Fracture and Injury Care

Dr. Bishop is a fellowship trained surgeon in Foot and ankle fractures. Fott and ankle injuries are common and can range from mild sprains to severe fractures. Proper diagnosis and treatment are essential to ensure healing and restore function. Here's a comprehensive overview:

Types of Foot and Ankle Injuries

Ankle Sprains

- Cause: Overstretching or tearing of ligaments, typically on the outer (lateral) side of the ankle.
- Symptoms: Swelling, bruising, and pain during movement or weight-bearing.
- Grades:
1. Grade I: Mild stretching of the ligament.
2. Grade II: Partial tear of the ligament.
3. Grade III: Complete tear of the ligament.

Ankle Fractures

- Cause: Breaks in one or more bones forming the ankle joint (tibia, fibula, talus).
- Symptoms: Severe pain, swelling, deformity, inability to bear weight.
- Types:
1. Lateral malleolus fracture
2. Medial malleolus fracture
3. Bimalleolar or trimalleolar fractures (involve multiple bones)

Foot Fractures

- Cause: Trauma, twisting injuries, or repetitive stress.
- Types:
1. Toe fractures: Often caused by stubbing or dropping an object.
2. Metatarsal fractures: Can result from direct trauma or overuse.
3. Navicular and Cuboid fractures: Less common, but may occur with high-impact injuries.
4. Lisfranc injuries: Dislocation or fracture of the midfoot bones.
5. Calcaneal fractures: Typically caused by falls from height or car accidents.

Stress Fractures

- Cause: Overuse or repetitive stress, often in athletes or active individuals.
- Common Sites: Metatarsals, navicular bone, calcaneus.

Tendon Injuries

- Achilles Tendon Rupture: Sudden, sharp pain at the back of the heel often following a push-off motion.
- Peroneal Tendon Injuries: Lateral ankle pain and instability.

Soft Tissue Injuries

- Contusions: Bruising from direct trauma.
- Ligament Tears: Complete disruption of ligament fibers.

Diagnosis

Clinical Examination:

Assess swelling, deformity, range of motion, and weight-bearing ability.

Imaging:

- X-rays: Standard for identifying fractures.
- MRI: Used for ligament, tendon, or soft tissue injuries.
- CT Scan: Provides detailed images of complex fractures.
- Ultrasound: Evaluates tendon injuries or soft tissue swelling.

Treatment Options

Non-Surgical Management

1. RICE Protocol:
- Rest: Avoid weight-bearing activities.
- Ice: Reduce swelling and pain.
- Compression: Use elastic bandages or wraps.
- Elevation: Keep the foot/ankle raised above heart level.
2. Immobilization:
- Casts or Splints: Stabilize fractures or severe sprains.
- Walking Boots: Allow partial mobility while protecting the injured area.
3. Medications:
- NSAIDs (e.g., ibuprofen) for pain and inflammation.
4. Physical Therapy:
- Focuses on restoring range of motion, strength, and balance after the acute phase.
5. Orthotics:
- Custom insoles or braces for long-term support and prevention.

Surgical Management

1. Indications:
- Severe fractures (e.g., displaced, open, or comminuted fractures).
- Ligament injuries causing joint instability.
- Failure of conservative treatment.
2. Procedures:
- Open Reduction and Internal Fixation (ORIF): Plates, screws, or rods are used to align and stabilize fractures.
- Arthroscopy: Minimally invasive surgery for ligament repairs or small fractures.
- Tendon Repairs: Suturing torn tendons like the Achilles or peroneal tendons.
3. Recovery:
- Weight-bearing restrictions based on fracture severity and surgical repair.
- Gradual return to activity with physical therapy.

Complications

- Chronic pain
- Post-traumatic arthritis
- Nonunion (failure of bone healing) or malunion (improper alignment)
- Nerve or blood vessel injury
- Swelling and stiffness

Rehabilitation

1. Early Phase (Weeks 1-6):
- Protect the injury with immobilization.
- Begin gentle range-of-motion exercises as advised.
2. Mid-Phase (Weeks 6-12):
- Transition from immobilization to weight-bearing (as tolerated).
- Start strength training and balance exercises.
3. Late Phase (3+ Months):
- Focus on functional recovery and return to sports or daily activities.
- Gradual progression to high-impact exercises.

Prevention of Future Injuries

- Wear appropriate footwear for activities.
- Warm up and stretch before exercise.
- Strengthen foot, ankle, and leg muscles.
- Use protective gear for sports and high-risk activities.
- Avoid sudden increases in activity intensity.
Consult Dr. Bishop immediately at 480-342-9999 if you suspect a foot or ankle injury for a personalized treatment plan.
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