Foot Injuries
This page was last updated: April 21st, 2022
Coronavirus / COVID-19 update
During the COVID-19 risk period, wherever possible we’ll be reducing face-to-face appointments and helping you manage your injury remotely. This means that, in accordance with the British Orthopaedic Association guidelines, your individual treatment and follow-up plan may be different to what happens under normal conditions. An orthopaedic consultant or a member of the orthopaedic team will always review your notes and x-ray, and decide if a face-to-face follow-up is necessary.
If we haven’t asked to see you for a follow up, we may offer you an open appointment, where you can make an appointment to see someone at any time in the six months after your injury. If you’d like to book an appointment, please call 01736 758892.
About your foot
Your foot is a complex part of your body. It has 26 bones in 3 sections.
Muscles, tendons and ligaments support the bones and joints of your feet so that they can support your whole body weight while walking, running and jumping. Despite this, trauma and stress can cause bone breaks or severe injuries in the foot.
The hindfoot
It has 2 bones. The talus bone which connects to the bones of your lower leg and the calcaneum bone which forms your heel. Fractures in your hindfoot, for example your heel, happen because of extreme force.
The midfoot
It includes the navicular, cuboid, and 3 cuneiform bones.
The forefoot
It has 5 metatarsal bones and 14 toe bones called phalanges.
A joint called the mediotarsal separates your hindfoot from your midfoot.
The Lisfranc joint separates your midfoot from your forefoot.
See the individual care plan below for your type of fracture to understand more about your injury, treatment and how to recover.
Advice for a recent foot injury
In the first 72 hours, it’s important to:
- rest your foot – you may have been told to keep all weight off your injured foot
- elevate it above hip level
- apply a cold pack regularly
- protect your foot by using crutches and a boot for walking
Rest
Ice
Compression
Elevate
Rehabilitation
Medication
The Emergency Department (ED) or a Minor Injuries Unit (MIU) may have prescribed you with some pain relief. Take these as instructed to help manage the pain.
If you do not feel that this medication is helping, talk to us during your appointment in Fracture Clinic, or your GP, about an alternative option.
Cold packs
Ice is a great natural anaesthetic that helps relieve pain and controls swelling. Apply ice packs or a bag of frozen peas wrapped in a wet thin towel to your foot for up to 15 minutes every few hours.
Do not place ice in direct contact with the skin.
Do not leave the ice pack on for more than 20 minutes at a time in one hour.
Rest and elevation
It’s normal to experience swelling after your injury. Elevation reduces swelling, which in turn relieves pain and speeds up your healing. Keep your foot elevated as much as possible during the first 24 to 72 hours.
Raise your leg on a stool or cushions above the level of your hip to elevate it as much as possible.
The swelling is often worse at the end of the day, elevating it will help with this.
Smoking
Medical evidence suggests that smoking prolongs fracture healing time. In extreme cases it can stop healing altogether. Stopping smoking during the healing phase of a fracture will help ensure optimal recovery from this injury.
For advice on stopping smoking and local support available, please discuss this with your GP or go to the NHS Smoke Free website.
Helping your recovery
Being healthy can help you recover from your injury faster. Eating well, staying hydrated and keeping as active as possible will all help. We’ve put together a set of videos on all the things you can do to help you recover as quickly as possible.
Care plans for your foot injury
Click on the box with your injury to find information that will help you understand your injury, guide you through your rehabilitation and explain what you can do to maximise your recovery.
An orthopaedic consultant or a member of their team will diagnose your injury. The information in these care plans will help you understand your diagnosis and is not exhaustive. Your consultant may give you a different, personalised care plan based on your injury and whether you need imaging (x-ray, CT scan, MRI or an ultrasound) or an operation.
Soft tissue foot injury
What is your injury?
You have damaged the muscles, tendons or ligaments in your foot. You may have done this by stepping awkwardly off a pavement and rolling over your ankle.
Soft tissue foot injuries can also happen from excessive overuse or exercising chronically fatigued muscles and tendons.
Types of soft tissue foot injury
Tendons are fibrous bands that attach muscles to bone. We refer to muscle or tendon damage due to overstretching as a ‘strain’. Ligaments are also fibrous bands that hold bones together. We call ligament damage due to overstretching a ‘sprain’.
Strains and sprains are both very common and can happen through accidents at home, at work or while playing sport.
Symptoms of soft tissue foot injuries
There are 3 grades of soft tissue foot injuries depending on the severity with different symptoms:
Grade 1 strain or sprain (mild)
- Minimal over-stretching. Possible minor microscopic fibre tearing
- Mild tenderness and minimal swelling.
Grade 2 strain or sprain (moderate)
- Partial fibre tears
- Moderate pain tenderness and swelling
- Unable to apply loading to the injured area without pain.
Grade 3 strain or sprain (severe)
- Complete rupture of the ligament’s structure
- Significant pain and swelling
- Inability to use the injured area
- Instability of the affected joint.
