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© Copyright 2019 by Jonathan Hook DPM, MHA. All Rights Reserved.

FOOT & ANKLE INJURIES

Foot and Ankle Fractures:

Fractures of the foot and ankle commonly occur secondary to trauma and unless severe, can go unnoticed because a patient may believe they have only sprained the soft tissue in that area. Symptoms of fractures include pain, discomfort during weight bearing, pain with movement of the nearby joints, bruising of the skin, and in emergent cases, loss of feeling and blood flow. After a thorough history and physical examination, a diagnosis of these injuries is confirmed by obtaining an X-Ray during your appointment with Dr. Hook. Further imaging such as a CT scan or an MRI may be needed for atypical fractures and any necessary surgical planning.

Depending upon the severity, type, and location of the fracture, you may require surgery. During any fracture surgery, the goal is to realign the broken portion of bone utilizing implanted hardware to improve healing and reduce the chance of arthritis later in life. Ankle fractures, heel (calcaneus) fractures, Lisfranc (midfoot) injuries, Jones fractures, stress fractures are the most common fractures Dr. Hook treats both surgically and conservatively.

Ankle Fractures:

A broken ankle is also known as an ankle fracture. This means that one or more of the bones that make up the ankle joint are broken. An ankle fracture typically occurs when you twist or 

rotate your ankle, roll your ankle, trip or fall, or impact your ankle in a car accident. A fractured ankle can range from a simple break in one bone to several fractures. In general, the more bones that are broken, the more unstable the ankle becomes. There may be ligaments damaged as well. The ligaments of the ankle hold the ankle bones and joint in position.

If the fracture is not out place and the ankle is stable, it can be treated without surgery. Nonoperative treatment typically involves a short leg cast or a walking boot followed by a course of physical therapy to improve ankle range of motion. If the fracture is out of place or if the ankle is unstable, the injury is typically treated with surgery. There is a wide range of surgical techniques available to treat ankle fractures. These surgeries can be completed in either an inpatient and outpatient basis. The postoperative course consists of approximately 4-6 weeks of no weight-bearing with crutches or a walker. All patients complete a course of physical therapy after surgery to improve ankle range of motion and overall function.

Calcaneus Fractures:

A fracture of the heel bone (calcaneus) can be a severe and disabling injury. Calcaneus fractures commonly occurs due to a high impact injury such fall from a ladder or a car crash. The mechanism of the fracture involves the heel bone becoming crushed and fractured under the weight of the body. When this occurs, the heel can widen, shorten, and become deformed.

Treatment often involves surgery to reconstruct the normal anatomy of the heel and restore mobility so that patients can return to normal activity. However, even with appropriate treatment, some fractures may result in long-term complications, such as pain, swelling, loss of motion, and arthritis. The postoperative course consists of approximately 4-6 weeks of no weight-bearing with crutches or a walker. All patients complete a course of physical therapy after surgery to improve foot and ankle range of motion and overall function.

Lisfranc (Midfoot) Injury:

Lisfranc (midfoot) injuries involve the bones and ligaments in the middle of the foot. The severity of the injury can vary from simple to complex, involving many joints and bones in the midfoot. These injuries can happen with a simple twisting injury, direct trauma, or a fall from a height. The symptoms of this injury may include pain and swelling, bruising, and pain that worsens with standing, walking, or attempting to push off on the affected foot. The pain can be so severe that crutches may be required.

If there are no fractures or dislocations of the joints and the ligaments are not completely torn, conservative treatment with a cast or boot may be all that is required for healing. Dr. Hook will want to follow up with you regularly and take additional x-rays to make sure your foot is healing. In the course of follow up, if there is any evidence that the bones in the injured joint have moved, then surgery will be needed to put the bones back in place.

Surgery is indicated for all injuries with fracture that involves abnormal positioning (subluxation) of the joints. The goal of surgical treatment is to realign the joints and return the broken bone fragments to a normal position. These surgeries can typically be completed in the outpatient setting. The postoperative course consists of approximately 4-6 weeks of non-weight-bearing with crutches or a walker. All patients complete a course of physical therapy after surgery to improve ankle range of motion and overall function.

 

Fifth Metatarsal (Jones) Fracture:

The fifth metatarsal is the long bone on the outside of your foot. A Jones fracture is a fracture through the base of the fifth metatarsal. This usually occurs from an injury where the foot and ankle are twisted downward and inward. Most fifth metatarsal fractures can be treated with weight bearing in a walking boot.

 

Jones fracture are unique fractures that may take longer to heal because of their location and the associated blood supply to the bone itself. In active individuals and when there is displacement of the fracture, surgery is often required to treat the fracture. In some cases, a Jones fracture may not heal at all, a condition called nonunion. Surgery is often required to treat a nonunion. These surgeries are minimally invasive and requires one screw to be placed percutaneously into the fifth metatarsal bone fracture. Surgery is typically be completed in the outpatient setting. The postoperative course consists of approximately 2 weeks of no weight-bearing with crutches or a walker. All patients complete a course of physical therapy after surgery to improve ankle range of motion and overall function.

Stress Fractures:

Stress fractures are small cracks in bone that occur due to overuse and increased activity. In the foot and ankle they commonly occur in the metatarsal bones. Stress fractures are often the result of increasing the amount or intensity of an activity too rapidly; such as increasing mileage too quickly during marathon training. Patients typically describe foot or ankle pain with activity that subsides with rest.

 

The most common way to diagnose a stress fracture is with an x-ray. At times, the stress fracture cannot be seen on regular x-rays. Occasionally, a computed tomography (CT) scan or magnetic resonance imaging (MRI) will be necessary. Stress fractures are typically treated with immobilization in a walking boot. Sometimes stress fractures may not heal (nonunion) which may require operative intervention.