So you can put your full weight on your foot againWe essentially differentiate between a gradual fracture (stress fracture) and a fracture caused by an accident.
Gradual fractures may be due to a bone metabolism disorder, nutritional deficiency or excessive strain. A treatment concept can only be created once the cause has been found. In general, we can treat these fractures without surgery.
But if the bones have shifted severely or only heal very slowly despite being immobilised, surgery should be considered.
Conservative treatment methods
Metatarsal fracture: treatment without surgeryIf a stress fracture is present, the cause will need to be found. Metabolism disorders and potential nutritional deficiencies will then need to be ruled out. Excessive stresses such as long walks (march fracture) can also cause fractures. Foot deformities can lead to excessive strains, causing a fracture after several months. Often, these haven’t shifted and are very hard to detect on an X-ray image, or can’t be detected at all. Magnetic resonance imaging is often the only thing in this case that provides any evidence. Treatment is then primarily focused on resolving the cause. If this is fixed, the stress fracture often heals by itself.
Fractures caused by accidents are typically treated using conservative methods. In this case, your foot is first immobilised in a calf plaster cast, shoe or walker for six to eight weeks. Weight is also taken off your foot using underarm crutches. To prevent thrombosis, you’ll need to wear a special-made shoe until you can put your full weight on your foot again. In addition, decongestive measures such as lymph drains can be beneficial.
We can stimulate bone healing in patients with poor bone status using ultrasound.
Surgical treatment methods
Metatarsal fracture: treatment through surgeryStress fracture: we’ll put your fracture back into place
A stress fracture may need to be operated on if it doesn’t heal under conservative treatment. For example, arthritis in the area of the big toe or a Hallux valgus deformity can lead to altered positioning and excessive strain on the outer edge of the foot. In this instance, it typically isn’t the fracture at all that will need to be operated on – instead, it’s the arthritis or deformity in the big toe, for example. If required, we can stimulate bone healing by injecting growth factors from your body’s own blood.
Jones fracture: your fracture can heal well using screws
A Jones fracture is a special type of stress fracture involving a fracture in the region of the fifth metatarsal bone. This area has poor blood flow. Sports with quick changes in direction such as tennis or football can lead to excessive strain on the bone, potentially leading to a gradual fracture. Foot deformities such as a flat foot can support the development of a Jones fracture due to excessive strain on the outer edge of the foot. Because of the poor blood flow in this area and high shear forces, it only heals very slowly under conservative treatment, or new bone forms. A screw implant neutralises the shear forces so the bones heal better. The intervention protects tissue as much as possible while using minimally invasive methods. Because we only have to make a very small skin incision, there is a reduced risk of a wound infection or wound healing disorder. The screws absorb the pulling forces of the tendon of the short fibular muscle and divert them over the fracture, so it can heal without being subject to any strain. This way, for simple fractures, you can generally build up your load capacity faster. The operated foot will need to be immobilised for six weeks in a plaster cast or walker. Depending on how it heals, you’ll then be able to put light strain on your foot again, and slowly step up the amount of weight in two to three weeks.
Comminuted fracture: we stabilise your bones using a plate
For comminuted fractures, individual bone parts can be threaded with a wire, like a pearl necklace. This is carried out under fluoroscopy. The surrounding soft tissue remains intact, which promotes healing and minimises surgical risk. If other joints are affected, plate osteosynthesis is generally applied. As part of this procedure, the individual broken bone pieces or joint parts are put together again step by step, and held together in their correct position with screws and a plate. Your foot will then need to be immobilised in a walker for six weeks.
Lisfranc fracture: we’ll put your joints back into position
For complicated patterns of injuries such as dislocations of the Lisfranc joint, we’ll need to identify how the accident happened exactly. After a thorough diagnosis using MRI or computer tomography, we’ll put your joints back into position by making an incision in the back of your foot. We’ll then immobilise your joints using screws or wires for eight to twelve weeks. During this time, you won’t be allowed to put weight on your foot. Your after-care will involve a calf plaster cast or splint. You’ll use underarm crutches to not put any weight on your foot. After six to eight weeks, a second smaller operation will be carried out to remove the screws or wires from your foot. Afterwards, you’ll be able to carefully start building up your load capacity.