What is Tarsal Fracture

A tarsal fracture is a break in one of the bones that are located in the middle and back of your foot (tarsals). There are seven tarsal bones in your foot that make up your heel, the arch of your foot, and connections to the long bones of your toes.

Types of tarsal fractures include:

• Cracks in a bone (stress fracture). This is most common in the tarsal bones of the heel and top of the foot.
• A completely broken bone that has not moved out of place (nondisplaced fracture).
• A completely broken bone that has moved out of place (displaced fracture).
• Multiple breaks resulting in three or more bone pieces (comminuted fracture).

What are the causes?

This condition may be caused by:

• Repeated stress on the tarsal bones over time.
• An injury that forcefully twists your foot.
• Falling from a height.
• A hard, direct hit or a crushing injury to your foot.

What increases the risk?

This condition is more likely to develop in people who have weak bones (osteopenia or osteoporosis). You may also be at greater risk for a stress fracture if you start a new athletic activity or try to advance too quickly. Tarsal fractures are also more common in athletes who participate in:

• Soccer.
• Basketball.
• Track or cross country.
• Dancing.
• Gymnastics.
• Football.

What are the signs or symptoms?

Foot pain is the most common symptom of this condition. The pain is typically:

• Felt in the middle of your foot.
• Described as achy, dull, or vague.
• Better with rest and worse with activity.
• Increased when you lean your body weight on your foot or rise up on tiptoe.

Other symptoms include:

• Foot swelling.
• Bruising.
• Pain when pressing on the top or bottom of your foot (tenderness).

How is this diagnosed?

This condition is diagnosed based on your symptoms and medical history, especially if you recently had an injury. Your health care provider will also do a physical exam to check for bruising, swelling, and painful movement of your foot. You may be asked if you can stand up on tiptoe or hop. Diagnosis is usually confirmed by:

• X-rays to check for a complete, displaced, or comminuted fracture.
• MRI or another imaging study if your health care provider suspects a stress fracture but cannot see it on an X-ray.

How is this treated?

The first treatments for stress fractures and nondisplaced fractures are usually nonsurgical. These may include:

• Using a boot or cast to keep your foot still (immobilization) and protect it while it heals.
• Using crutches to keep weight off your foot.
• Physical therapy to improve motion and strength.
• Medicine for pain.

If you have a displaced or comminuted fracture that makes your foot unstable, you may need surgery. This may include using screws, wires, or plates to provide stability. After surgery, you will need to wear a cast and eventually have physical therapy.

Follow these instructions at home:

If you have a boot:

• Wear the boot as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the boot if your toes tingle, become numb, or turn cold and blue.
• Do not let your boot get wet if it is not waterproof.
• Keep the boot clean.

If you have a cast:

• Do not stick 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 not put lotion on the skin underneath the cast.
• Do not let your cast get wet if it is not waterproof.
• Keep the cast clean.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• If your boot or cast is not waterproof, protect it with a watertight covering when you take a bath or a shower.

Managing pain, stiffness, and swelling

• If directed, apply ice to the injured area.
  • Put ice in a plastic bag.
  • Place a towel between the bag and your boot, cast, or skin.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your toes often to avoid stiffness and to lessen swelling.
• Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

Driving

• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe to drive if you have a boot or cast on your foot.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.

Safety

• Do not use the injured limb to support your body weight until your health care provider says that you can. Use your crutches as told by your health care provider.

General instructions

• Do not put pressure on any part of the cast until it is fully hardened. This may take several hours.
• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. Tobacco can delay healing. If you need help quitting, ask your health care provider.
• Take over-the-counter medicines, prescription medicines, and vitamin supplements only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Give your body time to rest between periods of activity.
• Wear comfortable and supportive footwear when being active.
• If you are starting a new activity, build your time or distance gradually.
• Make sure to use equipment that fits you.
• Be safe and responsible while being active to avoid falls.
• Maintain physical fitness, including:
  • Strength.
  • Flexibility.
• Participate in alternative physical activities (cross train) to avoid over-stressing one area of your body.
• Include foods that contain calcium and vitamin D as part of a balanced diet to support strong bones. These include milk, beef liver, egg yolks, fatty fish, soybeans, dark leafy greens, cheese, and fortified cereals.

Contact a health care provider if:

• Your pain medicine is not helping.
• You cannot do your home care exercises because of pain or stiffness.
• Your boot or cast gets damaged.

Get help right away if:

• You have severe pain.
• Your toes turn pale and cold or blue.
• You lose feeling in your toes (have numbness).
• You have pain, redness, warmth, and tenderness in the back of your leg.
• You have chest pain or difficulty breathing.

Tarsal Fracture Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your foot. These exercises also help to relieve pain and stiffness.

Exercise A: Ankle alphabet

1. Sit with your left / right leg supported at the lower leg.
   1. Do not rest your foot on anything.
   1. Make sure your foot has room to move freely.
2. Think of your left / right foot as a paintbrush, and move your foot to trace each letter of the alphabet in the air. Keep your hip and knee still while you trace. Make the letters as large as you can without feeling discomfort.
3. Trace every letter from A to Z.

Repeat __________ times. Complete this exercise __________times a day.

Exercise B: Gastrocnemius, standing

1. Stand with your hands against a wall.
2. Extend your left / right leg behind you, and bend your front knee slightly.
3. Keeping your left / right heel on the floor and keeping your back knee straight, shift your weight toward the wall without arching your back. You should feel a gentle stretch in the back of your lower leg (calf).
4. Hold this position for __________ seconds.
5. Return to the starting position.

Repeat __________ times. Complete this stretch __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your foot. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise C: Dorsiflexors

1. Secure a rubber exercise band or tube to an object, such as a table leg, that will stay still when the band is pulled.
2. Secure the other end around your left / right foot.
3. Sit on the floor, facing the object with your left / right leg extended. The band or tube should be slightly tense when your foot is relaxed.
4. Slowly flex your left / right ankle and toes to bring your foot toward you.
5. Hold this position for __________ seconds.
6. Slowly return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Plantar flexors

1. Sit on the floor with your left / right leg extended.
2. Loop a rubber exercise band or tube around the ball of your left / right foot. The ball of your foot is on the walking surface, right under your toes.
3. Hold the two ends of the band in your hands.
4. Slowly point your toes downward, pushing them away from you.
5. Hold this position for __________ seconds.
6. Slowly return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Single leg stand

1. Stand near a railing or in a doorway. You may hold onto the railing or door frame as needed.
2. Stand on your left / right foot. Keep your big toe down on the floor and try to keep your arch lifted.
3. Hold this position for __________ seconds.
4. If this exercise is too easy, you can try it with your eyes closed or while standing on a pillow.

Repeat __________ times. Complete this exercise __________ times a day.