Avulsion Fracture of the Foot

What is Avulsion Fracture of the Foot

Avulsion fracture of the foot is a tearing away of a piece of bone in the foot. Bones are connected to other bones by strong bands of tissue (ligaments). Muscles are also connected to bones with strong bands of tissue (tendons).

Avulsion fractures occur when severe stress on a ligament or tendon causes a small piece of bone to be pulled away from the main portion of the bone. This is typically caused by trauma or injury.

Athletes may develop an avulsion fracture of the foot gradually (chronic avulsion fracture). Common locations of avulsion fracture of the foot are the heel bone and the long bone in the foot that connect to the fifth toe (fifth metatarsal bone).

What are the causes?

This condition may be caused by:

  • A sudden or repetitive twisting or rolling of your foot or ankle.
  • A fall.

What increases the risk?

You are more likely to develop this condition if:

  • You participate in activities during which twisting the ankle or foot are likely, such as:
    • Dancing.
    • Track and field.
    • Walking on uneven surfaces.
  • You have had diabetes for many years.
  • You have osteoporosis.
  • You are female and older than age 70.

What are the signs or symptoms?

The main symptom of this condition is intense pain at the time of injury. You may also feel a pop or tearing. Other signs and symptoms may include:

  • Swelling in the heel area.
  • Bruising in the heel and ankle.
  • The injured area feeling warm to the touch.
  • Pain with movement or when you use your foot to support your body weight (weight-bearing).
  • Pain when pressure is applied to the injured area.
  • Difficulty walking.

How is this diagnosed?

An avulsion fracture is usually diagnosed with a physical exam and imaging tests, such as:

  • X-ray. This will show if any bones are fractured or out of place (displaced).
  • MRI. This will show your tendons and ligaments. Some avulsion fractures are associated with an injury to a tendon or ligament.
  • CT scan. This will show a more detailed image of your injury than an X-ray does.

How is this treated?

Treatment for this condition depends on the size of the torn piece of bone and how far it has been displaced.

  • Treatments for small avulsion fractures may include:
    • Rest, ice, pressure (compression), and raising (elevating) your injured foot (RICE therapy).
    • Preventing the injured foot from moving (immobilization) for up to six weeks. This may be done by wearing a boot, a stiff-soled shoe, or a cast. Crutches may also be used to help support your body weight until your foot heals.
  • Treatment for large avulsion fractures may include:
    • Surgery to reattach the bone to the tendon or the ligament.
    • Crutches or a rolling scooter to support your body weight until your foot heals.
  • Other treatments may be recommended, including:
    • Physical therapy to regain full use of your foot. This may last for several months.
    • Medicines that reduce pain and swelling (NSAIDs).

Follow these instructions at home:

If you have a cast, boot, or a stiff-soled shoe:

  • Loosen the boot or shoe if your toes tingle, become numb, or turn cold and blue.
  • Wear the boot or shoe as told by your health care provider. Remove it only if your health care provider tells you to do that. Use crutches as told.
  • Do notstick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
  • Check the skin around the cast every day. Tell your health care provider about any concerns.
  • You may put lotion on dry skin around the edges of the cast. Do notput lotion on the skin underneath the cast.
  • Keep the cast, boot, or shoe clean and dry.
  • If the cast, boot, or shoe is not waterproof:
    • Do notlet it get wet.
    • Cover it with two layers of watertight covering when you take a bath or a shower.

Managing pain, stiffness, and swelling

  • Apply ice to the injured area.
    • If you have a removable boot or stiff-soled shoe, remove it as told by your health care provider.
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag or between your cast and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.
  • Take over-the-counter and prescription medicines only as told by your health care provider.

Keep your foot raised above the level of your heart when you are sitting or lying down.

General instructions

  • Rest your foot until your health care provider says that you can resume activity.
  • Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay bone healing. If you need help quitting, ask your health care provider.
  • Keep all follow-up visits as directed by your health care provider. This is important.

Contact a health care provider if:

  • Your pain gets worse.
  • You have chills or a fever.
  • You have any of these problems with your cast:
    • It is damaged.
    • It has a bad odor or has stains caused by fluids from the wound.
    • It feels like your cast is a bit tight.

Get help right away if:

  • Your foot is cold, blue, or pale.
  • You have pain, swelling, redness, or numbness below your cast.
  • You have numbness or tingling in your foot.
  • You have increased pain in your foot or have pain that is not relieved by pain medicine.
  • You cannot move your toes or foot.

Summary

  • A trauma or injury may cause an avulsion fracture of the foot, where severe stress on a ligament or tendon causes a small piece of bone to be pulled away from the main portion of the bone.
  • There are surgical and non-surgical treatment options. You and your health care provider will discuss the type of injury that you have and the options that are best for you.
  • It is important to keep all follow-up appointments with your health care provider.
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