Healing
This ranges from 2 to 12 weeks depending on the severity of your injury. Recovery times can also depend on your age, general health and occupation.
Follow up
You may need a detailed examination by a member of our Emergency Department (ED) team or one of our Minor Injury Units (MIU) at the time of injury. We recommend you go straight to the ED if:
- you can’t put any weight on your injured foot
- you have an unusual deformity or shape in your foot
- you heard a pop or crack at the time of your injury
- surrounding bony structures feel painful
- you feel numbness or pins and needles at the injury site or anywhere else.
The ED or MIU team will decide if you need a referral to the Fracture Clinic or to physiotherapy.
Your rehabilitation plan
For the first 3 days after your injury, you must:
- follow the PRICER rules (protect, rest, ice, compression, elevation, rehabilitation)
- get a diagnosis from our ED
- move your foot gently without pain if possible.
Between 3 days and 4 weeks you should:
- reduce swelling and stiffness
- begin to regain normal movement.
From 4 to 12 weeks you should be able to:
- regain normal movement in your foot
- return to normal activities.
Stress fracture: in the foot
What is your injury?
It’s typically an overuse injury. It happens when muscles become fatigued and can’t absorb added shock. Eventually, the fatigued muscle transfers the overload of stress to the bone causing a tiny crack called a stress fracture.
The most common type of foot fracture is a stress fracture which happens when repeated activities produce small cracks in the bones. Stress fractures are often the result of increasing the amount or intensity of an activity too quickly.
Healing
A stress fracture needs complete rest from the activity that caused your injury to allow the bone to heal.
We may give you a boot and crutches to help ease your symptoms and allow you to walk pain free. It can take 6 months to completely heal. During this time, you’ll be able to do non weight bearing exercises such as swimming and cycling.
Follow up
We may need to follow up with you. If we decide you need a follow-up, you:
- will see a specialist in the Fracture Clinic after your injury
- may have further x-rays
- get further advice about ongoing management.
If you feel you’d like to see someone, you can book an open appointment at any time in the 6 months after your injury. Please call 01736 758892 to make an appointment.
Please contact the Fracture Clinic on 01872 253091 if:
- you’re unable to follow this rehabilitation plan
- you have any questions
- you experience significant pain and swelling after 12 weeks
- you experience pain or symptoms other than at the site of the original injury or surrounding area.
Your rehabilitation plan
For the first 6 weeks after your injury:
- try to walk as normally as possible – putting weight through your injured foot helps increase the healing speed
- wear the boot for comfort when walking – it’s not needed to help heal the fracture
- try walking on your heel as you may find it easier
- use crutches to take the weight off your foot
- take the boot off at night and when resting at home
- start the exercises below to get your movement back.
Between 6 and 8 weeks:
- stop using the boot and walk without crutches (initially in the house and then outside)
- wear the boot if you go on a long walk
- continue with the exercises to regain flexibility in your foot and ankle.
From 8 to 12 weeks:
- resume day-to-day activities but respond to any pain you might experience
- you can expect to have a healed injury
- heavy tasks or long walks may still cause some discomfort and swelling.
Exercises
Follow the exercises below without causing too much pain. This will prevent your ankle and foot from becoming too stiff and help the healing process. It will also promote circulation and reduce the risk of developing a blood clot (Deep Vein Thrombosis, or DVT).
Do these initial exercises 3 to 4 times a day.
Ankle and foot range of movement exercises
Repeat these 10 times each:
1. Point your foot up and down within a comfortable range of movement.
2. Make circles with your foot in one direction and then in the other direction
3. With your heels together move your toes apart as shown in the picture.
You can find out more about stress fractures in the foot, and see demonstrations of the exercises in this video from Brighton and Sussex University Hospitals.
Toe fracture and toe dislocation
What is your injury?
You have either fractured or dislocated one of your toes. Fractures of the toe are among the most common lower limb fractures. They’re most frequently caused by a crush injury or axial force such as ‘stubbing’ your toe.
Healing
This injury normally takes up to 12 weeks to heal, but this may differ depending on your individual circumstances.
Follow up
Unless you have injured your big toe, injuries like yours usually heal well on their own over time. Most people won’t need a follow-up but if you do, we’ll contact you by phone. If it’s your big toe, our Emergency Department (ED) will refer you to our virtual Fracture Clinic where we’ll review your injury. You should get a letter from the virtual Fracture Clinic telling you more about your injury.
If you feel you’d like to see someone, you can book an open appointment at any time in the 6 months after your injury. Please call 01736 758892 to make an appointment.
Please contact the Fracture Clinic on 01872 253091 if:
- you’re unable to follow this rehabilitation plan
- you have any questions
- you experience pain and swelling after 12 weeks
- you experience pain or symptoms other than at the site of the original injury or surrounding area
- the tape or strut from your buddy strapping peels or loosens.
