If you’ve injured your foot or ankle and suspect a fracture, it’s important to remain calm and assess the situation to determine the urgency. Here’s a guide to help you decide on the next steps:
- Check for an Open Fracture (Most Urgent)
- An open fracture, where the bone has broken through the skin, is a serious podiatric emergency.
- Action: If bone is visible, cover the area with the cleanest cloth or towel available and go to the Emergency Room (ER) immediately.
- Causes: Open fractures can occur when broken bone fragments pierce the skin from within, or when an external object (like in a gunshot wound or chainsaw accident) penetrates the soft tissue and bone.
- Historical Note: Before the discovery of antibiotics, open fractures were often lethal due to infection.
- Assess Neurovascular Status (High Urgency if Compromised)
- Next, check the blood flow and nerve function to the injured area. While common symptoms like pain, swelling, redness, and warmth are expected with a fracture, certain signs indicate a more dangerous situation.
- Dangerous Signs:
- Numbness or tingling in the foot or toes
- Inability to wiggle toes
- Pale or bluish skin discoloration
- Skin that feels cold to the touch compared to the other limb
- Pain that seems disproportionately severe for the injury
- Inability to feel a pulse in the foot
- Action: If you suspect any compromise to the neurovascular status, this is another podiatric emergency. Go to the ER immediately.
- Evaluate for a Closed, Displaced Fracture
- If the skin is intact (a closed fracture) and the neurovascular status appears normal, try to determine if the fracture is significantly displaced (out of its normal alignment).
- Assessment: Carefully compare the injured limb to your uninjured one. Look for any obvious deformity, such as an abnormal angle or bend.
- Action: If a deformity is present, the fracture likely needs to be professionally reduced (realigned). Do not put any weight on the injured limb. Go to an Urgent Care center or the ER as soon as possible.
- Address a Closed, Non-Displaced Fracture
- If the fracture appears to be closed, non-displaced (no obvious deformity), and neurovascular status is intact, your immediate goal is to stabilize the limb and manage symptoms.
- Actions:
- Stabilize: Gently apply an ACE bandage, turf toe liner, surgical shoe, CAM boot, or a makeshift splint to the injured area to limit movement.
- No Weight-Bearing: Do not put any weight on the injured limb.
- R.I.C.E.: Rest, Ice (apply for 15-20 minutes at a time, with a barrier between the ice and skin), Compress (as with the ACE bandage), and Elevate the lower extremity to help reduce pain and swelling.
- Seek Care: Go to an Urgent Care center or contact your local podiatry office for an urgent appointment for proper diagnosis and treatment.
Important Note: This information is for guidance in emergency situations and does not replace professional medical advice. Always seek evaluation from a qualified healthcare provider for any suspected fracture.
Read more
Evidence-based treatment of open ankle fractures
A systematic review of ankle fracture-dislocations: Recent update and future prospects
Os Wight Foot and Ankle Institute 