When you sustain an injury to the foot, it may initially be difficult to discern between a sprain and fracture. A sprain involves damage to the ligaments of the foot, whereas a fracture is a break in any one or more of the 26 bones in the foot.
Since a different treatment protocol is used for a sprain or a fracture, it is important to know the difference. A failure to seek medical intervention when needed may result in long-term problems with the foot and limited functional abilities, especially in sports, where the normal structures are placed under stress in the course of activities.
These signs will help you to discern between a sprained foot and a foot fracture:
- Did you hear a sound when the injury occurred? A sound of "cracking" may indicate a fracture whereas a "popping" or "tearing" sound may signal a sprain.
- Could you take weight on the foot following the injury. If you had excruciating pain in the injured area when you attempted to put your weight on it afterwards, it may be a sign of a fracture.
- Swelling following an ankle sprain is not unusual, but swelling with associated distortion of the normal shape of the foot may mean you fractured a bone in your foot
- Numbness in the affected area may also indicate a fracture
- Is it possible to move the joints in your foot without too much pain? Can you wiggle your toes? If no movement is possible a fracture may be present
- Is there a particular area that is very sensitive to touch and severely painful? This may indicate a fracture
Tests to confirm fractures:
- Normal x-rays are taken to diagnose a fracture or exclude it. However, x-rays may miss the fracture under certain circumstances. Depending on where the fracture is, certain x-rays may show up normal even though other methods of examination and the symptoms strongly suggest a fracture
- Since fractures may sometimes not show up on x-rays, a bone scan can provide a more accurate diagnosis
- Once a fracture is confirmed a CT scan or MRI can be done to determine the extent of the damage. Whereas x-rays do not show damage done to tendons, ligaments and cartilage these scans can give a clear picture of the condition of the soft tissue structures such as ligaments and tendons.
If a fracture was diagnosed, surgery and or immobilization may be the next step in addressing the injury. If a fracture is excluded and a sprain diagnosed, the information below will be useful.
Healing process for sprains commence immediately following the injury and goes through several phases:
- Inflammation: As an initial response to tissue injury, there is blood and tissue fluid in the injured area. Any superficial bleeding will be noticed as a bruise. Sometime later, the bruise may be noticed in an area lower than the injured area. This is due to the effect of gravity. The building up of tissue fluid may result in swelling. Repair is started at the site of injury and the inflammatory reaction is the acute response phase. It may last up to 72 hours from the time of injury. Redness, heat, swelling, pain and loss of normal function of the area are the initial signs and symptoms. Applying the principle of rest, ice, compression, elevation and referral as soon as possible after sustaining the injury is key to minimizing the recovery time.
- Repair: Over the next period, which may last up to six weeks, certain processes occur within the damaged tissue where an initial hematoma that was formed during the inflammatory phase is now replaced with fibrous tissue. This new fibrous tissue or "scar" tissue is not as organized and neatly laid down as the original tissue before damage. A process of re-organization is started so that the phase of repair moves on the the remodeling phase. At this point in the recovery process treatment by a physical therapist is valuable. The therapist will employ massage, stretching, exercise, mobilization techniques and electrical modalities to speed up healing.
- Remodeling: During this phase the disorganized scar tissue is changed into a more structured tissue that is laid down in parallel arrangement. This phase is successful when the new tissue is strong and allows for full function and no risk of re-injury. Treatment in this stage involves rehabilitation and proprioception. All strengthening is still done under supervision to prevent any damage to soft tissue structures
The following treatment should be started as soon as possible after the injury has been examined, a fracture excluded and a sprain diagnosed
- Resting the affected area speeds up recovery time. Activity and massage done to soon following the injury may aggravate bleeding and slow the healing process
- Ice the injured area, but never apply the ice directly to the skin to prevent skin burn. A thin fabric can be placed between the ice and the skin. Do not apply ice if you have circulatory problems in the extremities. Never apply ice over open wounds or areas with impaired sensation. For a superficial injury the ice can be applied for 15 minutes. If it is a deeper injury, 30 minutes of ice may be applied. The application of ice should numb the affected area. You may experience sensations of cold, then a short period of warming, followed by aching and pain and thereafter the sensation of numbness will be felt. Prepare yourself for these sensations as numbness is the aim of the ice treatment. Apply the ice 2 hourly for when you are awake, a minimum of 4 times per day. Continue with the compression and elevation between the periods of ice treatment.
- Apply a compression bandage over the ice pack, starting below the injured area. There should be tension when applying the bandage but never to the point where the blood circulation is affected. You can check if the blood circulation is right by briefly pinching an area below the bandaged area with your finger and thumb. When you release the pressure, the skin color should quickly return to normal as an indication that the blood circulation is not affected by the bandaging. Should there be any numbness or discoloration in the area below the bandage, re-apply with less tension.
- Elevate the area to above heart level. Find a position where you can lie down with the injured area elevated without placing strain on other parts of your body like your neck or lower back.
- Referral: When in any doubt, see your doctor or physical therapist for further examination and management.
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