Foot and Ankle

Closed Fracture Treatment and Infection Prevention

A closed fracture is a broken bone that does not break through the skin. There are four commonly seen closed fractures. These fractures include wrist fractures, hip fractures, ankle fractures and spinal compression fractures. Hip fractures and spinal compression are often seen in the elderly. Fractures require emergency treatment. If neck, back or hip injury is suspected or if there is exposed bone do not move the person.


Diagnosis of fractures can generally be made through physical examination and x-rays. A compression fracture or a wrist fracture may not show on an x-ray. In this case, a CT or MRI can be used to locate the fracture. Often, the fracture will only be immobilized and a repeat x-ray done in 10-14 days when the healing makes the fracture more visible. With a skull fracture, a CT may be done, rather than an x-ray, to determine if there is brain injury secondary to the fracture.


Factors that predispose bones to fractures are:

  • Osteoporosis
  • Advanced age
  • Endocrine and GI issues
  • prolonged use of steroids
  • inactivity
  • smoking and alcohol


Treatment of these fractures is dependent on the severity and can include the following:


  • Reduction
  • Cast, sling or walking boot for immobilization
  • External fixation – intervention used with traumatic soft tissue injury and open fracture
  • Internal fixation – Surgical intervention with placement of pins, screws, plates, or rods.


Additional treatment includes medications for pain and to prevent infection.


A cast or other form of immobilization is meant to hold the bones in proper alignment and to provide protection from additional injury. Reduction is when the bone is set back in place to heal. Some fractures are realigned and held in place through internal fixation or external fixation. External fixation is a way to hold fragments of fractured bone together using metal pins with a compression device attached on the surface of the skin.

The treatment of closed fractures is highly dependent on age, patient preference and surgeon preference

External fixation is used when:

  • there is an open fracture with soft tissue damage
  • fractures with deficient bone (osteoporosis)
  • Infection


Rehabilitation begins right away because long-term immobilization causes muscles to become stiff. It takes 4 to 6 weeks to heal depending on the severity of the fracture and surrounding damage. Physical Therapy begins rehabilitation and has several goals.


The goals of Physical Therapy include:

  • promoting circulation
  • preventing clots
  • enhances the healing process
  • Once the cast is removed, exercise in a pool is beneficial and promotes mobility. The water also relaxes muscles making movement easier.


Treatment of closed fractures is highly dependent on age, patient preference and surgeon preference.

Lisfranc (Midfoot) Injury Overview from a Top Gilbert Orthopedic

Lisfranc (Midfoot) Injury

A Lisfranc injury involves the ligaments and joints of the foot’s middle region. This injury is often the result of an accident or fall. A Lisfranc injury may be mistaken for a sprain, which is why many people delay seeking treatment.

What are the symptoms of a Lisfranc injury?

The symptoms associated with a Lisfranc injury include pain and swelling at the top part of the foot. Bruising can occur on the bottom and top of the foot ankle painfoot. With a severe Lisfranc injury, the foot can become distorted, and weight-bearing is excruciating.

What causes a Lisfranc injury of the midfoot?

The midfoot region is comprised of ligaments and joints. These ligaments hold the bones together like puzzle pieces, and they maintain the foot’s arch. When bones and/or ligaments are injured, they shift out of position. The Lisfranc injury is often the result of a low-energy slip or fall. During sporting activities, twisting frequently occurs, and a misstep or stumbling can result in this type of injury. High-energy Lisfranc injuries are the result of direct trauma, a car accident, or a fall.

How common are Lisfranc injuries?

According to a recent study, Lisfranc injuries are rare, accounting for only 0.2% of all fractures. The incidence is reported as 1 per 55,000 persons per year. This injury is more common during the third decade of life, but it can occur at any age. Lisfranc injuries are more common in men than women, and athletes are more affected than the general population.

How can I tell if it’s a Lisfranc injury or a sprain?

Unrecognized Lisfranc injuries can have serious complications, such as buildup of pressure in the muscles that can damage blood vessels and nerves. In addition, if the foot doesn’t improve after standard sprain treatment (rest, ice, and elevation), or if you notice extensive bruising on the bottom of the foot, you should see a doctor right away.

