Tarsal Fracture

Tarsal Fracture



Description


A tarsal fracture is a broken bone in the back half of the foot (hindfoot). The tarsal bones are the major bones of the hindfoot and include the talus, which is part of the ankle, and the calcaneus, or heel bone.



Common signs and symptoms



• Sharp pain, especially with standing or walking on the foot; may be preceded by a dull pain for 2 weeks to 2 months

• Tenderness, swelling, and later bruising of the foot

• Numbness or paralysis from swelling in the foot, causing pressure on the blood vessels or nerves (uncommon)


Causes


Tarsal fracture is caused by a direct blow or twisting injury to the foot or ankle, repetitive high-impact loads to the foot, or landing wrong on the foot and ankle. To break any of these bones usually requires a significant injury or force.



Factors that increase risk



• Participation in contact sports, distance running, and sports that require jumping and landing (basketball, volleyball)

• Previous foot or ankle sprains or dislocations or repeated injury to any joint in the foot

• Poor physical conditioning (strength, flexibility)


Preventive measures



• Appropriately warm up and stretch before practice and competition.

• Maintain appropriate conditioning that includes cardiovascular fitness and strength, flexibility, and endurance training.

• For participation in jumping sports (basketball, volleyball) or contact sports (football, rugby), protect vulnerable joints with supportive devices, such as braces, wrapped elastic bandages, tape, or high-top athletic shoes.

• Wear proper protective equipment, and ensure a correct fit.


Expected outcome


With appropriate treatment and normal alignment of the bones, healing can be expected in 6 to 8 weeks. Occasionally, surgery is necessary to realign fractures that are displaced.



Possible complications



• Nonunion (fracture does not heal)

• Malunion (fracture heals in a bad position)

• Chronic pain, stiffness, or swelling of the foot

• Excessive bleeding in the foot or at the dislocation site, causing pressure and injury to nerves and blood vessels (rare)

• Bone death due to interrupted blood supply associated with the fracture

• An unstable or arthritic joint following repeated injury or delayed treatment


General treatment considerations


If the bones are in appropriate alignment, the initial treatment consists of ice and elevation of the injured foot and ankle at or above heart level to reduce swelling. Crutches and medications help to relieve pain. Immobilization by splinting, bandaging, casting, or bracing for 6 or more weeks, usually while using crutches and not walking on the injured foot, are recommended to protect the bones while they heal. Severe fractures, breaks that are not in appropriate alignment (displaced), or multiple foot fractures may require surgery to restore and maintain the joint in its normal position. Surgery usually includes repositioning the bones and holding them in place with plates, screws, or pins. After immobilization (with or without surgery), stretching and strengthening of the injured and weakened joint and surrounding muscles are necessary because of the injury and the immobilization. Usually these are done with the assistance of a physical therapist or athletic trainer. A stiff-soled shoe and arch supports (orthotics) may also be required when returning to sports.



Medication



• Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen (do not take for 7 days before surgery), or other over-the-counter pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician, and contact your doctor immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Stronger pain relievers may be prescribed as necessary. Use these only as directed, and take only as much as you need.


Cold therapy


Cold is used to relieve pain and reduce inflammation for acute and chronic cases. It should be applied for 10 to 15 minutes every 2 to 3 hours as needed and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.


image

Figure 1


From Jenkins DB: Hollinshead’s functional anatomy of the limbs and back, ed 6, Philadelphia, 1991, W.B. Saunders, p 286.



When to call your doctor



• Pain, tenderness, or swelling worsens despite treatment.

• You experience pain, numbness, or coldness in your foot.
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Jul 19, 2016 | Posted by in SPORT MEDICINE | Comments Off on Tarsal Fracture

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