What is a fracture?
Simply put, a fracture is a broken bone. 
There are many types of fractures:  Open fractures, Closed fractures, Transverse fractures, Oblique fractures, Spiral fractures, Stress fractures, and so on.  But these are all simply ways to classify different types of broken bones.


How do you get fractures?
A bone can become fractured from one of two ways: 
  • A sudden trauma (like a fall down some stairs, or a car accident)
  • A slow, gradual build-up of strain that eventually over-fatigues the bone until it breaks (known as 'stress fractures', these are very frequently seen in the foot)

While there is not too much you can do to avoid accidental trauma, there are a host of factors that can influence whether a bone will be likely to break from a gradual build-up of stresses from overuse. 

For example, your occupation plays a role (jobs that require long periods of weight bearing will put more stress on bones that more sedentary ones); your shoes make a difference (high heels, for example, can put an enormous strain on your metatarsal bones); weight, health and nutrition also play major roles.

Additionally, certain inherited metabolic bone diseases can make it weaker than normal (as with Osteogenesis Imperfecta, for example), and certain acquired diseases can affect bone (as with Paget's disease and Rickets).  Most common, however, is the weakening of bone over time from osteoporosis.

Which bones can become fractured?  
Any bone can become fractured, especially from trauma.  In the foot, the most likely bones to become fractured, though, are the heel bone (calcaneus), the ankle (usually the fibula), the ball of the foot (metatarsals), and toe bones (phalanges). 
How do you treat fractures?
Fractures are pretty well treated with the same concept in mind: for a fracture to heal, the two opposing bony ends from moving.  This is called 'immobilization'.  This can be achieved from fibreglass or plaster casts, soft casts (like an Unna's boot, e.g.), splints, taping, or from surgical implantation of wires, pins, screws, plates, or a device known as an external fixator. 
But you don't treat fractures of the toe bones, right?
Yes you should.   Admittedly, toe bone fractures seem to be ignored in a lot of emergency rooms, but they shouldn't be. 
Your toe bones are no different from any bone in your body.   Those same E.R. doctors would likely treat the exact same fracture if it were in the hand, for example, and the foot goes through a lot more stress and strain with each step than does your hand.  In fact, because the bones are so small, the fracture is somewhat more likely to extend into a joint than in other bones, which can cause long-term arthritis and pain. 
It's too bad toe fractures (and even metatarsal fractures) are ignored as much as they are.  It's quite easy to immobilize a toe with tape, for example.  Not only does this allow them to heal more quickly, but they heal with less pain, too.  So, by all means, yes, fractures of the toe bones should be treated.
How do you know which is the best way to treat a given fracture?
Each fracture is different, and the decision on treatment is made on a case-by-case basis.  Some bones heal better or more quickly than other bones, and some fracture patterns heal better or more quickly than other fracture patterns, even within the same bone. 
The physician must understand all the science behind healing, but also apply the science to each case.  This is why medicine is both a science and an art. 
How do you avoid fractures?
It may be hard to avoid fractures completely, as it's hard to avoid unexpected trauma.  But there are some simple things you can do to avoid certain fractures, such as stress fractures:
  • Wear appropriate shoes.  High heels predispose you to fractures of the bones in the ball of the foot, and poor work shoes can predispose you to ankle injuries, stress fractures of the toe bones, and other injuries. 
  • Avoid fatigue and over-stressing your bones.  New recruits in the army frequently suffer from stress fractures after 20-mile marches, for example, and long periods of shopping, aerobics, or other weight-bearing can do the same thing to any of us. 
  • Don't smoke.  There is little question that smoking worsens your body's ability to heal, and this includes healing from small amounts of strain in bone, before they become fractures.
  • Eat well.  Good nutrition is vital to allow your body the nutrients it needs to repair small stresses of bone.
  • If you are a post-menopausal female, have a family history, or have other risk factors, you may be more likely to develop osteoporosis, a disease that thins and weakens bone.  Bone density tests are available, as are medications to help you keep the calcium in your bones.     



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This website is operated by 
The Achilles Foot Health Centre
S. A. Schumacher, D.P.M., F.A.C.F.A.S., F.A.C.F.A.O.M.  
Dr. S. A. Schumacher, Podiatric Corporation  

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