How does the doctor diagnose a Lisfranc injury?

The doctor makes his diagnosed using symptoms, a routine physical examination, and tests. X-rays are used to show shifted bones, fractures, and swelling. A magnetic resonance imaging (MRI) scan is used to see if there is ligament damaged. To determine the extent of bone injury, a computed tomography (CT) scan may be done.

case9-2How is a Lisfranc injury treated?

The treatment of a Lisfranc injury depends on how severely the structures are damaged, as well as if or not bones have shifted from normal positions. Non-surgical treatment involves casting, rest, and medications for pain. If the bones and ligaments have shifted from normal alignment, the doctor may need to perform surgery to restore normal foot anatomy. The surgery involves the placement of plates, wires, and/or screws that can later be removed after the foot has healed.

What can I expect with recovery after surgery?

Recovery following Lisfranc surgery depends on the severity of your injury. For most patients, the cast will be worn for six weeks followed by six weeks of a walking boot. No weight-bearing is permitted the first six weeks, however. Physical therapy is used to strengthen the ankle and foot and to help restore walking ability. Patients generally cannot return to sports and running for around 6-12 months.

Is Lisfranc surgery effective?

There are a few potential complications associated with Lisfranc injuries. They can result in arthritis and chronic pain of the midfoot. With surgery, infection, nerve damage, and swelling could occur. The outcome of Lisfranc surgery depends on the severity. Some patients will never return to their pre-injury level of activity. For some people, fusion joint surgery is necessary to alleviate arthritis pain.

The orthopedic doctors at Orthopedic and Sports Performance Institute offers top treatment for foot and ankle conditions including stress fractures, sprains, strains and Lisfranc injuries. If you or a loved one has suffered a foot or ankle injury, call the top Gilbert and Chandler orthopedic doctors today!


Kalia V, Fishman EK, Carrino JA, Fayad LM. Epidemiology, imaging, and treatment of Lisfranc fracture-dislocations revisited. Skeletal Radiol. 2012 Feb. 41(2):129-36.

Lattermann C, Goldstein JL, Wukich DK, et al. Practical management of Lisfranc injuries in athletes. Clin J Sport Med. 2007 Jul. 17(4):311-5.

Podiatrist Suggestion – Basic Physical Therapy Exercises for the Feet

Feet (or more specifically hind limbs) are one of the most important organs in the human body as it carries the weight of the entire body. Unlike other mammals that walk using their forelimbs as well, the entire human body is balanced between the two hind limbs only. This is precisely the reason why many who do not practise or carry out special care to their feet bones and muscles often face problems in the joints and ligaments at their middle age. Therefore, it is extremely important for people to take care of their limbs so that they are nimble and they are not in stress at any given point in time. On that front having a lean and light body helps as well.

Recently in Gilbert it is seen that victims of feet pain mostly face issues in the joints and ligaments which may include cramping muscles, hammertoes, bunions, fallen arches and many more. During any such occurrence of pain in the feet, victims are requested to visit and seek guidance from their doctors or podiatrist in this regard. There have been various studies and clinical researches on the precautions and exercises that can be practiced in order to prevent feet pain.

Tips by eminent doctors including podiatrist from Gilbert Az:-

Consult a doctor or podiatrist – Whenever there is pain in the feet, identification podiatrist gilbert azof the symptoms are  extremely important. If the pain is intense and is accompanied by swelling, discoloration or bruising, and the same do not alleviate even after application of ice and sufficient rest, then there is a chance of a fracture or dislocation of a bone. Whether you stay in Gilbert or not in such cases, the victim needs to consult a podiatrist on the recommended therapy that can be undertaken.

podiatrist in gilbert az

Toe-lift Exercises – The flexors and extenders are the crucial muscles in the toes which controls the gait of the person and chances of experiencing foot injuries during any accident. In order to ensure flexibility and durability of these muscles, people are advised to try toe-lift exercises where in they try to raise one toe at a time, and then practice lowering the same one at a time. This immensely help in gaining flexibility in the toe muscles.

marble exercises

Marble Exercise – People could also follow the marble exercise in order to improve the condition of their intrinsic and extrinsic muscles which prevent many a foot problems. In such an exercise, people have to sit on a couch and then pick up marbles using their feet and place them on a bowl. The same has to be done using both feet.

