Tarsal Fracture

with Rehab

The tarsal bones are a collection of 7 bones that collectively make up the back half of the foot (hind foot). A tarsal fracture is a break in one of these bones. The 7 tarsal bones are the ankle bone (talus), heel bone (calcaneus), the 4 cuneiform bones, the cuboid, and the navicular.

SYMPTOMS

  • Severe pain at the time of injury, which may persist for several weeks.

  • Tenderness, inflammation, or bruising (contusion) at the fracture site.

  • Swelling within the foot, causing numbness and paralysis, which are signs of nerve and blood vessel damage (uncommon).

CAUSES

Tarsal fractures occur when a force is placed on the bone that is greater than the bone can withstand. Common causes of injury include:

  • Direct trauma (injury from impact) to the foot.

  • Awkwardly landing on the foot after jumping.

  • Twisting injury to the ankle and foot.

RISK INCREASES WITH:

  • Contact sports (football, rugby, or lacrosse).

  • Jumping sports (basketball or volleyball).

  • Previous ankle or foot injury.

  • Poor strength and flexibility.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness (increases heart rate).

  • Protect the ankle and foot with taping, braces, or compression bandages.

  • Wear properly fitted shoes that are appropriate for the activity.

PROGNOSIS

If treated properly, tarsal fractures can be expected to heal with non-surgical treatment. Occasionally, surgery is necessary to treat bone fragments that are out of alignment (displaced fracture).

RELATED COMPLICATIONS

  • Failure of the fracture to heal (nonunion).

  • Healing of the fracture in a poor position (malunion).

  • Recurring symptoms that result in a chronic problem.

  • Prolonged healing time, if improperly treated or re-injured.

  • Bone death, due to poor circulation to the fracture site (rare).

  • Arthritis of the foot.

TREATMENT

Treatment first involves the use of ice and medicine, to reduce pain and inflammation. If the bone fragments are out of alignment (displaced fracture), then the bone must be immediately realigned (reduction) by a trained professional. Fractures that cannot be realigned by hand, or fractures where the bones poke out through the skin (open fracture), may require surgery to hold the fracture in place with screws, pins, and plates. Once in proper alignment, the foot and ankle must be kept still for a period of time to allow for healing. After this period, it is important to perform strengthening and stretching exercises to help regain strength and a full range of motion. These exercises may be completed at home or with a therapist.

MEDICATION

  • If pain medicine is necessary, nonsteroidal anti-inflammatory medications (aspirin and ibuprofen) or other minor pain relievers (acetaminophen) are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be given if your caregiver thinks they are necessary. Use only as directed and only as much as you need.

COLD THERAPY

Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours, and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

SEEK MEDICAL CARE IF:

  • Treatment does not seem to help, or the condition worsens.

  • Any medicines produce negative side effects.

  • Any complications from surgery occur:

  • Pain, numbness, or coldness in the affected foot.

  • Discoloration beneath the toenails (blue or gray) of the affected foot.

  • Signs of infections (fever, pain, inflammation, redness, or persistent bleeding).

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Tarsal Fracture

These exercises may help you when beginning to restore activity to your injured foot. Your symptoms may go away with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

RANGE OF MOTION - Dorsi/Plantar Flexion

  • While sitting with your right / left knee straight, draw the top of your foot upwards, by flexing your ankle. Then reverse the motion, pointing your toes downward.

  • Hold each position for __________ seconds.

  • After completing your first set of exercises, repeat this exercise with your knee bent.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION- Ankle Plantar Flexion

  • Sit with your right / left leg crossed over your opposite knee.

  • Use your opposite hand to pull the top of your foot and toes toward you.

  • You should feel a gentle stretch on the top of your foot and ankle. Hold this position for __________ seconds.

Repeat __________ times. Complete __________ times per day.

RANGE OF MOTION - Ankle Eversion

  • Sit with your right / left ankle crossed over your opposite knee.

  • Grip your foot with your opposite hand, placing your thumb on the top of your foot and your fingers across the bottom of your foot.

  • Gently push your foot downward with a slight rotation so your smallest toes rise slightly toward the ceiling.