Your rehabilitation plan
For the first 3 weeks after your injury:
- wear the boot for comfort – it’s not needed to heal your fracture but will help settle your symptoms
- early weight bearing (putting weight through your injured foot) helps increase the healing speed, so try to walk as normally as possible
- you may find it easier to walk on your heels
- use crutches for walking if we have given them to you
- take the boot off at night to wash and when resting at home
- start the exercises below immediately to get your movement back
- you may have your toes buddy strapped.
Buddy strapping stops your injured toe from moving by strapping it to an uninjured toe.
Between 3 and 6 weeks:
- remove the buddy strap after 3 weeks
- stop using the boot and walk without crutches (initially in the house)
- continue with the exercises to regain flexibility in your foot and ankle
- wear the boot for 6 weeks if you have pain without wearing it after 4 weeks.
From 6 to 12 weeks:
- resume day-to-day activities but respond to any pain you might experience
- you can expect to have a healed injury
- you may experience some mild pain and swelling for 3 to 6 months
- heavy tasks or long walks may still cause some discomfort and swelling.
Exercises
Follow the exercises below without causing too much pain. This will prevent your ankle and foot from becoming too stiff and help the healing process. It will also promote circulation and reduce the risk of developing a blood clot (Deep Vein Thrombosis, or DVT).
Do these initial exercises 4 to 5 times a day.
Ankle and foot range of movement exercises
Repeat these 10 times each:
1. Point your foot up and down within a comfortable range of movement
2. Keeping your leg and hips still, turn your feet in towards each other
3. With your heels together move your toes apart as shown in the picture.
After 6 weeks:
Stand up and hold onto a solid surface. Rise up onto your toes using both feet then progress to one foot. Only do this as comfort allows.
You can find out more about toe fractures and dislocation, and see demonstrations of the exercises in this video from Brighton and Sussex University Hospitals.
Base of the 5th metatarsal fracture
What is your injury?
You have fractured a bone on the outer part of your foot.
Healing
This injury normally takes up to 12 weeks to heal, but this may differ depending on your individual circumstances. You may have some discomfort up to a year after your injury.
Follow up
We will review your notes and x-rays. You’ll then get a letter from the doctor confirming that they’re happy with your treatment plan.
We may need to follow up with you depending on your fracture. Injuries like yours usually heal well on their own over time, so most people won’t need a follow-up.
If you feel you’d like to see someone, you can book an open appointment at any time in the 6 months after your injury. Please call 01736 758892 to make an appointment.
Please contact the Fracture Clinic on 01872 253091 if:
- you’re unable to follow this rehabilitation plan
- you have any questions
- you experience ongoing, significant pain and swelling after 12 weeks
- you experience pain or symptoms other than at the site of the original injury or surrounding area.
Your rehabilitation plan
For the first 3 weeks after your injury:
- early weight bearing (putting weight through your injured foot) helps increase the healing speed, so try to walk as normally as possible
- wear the boot for comfort when walking – it’s not needed to help heal the fracture
- you may find it easier to walk on your heel
- you may have been told you can use your own footwear and walk with crutches to take the weight off your foot
- take the boot off at night and when resting at home
- start the exercises below to get your movement back.
Between 3 and 6 weeks:
- stop using the boot and crutches
- start walking around your house and then outside
- wear the boot if you go on a long walk or need to walk on uneven ground
- continue your exercises to regain flexibility in your foot.
From 6 to 12 weeks:
- resume day-to-day activities but respond to any pain you might experience
- you can expect to have a healed injury
- heavy tasks or long walks may still cause some discomfort and swelling.
Exercises
Follow the exercises below without causing too much pain. This will prevent your ankle and foot from becoming too stiff and help the healing process. It will also promote circulation and reduce the risk of developing a blood clot (Deep Vein Thrombosis, or DVT).
Do these initial exercises 3 to 4 times a day.
Ankle and foot range of movement exercises
Repeat these 10 times each:
1. Point your foot up and down within a comfortable range of movement
2. With your heels together move your toes apart as shown in the picture
3. Make circles with your foot in one direction and then in the other direction.
You can find out more about base of the 5th metatarsal fractures, and see demonstrations of the exercises in this video from Brighton and Sussex University Hospitals.
You can also read more in our patient information leaflet (PDF, 170KB).
Midshaft 5th metatarsal fracture
What is your injury?
You have fractured a bone in your forefoot. It’s on the outside of your foot.
Healing
This injury normally takes 12 weeks to heal but this may differ depending on your individual circumstances.
Follow up
Injuries like yours usually heal well on their own over time, so most people won’t need a follow-up. If you do, we’ll contact you by phone.
If you feel you’d like to see someone, you can book an open appointment at any time in the 6 months after your injury. Please call 01736 758892 to make an appointment.
