Foot and Ankle Fractures/Dislocations
Normal Anatomy
The bones of the ankle are the tibia (shin bone on the inside of the ankle), fibula (small shin bone on the outside of the ankle) and the talus (bone at the top of the foot). The tibia, fibula and talus meet to form a complex hinge that does move to a mild degree towards the inside and outside, as well as rotates clockwise and counter-clockwise. There are many small bones in the foot arranged in a similar arrangement to those in the hand/wrist. The bones in the hindfoot and midfoot provide stability
Three bones of the ankle are surrounded by a thick layer of cartilage in the ankle joint and are held together by the ankle joint capsule, which supports, nourishes, and helps stabilize the ankle joint. In addition to the bony architecture of the ankle, ligaments hold the ankle together and give it stability and allow the ankle to function as a unit as it responds to the forces acted upon by the muscles about the leg. The ligaments on the inside and outside of the ankle limit excessive sideways motion of the ankle preventing a dislocation of unexpected forces move the foot in the wrong direction as occurs when someone trips or falls.
Tendons that arise from the three compartments of the leg span the ankle joint to attach to the foot. There are three main muscles on the front of the leg whose tendons cross the ankle to attach onto the foot and are responsible for bringing the foot up. The calf muscles in the back of the leg attach to the back of the heel bone (calcaneous) through the Achilles’ tendon. There is one main muscle on the inside of the leg called the Tibialis Posterior that becomes a tendon at or near the level of the ankle that inserts onto the foot and is responsible for turning the foot inward towards the big toe. There are two main muscles on the outside of the leg that become tendons at or near the level of the ankle that inserts onto the foot that pulls the foot outwards towards the small toe.
Pathology
Ankle fractures/dislocations can occur in young or older patients. These fractures usually occur from a fall or a twisting injury and may or may not be associated with an ankle dislocation. There are two bones in the leg that may break in an ankle fracture. Depending on how bad the injury is, one or both of these bones can break. X-rays show the break, its location, pattern, and any dislocation that may have occurred. A physical examination is important to check for injuries to other structures, such as muscles, tendons, and nerves.
Foot fractures/dislocations can occur in young or older patients. These fractures usually occur from a fall or a twisting injury, but can also occur from sports-related injuries and may or may not be associated with a foot dislocation. Depending on how bad the injury is, one or multiple bones in the foot can break and/or dislocate. X-rays show the break, its location, pattern and any dislocation that may have occurred. A physical examination is important to check for injuries to other structures, such as muscles, tendons, and nerves.
Treatment
Fractures of the ankle can be incomplete fractures and the bones do not move out of place too much. When this is the case, these fractures can be treated in a splint, cast, or a walking boot. When these fractures are complete, if the bones have moved around, and/or there has been an ankle dislocation, the ankle needs to be put back in place and surgery is often required. Surgery ensures that the bones are aligned in the correct position to prevent the early development of ankle arthritis. This surgery is done through small incisions and the bones are fixed in place with plates and screws. Therapists work with the patient after surgery to work on motion of the foot and ankle, and to begin walking again. Once the fracture is healed, most patients are able to return to their usual activities.
Fractures of the foot can be incomplete fractures and the bones do not move out of place too much. When this is the case, these fractures can be treated in a splint, cast, or a walking boot. When these fractures are complete, if the bones have moved around, and/or there has been a dislocation of the bones in the foot, surgery is required to put the bones back in place. Surgery ensures that the bones are aligned in the correct position. This surgery is done through small incisions and the bones are fixed in place with plates and/or screws. Therapists work with the patient after surgery to work on motion of the foot and ankle, and to begin walking again. Once the fracture is healed, most patients are able to return to their usual activities.