  • You should feel a gentle stretch on the inside of your ankle. Hold the stretch for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION - Ankle Inversion

  • Sit with your right / left ankle crossed over your opposite knee.

  • Grip your foot with your opposite hand, placing your thumb on the bottom of your foot and your fingers across the top of your foot.

  • Gently pull your foot so the smallest toe comes toward you and your thumb pushes the ball of your foot away from you.

  • You should feel a gentle stretch on the outside of your ankle. Hold the stretch for __________seconds.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION - Ankle Alphabet

  • Imagine your right / left big toe is a pen.

  • Keeping your hip and knee still, write out the entire alphabet with your "pen." Make the letters as large as you can without any increasing discomfort.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION - Ankle Dorsiflexion, Active Assisted

  • Remove shoes and sit on a chair, preferably not on a carpeted surface.

  • Place right / left foot on floor, directly under knee. Extend your opposite leg for support.

  • Keeping your heel down, slide your right / left foot back toward the chair until you feel a stretch at your ankle or calf. If you do not feel a stretch, slide your bottom forward to the edge of the chair, while still keeping your heel down.

  • Hold this stretch for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH – Gastroc, Standing

  • Place hands on wall.

  • Extend right / left leg behind you and place a folded washcloth under the arch of your foot for support. Keep the front knee somewhat bent.

  • Slightly point your toes inward on your back foot.

  • Keeping your right / left heel on the floor and your knee straight, shift your weight toward the wall, not allowing your back to arch.

  • You should feel a gentle stretch in the right / left calf. Hold this position for __________seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH – Soleus, Standing

  • Place hands on wall.

  • Extend right / left leg behind you and place a folded washcloth under the arch of your foot for support. Keep the front knee somewhat bent.

  • Slightly point your toes inward on your back foot.

  • Keep your right / left heel on the floor, bend your back knee, and slightly shift your weight over the back leg so that you feel a gentle stretch deep in your back calf.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Tarsal Fracture

These exercises may help you when beginning to restore activity to your injured foot. Your symptoms may go away with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your caregiver.

STRENGTH - Dorsiflexors

  • Secure a rubber exercise band or tubing to a fixed object (i.e. table, pole) and loop the other end around your right / left foot.

  • Sit on the floor facing the fixed object. The band should be slightly tense when your foot is relaxed.

  • Slowly draw your foot back toward you, using your ankle and toes.

  • Hold this position for __________ seconds. Slowly release the tension in the band and return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Plantar-flexors

  • Sit on the floor, with your right / left leg extended. Holding onto both ends of a rubber exercise band or tubing, loop it around the ball of your foot. Keep a slight tension in the band.

  • Slowly push your toes away from you, pointing them downward.

  • Hold this position for __________ seconds. Return to the starting position slowly, controlling the tension in the band.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Towel Curls

  • Sit in a chair, on a non-carpeted surface.

  • Place your foot on a towel, keeping your heel on the floor.

  • Pull the towel toward your heel only by curling your toes. Keep your heel on the floor.

  • If instructed by your physician, physical therapist or athletic trainer, add ____________________ at the end of the towel.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Ankle Eversion

  • Secure one end of a rubber exercise band or tubing to a fixed object (table, pole). Loop the other end around your foot, just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Drawing the band across your opposite foot, away from the pole, slowly, pull your little toe out and up. Make sure the band is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Return to the starting position slowly, controlling the tension in the band.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Ankle Inversion

  • Secure one end of a rubber exercise band or tubing to a fixed object (i.e. table, pole). Loop the other end around your foot, just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Slowly, pull your big toe up and in, making sure the band is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Return to the starting position slowly, controlling the tension in the band.

Repeat __________ times. Complete this exercises __________ times per day.

STRENGTH - Plantar-flexors, Standing

  • Stand with your feet shoulder width apart. Place your hands on a wall or table to steady yourself, using as little support as needed.

  • Keeping your weight evenly spread over the width of your feet, rise up on your toes.*

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

*If this is too easy, shift your weight toward your right / left leg until you feel challenged. Ultimately, you may be asked to do this exercise while standing on your right / left foot only.