Please contact the Fracture Clinic on 01872 253091 after 6 weeks if:
- you still experience significant pain and swelling
- you’re struggling to remove the boot.
Contact us if:
- you’re unable to follow this rehabilitation plan
- you have any questions
- you experience pain and swelling after 12 weeks
- you experience pain or symptoms other than at the site of the original injury or surrounding area.
Your rehabilitation plan
For the first 6 weeks after your injury:
- wear the boot for comfort – it’s not needed to heal your fracture but will help settle your symptoms
- early weight bearing (putting weight through your injured foot) helps increase the healing speed, so try to walk as normally as possible
- you may find it easier to walk on your heel
- use crutches for walking
- take the boot off at night, to wash and when resting at home
- start the exercises below to get your movement back.
Between 6 and 8 weeks:
- stop using the boot and walk without crutches (initially in the house and then outside)
- wear the boot if you go on a long walk
- continue with the exercises to regain flexibility in your foot.
From 8 to 12 weeks:
- resume day-to-day activities but be guarded by pain levels
- you can expect to have a healed injury
- you may experience some mild symptoms for 3 to 6 months
- heavy tasks or long walks may still cause some discomfort and swelling.
Exercises
Follow the exercises below without causing too much pain. This will prevent your ankle and foot from becoming too stiff and help the healing process. It will also promote circulation and reduce the risk of developing a blood clot (Deep Vein Thrombosis, or DVT).
Do these initial exercises 3 to 4 times a day.
Ankle and foot range of movement exercises
Repeat these 10 times each:
1. Point your foot up and down within a comfortable range of movement
2. With your heels together move your toes apart as shown in the picture
3. Make circles with your foot in one direction and then in the other direction.
You can find out more about midshaft 5th metatarsal fractures, and see demonstrations of the exercises in this video from Brighton and Sussex University Hospitals.
Metatarsal fracture to foot
What is your injury?
You have a fractured bone in your foot. There are five metatarsal bones and they form part of the forefoot. You have injured one or maybe more.
Healing
This injury normally takes 12 weeks to heal, but this may differ depending on your individual circumstances.
Follow up
Injuries like yours usually heal well on their own over time, so most people won’t need a follow-up. If you do, we’ll contact you by phone.
If you feel you’d like to see someone, you can book an open appointment at any time in the 6 months after your injury. Please call 01736 758892 to make an appointment.
Please contact the Fracture Clinic on 01872 253091 after 6 weeks if:
- you experience pain or swelling
- you’re struggling to remove the boot.
You can also contact us if:
- you’re unable to follow this rehabilitation plan
- you have any questions
- you experience significant pain and swelling after 12 weeks
- you experience pain or symptoms other than at the site of the original injury or surrounding area.
Your rehabilitation plan
For the first 3 weeks after your injury:
- wear the boot for comfort – it’s not needed to heal your fracture but will help settle your symptoms
- early weight bearing (putting weight through your injured foot) helps increase the healing speed, so try to walk as normally as possible
- use crutches for walking
- you may find it easier to walk on your heel
- take the boot off at night and when resting at home
- start the exercises below immediately to maintain and improve your movement.
Between 3 and 6 weeks:
- stop using the boot and walk without crutches (initially in the house and then outside)
- wear the boot if you go on a long walk
- continue with the exercises to regain flexibility in your foot.
From 6 to 12 weeks:
- resume day-to-day activities but respond to any pain you might experience by reducing the intensity of whatever you think caused the pain
- you can expect to have a healed injury by 12 weeks
- you may experience mild symptoms (pain, swelling) from 3 to 6 months
- heavy tasks or long walks may still cause some discomfort and swelling.
Exercises
Follow the exercises below without causing too much pain. This will prevent your ankle and foot from becoming too stiff and help the healing process. It will also promote circulation and reduce the risk of developing a blood clot (Deep Vein Thrombosis, or DVT).
Do these initial exercises 3 to 4 times a day.
Ankle and foot range of movement exercises
Repeat these 10 times each:
1. Point your foot up and down within a comfortable range of movement
2. Make circles with your foot in one direction and then in the other direction
3. With your heels together move your toes apart as shown in the picture.
You can find out more about metatarsal fractures to the foot, and see demonstrations of the exercises in this video from Brighton and Sussex University Hospitals.
Midfoot fracture
What is your injury?
You have fractured a bone in the midfoot area. This could be the navicular, cuboid or one of the cuneiform bones.
Healing
This injury normally takes 12 weeks to heal, but this may differ depending on your individual circumstances.
Follow up
Injuries like yours usually heal well on their own over time, so most people won’t need a follow-up. If you do, we will send you a letter with an appointment date.
If you feel you’d like to see someone, you can book an open appointment at any time in the 6 months after your injury. Please call 01736 758892 to make an appointment.
