Foot Fracture (Broken Foot)

First aid for a suspected broken foot

• Rest: stop activity and avoid weight-bearing if it hurts.
• Ice: a wrapped cold pack for 15 to 20 minutes every 2 to 3 hours for the first 48 hours.
• Elevate: keep the foot above heart level.
• Compression: a light elastic bandage, not too tight.
• Remove shoes, socks and rings on toes before swelling increases.
• Pain relief: acetaminophen (paracetamol) or ibuprofen at the label dose.
• Get assessed if you cannot walk, the bone is tender, or there is deformity.

How to tell if your foot is broken

Fractures and sprains can feel alike. A fracture is more likely with:

• tenderness when pressing directly on a bone
• inability to bear weight, or to take 4 steps
• significant swelling and bruising, sometimes spreading to the sole or toes
• deformity or a toe pointing the wrong way
• a crack or snap at the time of injury
• pain that persists or worsens instead of improving

Doctors use the Ottawa foot rules: an X-ray is needed if there is midfoot pain plus tenderness at the base of the fifth metatarsal or the navicular bone, or inability to bear weight for 4 steps.

Common types of foot fracture

Who is at higher risk

• runners, dancers and military recruits (stress fractures)
• people with osteoporosis, low vitamin D or low energy intake
• people with diabetes and neuropathy, who may not feel a fracture (and can develop Charcot foot; see diabetic foot)
• people with flat or high-arched feet
• sudden increases in training load

Diagnosis

• X-rays from several angles, sometimes weight-bearing views for Lisfranc injuries
• CT scan for complex midfoot and heel fractures
• MRI for stress fractures and ligament injuries when X-rays are normal

Treatment

Non-surgical

• Buddy taping a broken toe to its neighbor with padding
• Stiff-soled shoe or post-operative shoe
• Walking boot or cast, with or without crutches
• No weight-bearing for high-risk fractures, such as Jones and navicular fractures, for several weeks
• Gradual return to activity guided by pain and follow-up X-rays

Surgical

Surgery with screws, plates or wires is used for:

• displaced or unstable fractures
• Lisfranc injuries with joint shift
• Jones fractures in athletes or those that do not heal
• displaced heel fractures
• open fractures

Healing time and recovery

• toes: 4 to 6 weeks
• metatarsals: 6 to 8 weeks
• Jones fracture: 8 to 12 weeks, sometimes longer
• Lisfranc and heel fractures: 3 to 6 months or more, with physical therapy

Smoking, diabetes and returning to activity too early slow healing. Some people develop stiffness, ongoing pain or arthritis after midfoot and heel fractures.

Frequently asked questions

How can I tell if my foot is broken or sprained?

A fracture is more likely if there is tenderness when you press on a bone, severe swelling and bruising, deformity, or you cannot walk 4 steps. Sprains usually hurt over soft tissue around the ankle or foot. An X-ray is the only way to be sure.

Can you walk on a broken foot?

Sometimes. Many people can walk with toe or some metatarsal fractures, which is why fractures are missed. Walking on certain fractures, such as Jones or Lisfranc injuries, can delay healing or cause long-term problems. Get an X-ray if walking is painful.

How long does a broken foot take to heal?

Most foot fractures heal in 6 to 8 weeks. Toe fractures often heal in 4 to 6 weeks. Jones fractures, Lisfranc injuries and heel fractures can take 3 months or more. Full strength and comfort may take longer after the bone heals.

What is a Jones fracture?

A Jones fracture is a break at a specific point near the base of the fifth (little toe side) metatarsal, where blood supply is poor. It heals slowly and has a higher risk of not healing, so it often needs a non-weight-bearing cast or surgery, especially in athletes.

Do broken toes need treatment?

Most broken toes heal with buddy taping, a stiff-soled shoe, ice and elevation. See a doctor if the toe is crooked, the big toe is involved, there is a wound, the pain is severe, or you have diabetes, as these may need further treatment.