accurate diagnosis is essential, as this allows consideration of both non-operative and operative management.  Non-operative management consists of splinting the foot in a plantarflexed position to allow the tendon ends to heal to one another under good tension.  This is an option in ruptures that are diagnosed immediately and splinted in this position, as tension of the tendon is essential for good outcomes.  In cases of delayed diagnosis or higher demand patients, surgical repair of the rupture is indicated, and can be done via end-to-end repair, or percutaneous approaches.  No matter the treatment, recovery from this injury often can take 6-12 months for full functional recovery.  The second common ligamentous injury to discuss is ankle sprains, which can involve injury to one or more of the ankle ligamentous complex.  I wrote a previous blog a few months ago discussing this injury and the importance of appropriate management of these injuries.  Look back at this blog for more information!

No matter the injury, the doctors at Castle Rock Foot & Ankle Care are passionate about managing all forms of foot and ankle trauma.  If you suffer an injury, give the office a call, and we will make an effort to get you an appointment quickly to get you back on your feet!  

Author

Dr. Evan Smith Dr. Evan Smith is a Board-Qualified foot and ankle surgeon, providing personalized, high-quality care to the Castle Rock community as a physician with Castle Rock Foot & Ankle Care. Dr. Smith received a Bachelor of Science degree in Biology from Illinois Wesleyan University. He then went on to earn a Doctor of Podiatric Medicine degree at Des Moines University College of Podiatric Medicine and Surgery in Des Moines, Iowa, where he received The American Board of Podiatric Medicine Graduate Merit Award. Following medical school, he completed a three-year foot and ankle surgical residency program at Legacy Health in Portland, Oregon, gaining comprehensive training in all aspects of foot and ankle surgery. Dr. Smith takes pride in connecting with his patients and providing personalized care to get patients back to the activities they love.