Please contact the Fracture Clinic on 01872 253091 after 6 weeks if:
- you experience pain or swelling
- you’re struggling to remove the boot
- you’re unable to follow this rehabilitation plan
- you have any questions
- you experience pain and swelling after 12 weeks
- you experience pain or symptoms other than at the site of the original injury or surrounding area.
Your rehabilitation plan
For the first 6 weeks after your injury:
- wear the boot for comfort – it’s not needed to heal your fracture but will help settle your symptoms
- early weight bearing (putting weight through your injured foot) helps increase the healing speed, so try to walk as normally as possible in your boot.
- use crutches for walking
- take the boot off at night, to wash and when resting at home
- do the exercises below regularly to get your movement back.
Between 6 and 8 weeks:
- walk normally with your foot flat on the floor if we initially told you to only walk on your toes or heels or in the boot
- stop using the boot and walk without crutches (initially in the house and then outside)
- wear the boot if you go on a long walk
- continue with the exercises to regain flexibility in your foot and ankle.
From 8 to 12 weeks:
- resume day-to-day activities but respond to any pain you might experience
- you can expect to have a healed injury
- you may experience some mild symptoms for 3 to 6 months
- heavy tasks or long walks may still cause some discomfort and swelling.
Exercises
Follow the exercises below without causing too much pain. This will prevent your ankle and foot from becoming too stiff and help the healing process. It will also promote circulation and reduce the risk of developing a blood clot (Deep Vein Thrombosis, or DVT).
Do these initial exercises 3 to 4 times a day.
Ankle and foot range of movement exercises
Repeat these 10 times each:
1. Point your foot up and down within a comfortable range of movement
2. Make circles with your foot in one direction and then in the other direction
3. With your heels together move your toes apart as shown in the picture below
You can find out more about midfoot fractures, and see demonstrations of the exercises in this video from Brighton and Sussex University Hospitals.
Avulsion fracture to midfoot
What is your injury?
You have an avulsion fracture in your midfoot. It’s where a ligament pulls off a small fragment of bone.
It’s a common injury which heals naturally with time.
Healing
This injury normally takes up to 12 weeks to heal, but this may differ depending on your individual circumstances. You may be placed in a boot to make walking more comfortable.
Follow up
Injuries like yours usually heal well on their own over time so most people won’t need a follow-up. If you do, we’ll contact you by phone.
If you still feel you’d like to see someone, you can book an open appointment at any time in the 6 months after your injury. Please call 01736 758892 to make an appointment.
Please contact the Fracture Clinic on 01872 253091 if:
- you experience significant pain after 6 weeks
- you’re unable to follow this rehabilitation plan
- you have any questions
- you’re struggling to remove your boot
- you experience pain or symptoms other than at the site of the original injury or surrounding area.
Your rehabilitation plan
For the first 2 weeks after your injury:
- early weight bearing in your boot (putting weight through your injured foot) helps increase the healing speed, so try to walk as normally as possible
- wear the boot for comfort when walking – it’s not needed to help heal the fracture
- you may find it easier to walk on your heel
- take the boot off at night and when resting at home
- stop using crutches as soon as you can
- start the initial exercises straight away (see below).
Between 2 and 6 weeks:
- stop using the boot and walk without crutches (initially in the house and then outside)
- wear the boot if you go on a long walk
- start the exercises below labelled ‘exercises from week 2 onwards’.
After 6 weeks:
- you can expect mild symptoms for 3 to 6 months
- resume day-to-day activities but respond to any pain you might experience
- start the advanced exercises for sports rehabilitation (see below)
- heavy tasks or long walks may still cause some discomfort and swelling.
Exercises
Follow the exercises below without causing too much pain. This will prevent your ankle and foot from becoming too stiff and help the healing process. It will also promote circulation and reduce the risk of developing a blood clot (Deep Vein Thrombosis, or DVT).
Do these initial exercises for ankle and foot range of movement 3 to 4 times a day.
Repeat the following 10 times each:
1. Point your foot up and down within a comfortable range of movement
2. With your heels together, move your toes apart
3. Make circles with your foot in one direction, then the other.
Exercises from week 2 onwards
Ankle stretches
Hold both stretches for up to 30 seconds and repeat 5 times.
1. Sit with your leg straight out in front of you.
Put a towel/bandage around your foot and pull it towards you. Feel a stretch in the back of your calf.
2. Point your toes down as far as they go.
Advanced exercises for after 6 weeks
Balance exercises – for patients who could not stand on one leg before their injury
Step 1: Stand with your feet as close together as possible using the back of a chair for support. Hold this for 30 seconds.
If you can do this, move onto step 2.
Step 2: Follow step 1 above but remove your hand from the chair so that you’re balancing. Hold this for 30 seconds.
If you can do this move onto step 3.
Step 3: Holding onto the back of the chair, put one foot in front of the other as close together as possible. Hold this for 30 seconds.
If you can do this easily, try it without holding onto the chair but only if you feel confident to do so.