calf exercise -Podiatrist

Strengthen calf muscles by performing calf raises – Calf raises is an extensive exercise which has an impact on the calf muscles. In this exercise, the user first needs to stand in front of a wall and then raise his body on his toes. In order to ensure that he does not fall over, he can take support of the wall. Following this position, the user needs to lower the feet to the ground while maintaining posture and then again raise it. Doing these 10 times a day would ensure lot of strength in the calf muscles.

toe extension exercise-Podiatrist

Toe Extension Exercise– This exercise is performed by wrapping a rubber band around the middle of all five toes of the one foot. The rubber should not have high resistance so that it can strech.Now you have to stretch all of your toes apart which will cause the rubber band to stretch as far as it will go. Then hold the stretch for around five to six seconds and then relax your toes. Perform the stretch for about five times on each foot.


What Are the Most Common Ankle and Foot Injuries?

What Are the Most Common Ankle and Foot Injuries, and the Surgeries to Make Them Better Again


Out of all the musculoskeletal injuries, the most common injuries among people are related to the foot and ankle. Here, we will look at the 3 most common ankle and foot injuries that require surgery to get better.

What Are Acute Sprains?

Such sprains involve a disruption of the fibers, especially of the lateral ankle ligaments. This usually happens due to a twisting of the foot, where the anterior calcaneofibular and talofibular

[ File # csp8943177, License # 2230109 ] Licensed through in accordance with the End User License Agreement ( (c) Can Stock Photo Inc. / focalpoint

ligaments are affected the most. Immediate swelling that is experienced in the area is largely due to internal bleeding.

Most acute ankle sprains can be handled without any adverse results or need for surgical intervention, by following the simple yet very effective RICE method i.e. rest, ice, compression, and elevation. This therapy should be administered as soon as possible following an acute ankle sprain.

Chronic Ankle Sprain

The ankle sprain that doesn’t heal well can become instable, due to which a surgical procedure is needed. One of the techniques that is used to analyze and evaluate the instability of an ankle i.e. the drawer test; will demonstrate an excessive motion, especially in the anteroposterior direction at the ankle joint.

Surgical Procedure for This Sprain:

The most common surgical procedure that is undertaken in the case of chronic lateral ankle instability or chronic ankle sprain is known as the lateral ankle ligament reconstruction/repair procedure. Stability is brought to the damaged ligaments by tightening them, via a technique Achilles Tendon Tears2called double breasting which means that the layers are overlapped one upon the other.

Achilles Tendon Rupture

The one way to determine whether patients are suffering for acute Achilles tendon rupture is by asking them to lie in a prone position. If there is significant amount of loss in the plantar flexion tone, as compared to both the sides; then patients will need to undergo surgery, but for young patients, the same can be treated or managed with the help of a cast.

The patients that are eligible for this type of operative repair need to meet with the following criteria, i.e. they should be healthy , active, and aspiring to return to sporting events and activities.

Surgical Procedure for This Injury:

A number of surgical techniques can be used when it comes to repairing a torn Achilles tendon. The most common surgical procedures that are used to repair Achilles tendon involve the re-approximating of the torn ends, and sometimes, reinforcing them by another tendon.    

Ankle Fracture

Ankle joints are most commonly affected by bone fractures. The injury occurs when the malleoli around the ankle joint are broken, which results in patients experiencing severe pain and swelling, followed by the inability to put their weight on the injured foot.

Surgical Procedure for This Fracture:

ORIF or open reduction and internal fixation are the surgical procedures that are most frequently used when it comes to repairing ankle fractures. This is where fractured bones are openly operated upon and realigned. Metal plates and/or screws are then used to keep the bones secure and in place, in the correct position.

At OSPI, the orthopedic and pain management doctors offer comprehensive foot and ankle treatments. This includes top notch foot and ankle specialists treating patients from Gilbert, Chandler, Mesa, Queen Creek, Casa Grande, Maricopa and surrounding areas.

Most insurance is accepted at Orthopedic and Sports Performance Institute. CALL US NOW    480-899-4333