FRACTURE REPAIR 

FOOT & ANKLE FRACTURES

When patients have the unfortunate and unexpected experience of fracturing their foot or ankle, life, as you know it changes. It can feel like a being in a whirlwind of confusion with uncertainty of how your daily activities are going to transpire as you have now become severely limited in your physical abilities. Not only have you and may currently still be experiencing a significant amount of discomfort & pain but you have also become dependent on the help of others. This can be a very overwhelming affair in your life but rest assured you will recover and will eventually get back on your feet.

There are many different types of fracture injuries that can occur in the foot & ankle and it is highly based on the mechanism of injury. Whether the injury is a result from twisting your ankle, stepping in a hole, falling, dropping a heavy object on your foot, or even from a car accident, a variety of different fractures as well as multiple injuries can occur. It is important to have your injury examined by a specialist to determine the extent of the damage to ensure that you have the most optimal chance at a speedy and healthy recovery. If your injuries are ignored, you potentially could experience a lifetime of continued discomfort and physical disability.  

TREATING THE FRACTURE

Once you’ve been evaluated and x-rays have been obtained, your specialist will determine if surgery is required. If the broken bones are in a position where they can adequately heal if undisturbed, surgery may be deferred and you can be treated with a hard cast.

If the injury requires surgery, most foot and ankle fractures are not emergent cases and can be treated within a short time after the injury. In some cases it actually may be better to wait a few days before stabilizing the fractures to allow for swelling to decrease, which is vital for wound closer and for the skin to heal. Surgery for broken bones typically involves reducing the bones back into place and stabilizing the fracture site with a combination of plates, screws, and or pins. These are used to maintain strength and stability to the bones as they heal and commonly do not need removal unless they become an irritant or problematic during your recovery period.

When the surgery is complete, a post-operative block is administered around the surgical site to yield numbness and a painless recovery and return home. Even thought it is sometimes typical for the local anesthesia to render numbness to the foot until the following morning. A prescription for pain medicine and an anti-inflammatory will be given before the surgery and it is recommended that these be filled so that you have these ready after your surgery. I recommend that you begin using your pain medication around dinnertime the night of your surgery. Ice, foot elevation on a pillow, and rest will all help to aid in a smooth recovery after your procedure. 

RECOVERING FROM YOUR INJURY

The post-operative course and recovery period is the same for patients undergoing surgery or just getting a hard cast for the fracture. The hard cast is not to be changed or tampered with until seen by your doctor and is not to get wet. Patients are not permitted to walk on the foot and should use some form of assistance such as crutches. For those individuals unable to safely use crutches, other devices such as walkers, wheelchairs, and roll-a-bout scooters are excellent alternatives to navigate around while not putting the operative foot down. This is very important for optimal healing as this helps to protect the fracture site. If there is motion at the fracture site, this can potentially delay or even halt your healing. At six weeks, patients are typically transitioned to a walking boot and I encourage passive range of motion of the ankle at this point with the boot off. In the case of ankle fractures, the ERMI Ankle Flextionator is an excellent home physical therapy device that helps with increasing ankle range of motion. When instructed, patients begin weight bearing with the aid of crutches on an incremental basis by adding 10% of your body weight daily as tolerated on the foot. Over the course of the next few weeks, you are typically able to return to normal supportive shoes as tolerated. In general the recovery period involves two to three months until the individual is back to walking in normal shoes. 

OTHER THINGS TO CONSIDER 

Although everyone heals at a different rate, you can control some variables that can speed up your recovery. Probably the most important part of your recovery is staying off of your foot. If you walk on your cast, it can break down, your foot will become mobile and this can put extraneous stress and forces on your fracture site. This will most certainly cause a delay and in some cases alter your recovery. Stop Smoking! Although this can be a very stressful situation, smoking and its negative effects on bone healing have been well documented in medical literature. This alone can make the difference in prolonging your time in a cast and staying non-weight bearing. Another important factor is your activity level. The more active you are the more swelling you will experience and these directly correlates with the amount of discomfort that you have. Decrease your activities, rest, elevate your foot on a couple of pillows, and use ice behind your knee. Lastly, if your insurance permits, external bone stimulators are an excellent adjunct to facilitate osseous healing. These small ultrasound devices have proven to enhance the rate of bone healing in fresh fractures as well as those that have not healed in a timely manner. The device is painless, safe, and helps to stimulate bone healing.