Balance exercises – for patients who could stand on one leg before their injury
Step 1: Holding onto a firm surface (back of a chair or a table), try to stand on one leg. Hold this for 30 seconds making sure it does not cause any pain. Once you can do this pain free, move onto step 2.
Step 2: Follow step 1 above but remove your hand from the surface so that you’re balancing. Hold this for 30 seconds.
If you can do this move onto step 3.
Stage 1 – Exercises for patients who want to develop dynamic ankle control and improve proprioception, for return to sport or uneven ground.
- Standing on an uneven surface such as a doubled-over pillow or wobble cushion, attempt to balance for 30 seconds. Once you can do this pain free, move to step 2.
- When you feel confident, repeat these steps whilst turning your head side to side. Always stand in a safe environment with a firm surface close by should you need it. Hold this for 30 seconds.
Stage 2 – For patients who want to develop dynamic core control for sports.
- Stand with one foot in front of the other with your hands together. Swing your arms in a figure of eight in both directions for 1 to 2 minutes.
- Follow step 1 as above but bring your feet together so they’re touching toe to heel.
- Follow steps 1 and 2 but do them while turning your head from side to side.
You can find out more about avulsion fractures to midfoot, and see demonstrations of the exercises in this video from Brighton and Sussex University Hospitals.
Calcaneal fracture
What is your injury?
You have fractured your heel bone after a high impact collision, for example a fall from height or a motor vehicle accident.
A calcaneal fracture happens when an excessive force crushes the heel bone against the talus (the lowest bone of the ankle). The joint between the calcaneus and the talus is known as the subtalar joint. It’s an essential part of flexing, standing, and walking. It works with the ankle joint for dynamic movement.
Damage to the subtalar joint can lead to long term problems such as chronic pain, stiffness and the development of post-traumatic arthritis in your hind foot.
Types of calcaneal fractures
There are several types of fracture patterns that can happen in your heel bone. Some have simpler patterns that don’t involve the joint and usually heal without any long term issues.
Others are more complex with fragment displacement and extend into one of multiple joints. They often don’t heal properly without surgery.
Symptoms of a calcaneal fracture
You may:
- feel sharp, severe pain
- have extensive swelling and bruising around your heel
- be unable to bear weight
- have general pain in your heel that gradually worsens. This could be a sign of a stress fracture which typically only hurts during activity and improves with rest.
Healing
Heel bone fractures are difficult to treat and usually need longer healing times. Your foot and ankle specialist will assess your injury and decide whether you need an operation.
Before surgery, it’s important to keep your whole leg elevated and follow PRICER rules:
- Protect
- Rest
- Ice
- Compression
- Elevate
- Rehabilitation
Smoking, age, diabetes and other vascular diseases can negatively affect healing times.
Complications of calcaneal fractures
Calcaneal fractures can be serious injuries and may lead to lifelong challenges, such as:
- arthritis, stiffness and pain in the joint
- failure of the bone to heal in the correct position
- decreased ankle motion
- walking with a limp due to collapse of the heel bone and shortened length in the leg
- difficulty doing your current job.
If you develop complications, you may need additional surgery, and/or long term or permanent use of a brace or arch support to help you manage. Rarely, people with this injury may need an amputation.
Follow up
We will see you in the Fracture Clinic for x-rays and a clinical examination. Sometimes you may need a CT or MRI scan. Follow ups will depend on your injury.
Your rehabilitation plan
This will be individual to you. A foot and ankle consultant will decide how best to manage your injury.
You will NOT walk on your affected leg for at least 6 to 12 weeks. You may need to take medication to prevent a blood clot as prescribed by us. If this has not happened please contact your GP or the Fracture Clinic immediately.
We’ll refer you to physiotherapy when we feel it’s appropriate for you to start rehabilitation.
Talus fracture
What is your injury?
You have broken the main bone which connects your foot to your leg. You may have fractured it in a car collision or fallen from a significant height.
Talus injuries can also happen during sports such as snowboarding.
The talus bone helps you to transfer weight and pressure across the ankle joint. It’s important for ankle movement. A talus fracture often means a loss of mobility and function.
A talus fracture that doesn’t heal properly can lead to complications including a limp, arthritis, and chronic pain.
Healing
Healing will take 12 weeks and maybe longer. Cartilage mostly covers the talus bone which makes these injuries hard to heal.
If the bones move out of place, you’ll need an operation to reposition the bone fragments using screws or metal plates. You may have swelling around the foot for several months after the operation. Surgery reduces the risk of complications later on.
In some cases, fractures can heal without surgery using a plaster cast or a boot. This helps to hold the bones in place while they heal.
You must NOT put any weight through your injured leg or walk on it for 6 to 12 weeks. When the bone heals, you will start physiotherapy to maximise movement in your foot and ankle.
