■ ■ ■ Description

A tarsal fracture is a broken bone (fracture) in the back half of the foot (hindfoot). The tarsal bones are the major bones of the back half of the foot and include the talus (part of the ankle) and calcaneus (heel bone).

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■ ■ ■ Common Signs and Symptoms

• Sharp pain, especially with standing or walking on the foot; may be preceded by a dull pain for 2 weeks to 2 months

• Tenderness, swelling, and later bruising of the foot

• Numbness or paralysis from swelling in the foot, causing pressure on the blood vessels or nerves (uncommon)

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■ ■ ■ Causes

Tarsal fracture is caused by a direct blow, twisting injury to the foot or ankle, repetitive high-impact loads to the foot, or landing wrong on the foot and ankle. To break any of these bones usually requires a significant injury or force.

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■ ■ ■ Risk Increases With

• Participation in contact sports, sports that require jumping and landing (basketball, volleyball), and distance running

• Previous foot or ankle sprains or dislocations or repeated injury to any joint in the foot

• Poor physical conditioning (strength and flexibility)

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■ ■ ■ Preventive Measures

• Appropriately warm up and stretch before practice or competition.

• Maintain appropriate conditioning:

  • Cardiovascular fitness

  • Strength, flexibility, and endurance

• For participation in jumping (basketball, volleyball) or contact sports, protect vulnerable joints with supportive devices, such as braces, wrapped elastic bandages, tape, or high-top athletic shoes.

• Wear proper protective equipment and ensure correct fit.

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■ ■ ■ Expected Outcome

• With appropriate treatment and normal alignment of the bones, healing can be expected. Occasionally, surgery is necessary to realign fractures that are displaced.

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■ ■ ■ Possible Complications

• Nonunion (fracture does not heal)

• Malunion (heals in a bad position)

• Chronic pain, stiffness, or swelling of the foot

• Excessive bleeding in the foot or at the dislocation site, causing pressure and injury to nerves and blood vessels (rare)

• Some bones have a risk of bone death due to interrupted blood supply associated with the fracture

• Unstable or arthritic joint following repeated injury or delayed treatment

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■ ■ ■ General Treatment Conditions

If the bones are in appropriate alignment (position), the initial treatment consists of ice and elevation of the injured foot and ankle at or above heart level to reduce swelling. Crutches and medications help to relieve pain. Immobilization by splinting, bandaging, casting, or bracing for 6 or more weeks, usually while using crutches and not walking on the injured foot, are recommended to protect the bones while they heal. Severe fractures, fractures that are displaced (not in appropriate alignment), or multiple foot fractures may require surgery restore and maintain the joint in its normal position. Surgery usually includes repositioning the bones and holding the position with plates, screws, or pins. After immobilization (with or without surgery), stretching and strengthening of the injured and weakened joint and surrounding muscles (due to the injury and the immobilization) are necessary. Usually these are done with the assistance of a physical therapist or athletic trainer. Also, a stiff-soled shoe and arch support (orthotic) may be required when returning to sports.

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■ ■ ■ Medication

• Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before  surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Strong pain relievers may be prescribed as necessary. Use only as directed and only as much as you need.

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■ ■ ■ Cold Therapy

• Cold is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

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■ ■ ■ Notify Our Office If

• Pain, tenderness, or swelling worsens despite treatment

• You experience pain, numbness, or coldness in the foot

• Blue, gray, or dusky color appears in the toenails

• Any of the following occur after surgery: fever, increased pain, swelling, redness, drainage, or bleeding in the surgical area

• New, unexplained symptoms develop (drugs used in treatment may produce side effects)