Pediatric foot fractures are <10% of all fractures in children. They are more common in adolescents with a mean age of 13 years old.
Types of Fractures
The foot is divided into 3 Parts:
- Hindfoot: Talus, Calcaneus (heel bone):
- Most common fracture is a fracture at the neck of the talus. The blood supply to the talus bone can be affected by this fracture. A fracture of the lateral process of the talus is known as “snowboarder’s fracture”.
- Calcaneal (heel) fractures are very rare under 15 years of age. Some calcaneal fractures can cause tension on the overlying skin which must be treated urgently. Overuse can cause inflammation at the growth plate (apophysis) of the calcaneus which is called Sever’s disease.
- Midfoot: Navicular, Cuboid, Cuneiforms:
- Isolated fractures of the mid-foot are rare in children.
- The Lisfranc ligament runs between the medial cuneiform and second metatarsal bones. A fracture at the bottom of the second metatarsal is concerning for injury to the Lis Franc ligament and may be further evaluated with a CT or MRI. Fractures of the cuboid can also be associated with Lisfranc injuries.
- Forefoot: Metatarsals, Phalanges (toes):
- The most common pediatric foot fractures are metatarsal fractures. In toddlers, most common injury is to the first metatarsal (great toe side). 5th metatarsal (small toe side) is most common in teenagers. Overuse can cause stress fractures in the metatarsal.
- The second most common pediatric foot fractures are phalanx (toe) fractures. Fractures at the bottom of the nailbed may require surgery to prevent infection.
- In growing children, fractures in the foot may involve the growth plate (physis). It is rare for growth plate fractures of the foot to affect the growth of the foot.
If there has been a significant fall, collision or crushing involving the foot and there is pain, swelling or a crack was felt, an X-ray should be obtained to check for fracture. Children with foot fractures are usually unable to put weight on the foot or limp significantly with walking.
Doctors will check the skin for any open wounds, bruising or swelling. In fractures of the heel bone, the skin will be checked to ensure it is not pale as the bone can push the skin and restrict the blood flow. The foot will also be assessed to be sure the muscles and nerves are working and the circulation is normal.
X-rays will be performed the confirm the diagnosis of a foot fracture. A doctor may order a CT scan or MRI to help guide treatment decisions if the fracture is displaced or involving a joint or growth plate.
Depending on the way the bone is broken, a hard sole shoe, walking boot or cast may be used for treatment. Sometimes your doctor will want you to use crutches to keep the weight off of the foot while the bones heal. If the bones have moved or “displaced”, surgery may be recommended. Different implants including pins, screws, and plates may be used to treat foot fractures. A cast or boot will be used after surgery to protect the fracture while it heals.
Most children recover from their foot fractures within 1-3 months depending on the bone that was fractured. After they come out of their boot or cast, they will often limp and turn their feet out for a short period of time. Most children will not require physical therapy to regain their motion and strength in that leg. If your child was treated with an implant, the doctor may recommend removing the implant in the future. Your doctor may follow the fracture longer if it involved a joint or a growth plate.
Q. Are all foot fractures the same?
Fractures of the foot may differ based on their location within the foot, mechanism of injury, severity, and pattern of the fracture.
Q. How do I know if I should see a doctor?
If there is any suspicion of a fracture, or a foot injury is causing significant pain and inability to walk, it is recommended to seek consultation from a doctor.
Q. Will this affect my child’s ability to play sports?
Most foot fractures in children have a high rate of healing, and they almost always return to their previous level of activity without limitations. Assuming the treatment course goes as planned, the most common foot fractures should not affect your child’s ability to play sports. Some less common, or more severe fracture types may require a longer recovery.
Q. Can my child walk on a broken foot?
Many foot fracture patterns are considered to be stable. These fractures can be treated appropriately in a “walking” shoe, boot, or cast while they heal. Other fracture patterns may not be appropriate for walking, and a 4-6 week period of non-weight bearing treatment will be prescribed while the fracture heals.
Q. How long will recovery be?
Most fractures will heal within 4-6 weeks. Recovery to full activity will depend on fracture healing, severity of injury, and type of activity. After bone healing, the muscles of the foot and ankle will gradually return to their pre-injury strength. Typically, this is between 6-12 weeks.
Q. Will my child need physical therapy?
Most children can safely return to activity with a home-based exercise program focusing on motion and strength. Older children returning to high-level athletics, or children with a longer recovery process may benefit from a formal physical therapy program.
Q. If surgery is pursued, will the implants stay in permanently?
When smooth metal pins are placed as part of surgery, they are usually removed in clinic in 3-4 weeks. If a plate and screws are placed, they are usually intended to stay in for good. If the plate and screws prove to be irritating or painful, an implant removal surgery can be planned, usually greater than 6 months after the injury.