Outlook

Toe fractures are common and generally heal well with little or no therapy. Although the bones may take three to eight weeks to heal, pain usually improves much earlier. Rarely, very severe fractures, especially of the big toe, may require a cast or surgery.

• Metatarsal fractures usually heal well. The first metatarsal (the one attached to the big toe) sometimes requires a cast or surgery and a prolonged period on crutches, but the middle three metatarsals can usually be treated with a rigid flat-bottom shoe and partial weight bearing. "March fracture" is a metatarsal stress fracture that commonly occurs in joggers and requires stopping jogging for four to six weeks.
  
  
• The fifth metatarsal (the one attached to the pinkie toe) is the most commonly broken bone in the midfoot. There are two general types of these fractures:
  
  
  • One type is the proximal avulsion fracture. These are very common and usually happen at the same time as a sprained ankle. They heal very well with a rigid flat-bottom shoe or elastic bandage and weight bearing as tolerated.
    
    
  • The other type is the Jones fracture, which is much less common but does not heal as well. This fracture gets worse with time if you keep walking on it, so non-weight bearing is very important. People with this fracture often (35-50% of the time) develop problems healing that require an operation.
  
  
• Fractures at the joint between the cuneiforms and the metatarsals (mid-foot) are called Lisfranc fractures. These are rare, but can be difficult to diagnose and treat. Weight-bearing x-rays (taken while standing on the injured foot) are sometimes needed to diagnose this problem. These fractures sometimes require surgery.
  
  
• Navicular fractures are rare and most often represent stress fractures in young athletes. They usually heal well with a rigid flat-bottom shoe and weight bearing as tolerated. Severe fractures through the navicular bone sometimes require surgery.
  
  
• Calcaneal (heel bone) fractures often occur in people who fall from a height and land on their feet. These people often have other injuries as well, so they should be examined carefully. The most common fracture of the calcaneus, the intraarticular joint depression fracture, usually requires surgery. Other fractures of the calcaneus can usually be treated with splints or casts and non-weight bearing.
  
  
• There are many types of talar fractures, some of which are difficult to diagnose and treat. Lateral process fractures often occur from snowboarding injuries. Posterior process (Shepherd) fractures are found in athletes who dance or kick. The diagnosis of these injuries often cannot be made in the doctor's office or emergency department on the initial visit and require bone scans or other imaging studies if symptoms continue. Treatments vary but often splints or casts and a period of non-weight bearing is required.