Complications of talus fractures
In the early stages of your injury, you may have significant swelling which can lead to wound problems and infection. You have an increased risk of complications if you:
- smoke
- have diabetes
- have poor circulation.
Later complications
Talus fractures can be serious injuries and may lead to lifelong challenges.
Even after treatment or an operation, you may have persistent pain, stiffness and swelling.
Depending on the type and severity of the fracture, most people return to work and recreational activities. Some, however, may have difficulty doing their current job.
Rarely, some talus fractures lead to amputation.
Avascular necrosis (AVN)
Unstable talus fractures can disrupt the blood supply to the bone. Sometimes, the blood supply returns and normal healing begins. In other cases, the bone cells die without a blood supply leading to a gradual and painful collapse of the bone. This condition is called avascular necrosis (AVN) or osteonecrosis.
When the bone collapses it damages the cartilage which covers and protects the bone. This leads to increased pain, arthritis and loss of mobility and function. If you have a severe talus fracture, it’s more likely that you’ll develop AVN.
Post traumatic arthritis
The majority of talus fractures result in some degree of post traumatic arthritis. You may have cartilage damage even when your bones heal normally and over time, you may feel pain and stiffness.
In cases of extreme arthritis or AVN that limit activity, you may need further surgery, such as a joint fusion or ankle replacement to relieve your symptoms.
Follow up
We will see you in the Fracture Clinic for x-rays and a clinical examination to help us decide how best to manage your injury. Sometimes you may need a CT scan. We will see you regularly to monitor healing and your risk of avascular necrosis.
We’ll tell you if you need an operation.
Your rehabilitation plan
This will be individual to your injury and decided by a foot and ankle team consultant.
Lisfranc fracture
What is your injury?
You have stretched or torn ligaments or broken bones in the middle of your foot. It’s a very serious injury and can happen in one or both of your feet.
The middle of your foot or ‘midfoot section’ refers to the area around the foot arch. It contains the Lisfranc ligament and joint which can be damaged in a Lisfranc fracture.
The severity of the fractures vary between each patient and determine your treatment plan and recovery.
Causes of a Lisfranc injury
You may have fallen and twisted your foot or crushed your foot while flexing it. Lisfranc injuries can also happen by falling from a significant height which needs extensive treatment.
Symptoms of a Lisfranc injury
They’ll vary according to the severity of the fracture. Typically you’ll have swelling and tenderness in your midfoot or the top of your foot. Your pain can feel worse when you walk or stand.
You may have bruising on the top or bottom of your foot. Sometimes a Lisfranc injury may be mistaken for a sprain.
Diagnosis
We will examine your foot to assess the type of Lisfranc injury you have. As well as checking for tenderness, pain and bruising, you’ll have tests including x-rays, MRIs and CT scans.
Healing
This injury normally takes over 12 weeks to heal, but this may differ depending on your individual circumstances. It’s a significant life changing injury and it’s likely you’ll have some residual pain and swelling for over 12 months.
Do NOT put weight through your injured foot until you have been told to do so by a member of our foot and ankle team. We’ll tell you about your rehabilitation plan depending on the severity of your injury.
Complications of a Lisfranc injury
A Lisfranc injury can be a serious injury and may lead to lifelong challenges, difficulty doing your current job, and, rarely, can lead to an amputation.
Treatment
This can be similar to foot sprains and include rest, ice and elevating your injured foot for mild symptoms.
You may have crutches to help relieve pain when standing or walking. In more serious cases, you may have a cast or a boot.
Surgery
You may need an operation to reposition your bones while your foot heals using pins, screws or plates. In some cases we may use fusion treatment to remove the cartilage around the joints and fuse the bones in the midfoot together using screws.
Following your surgery, you may need to wear a cast for 6 to 8 weeks. You may need crutches to help support your body weight.
We usually remove pins and plates at around 4 to 6 months after surgery.
Follow up
You’ll get a follow-up appointment at the Fracture Clinic at week 1, 6 weeks and 12 weeks after your injury. Sometimes we need to follow up on a longer term basis or through our elective service.
Please contact the Fracture Clinic on 01872 253091 if you do not get your appointment letters. You can expect an appointment within the first week of your injury.
You can book an open appointment at any time in the 6 months after your injury. Please call 01736 758892 to make an appointment.
Please contact the Fracture Clinic on 01872 253091 after 12 weeks if:
- you experience increased pain or swelling
- you’re struggling to remove the boot
- you have any questions
- you experience pain or symptoms other than at the site of the original injury or surrounding area.
Your rehabilitation plan
This will be individual to your injury. A member of our orthopaedic team will discuss this with you.
You’ll also need to take blood thinning medication for the first 6 weeks as prescribed by a member of our team. If this has not happened please contact your GP or the Fracture Clinic immediately.
Using your boot and crutches
Wear your boot and use your crutches as instructed in the care plan for your injury above. This video shows you how to fit and wear your boot.
Boot advice for people with diabetes
If you’re diabetic, please contact the Fracture Clinic on 01872 253091 to discuss your boot. It’s important if you have problems with your skin. We can provide you with a specialist diabetic boot.
Footwear for your uninjured foot
Choose a supportive shoe or trainer with a firm sole for your uninjured foot. You’ll notice that your boot has a thicker sole. By matching this height on the uninjured side, you’ll reduce stress on your other joints.
You can buy an adjustable shoe balancer to match the height of your injured side.
How to use crutches
These videos show you how to use your crutches.
What should I do with my boot and crutches when I no longer need them?
We can’t use the boot again. You should not return it to the hospital.
You can return crutches to the Fracture Clinic or your local physiotherapy department.
Preventing complications
Caring for your wound and stitches
If you’ve had an operation on your foot, you’ll need to keep your stitches dry and clean. You should also look out for any redness or signs of swelling, bleeding or pus as these can be signs of an infection.
You can find information about how to care for your stitches, if/when they need to be removed and signs of an infection on our surgery for fractures and soft tissue injuries page.
Read more in our patient information leaflet about managing fracture infections (PDF, 92KB)
Blood clots and Deep Vein Thrombosis (DVT)
Because your lower limb is immobilised and you’ll be moving less than normal, you’re at higher risk of developing a blood clot or Deep Vein Thrombosis (DVT). This can be life threatening if left untreated.
Symptoms of DVT in the leg are:
- throbbing or cramping pain in one leg (rarely both legs), usually in the calf or thigh
- swelling in one leg (rarely both legs)
- warm skin around the painful area
- red or darkened skin around the painful area
- swollen veins that are hard or sore when you touch them.
These symptoms can also happen in your arm or tummy if that’s where the blood clot is.
More information about DVT
Watch this video about how to prevent DVT.
Learn more about DVT including symptoms, who is at risk and how to treat it.
Find out how to reduce the risk of blood clots when you have an immobilised lower limb (PDF, 108KB).
Preventative medication for DVT
If you have been told not to put any weight through your leg, you should have been assessed in ED or MIU and told if you need to take preventative medication.
If you haven’t had this conversation please call your GP for an urgent appointment.
If you have a Lisfranc injury, you will have been prescribed a course of a blood thinner. You may need to take tablets or inject the medication into your tummy.
Pressure sores and ulcers
Wearing a boot or plaster combined with not moving your limb can lead to pressure sores or ulcers. These are injuries to the skin and underlying tissue caused by prolonged pressure, rubbing or tension.
They often develop gradually, but can sometimes form in a few hours.
Signs and symptoms of a pressure sores
These include:
- skin discolouration – red patches for people with pale skin, purple or blue patches for people with dark skin
- discoloured patches that do not turn white when pressed
- a patch of skin that feels warm, spongy or hard
- pain or itchiness in the affected area.
Take your boot off every day to check your skin. Make sure it’s not rubbing.
If you have a plaster cast, look out for a change in colour (red or white) of your skin above or below the plaster, an increase in pain inside the plaster or pins and needles.
Watch this video to learn how to prevent pressure sores
Read more about pressure sores
If you think you have a pressure sore or ulcer
Call the Fracture Clinic straight away on 01872 253091.
For out of hours advice please call 01736 758909.
Sepsis
Sepsis (also known as blood poisoning) is a serious infection that can be life threatening. There is no one sign for sepsis so it can be hard to spot.
Call 111 immediately if you develop any of the following:
- Slurred speech or confusion
- Extreme shivering or muscle pain
- Passing no urine in a day
- Severe breathlessness
- It feels like you’re going to die
- Skin is mottled or discoloured.
Find out more about the symptoms of sepsis on the NHS website.
These videos also explain what sepsis is and how to spot the early signs.
Living with your injury
Work
Decisions to return to work are made on a unique basis and should be discussed with the Fracture Clinic, your GP and your employer.
You may need time off work and when you return, you may need light or amended duties. When you should return to work will depend on your profession and your injury.
You can get a fitness to work statement or a sick note when you come into the Fracture Clinic. If you don’t need to come and see us, you can get one from your GP.
Driving
If you have an injury to your foot, you can return to driving when you:
- have been told you no longer need your boot or crutches
- can walk comfortably
- can perform an emergency stop pain free.
Always test your ability to drive with the ignition off and in a safe environment.
If you have a follow-up appointment with us, please wait until your consultant or physiotherapist has given you clearance to drive. If you’re in any doubt, do not drive until you have spoken to our team.
Sport
You should not do any sports for 6 weeks.
You must avoid contact sports and heavy lifting for 12 weeks.
*Thank you to Brighton and Sussex University Hospitals for kindly letting us use information from their care plans to create this site.
Thank you also to Sussex and Ankle Foot Clinic for kindly letting us use their illustration of a Lisfranc injury.
