Avulsion fractures occur when part of the bone is fragmented and broken off from the rest of the bone. Unlike a standard fracture where a
crack or break suddenly develops in the bone, or a stress fracture where tiny hairline cracks develop and worsen over time, an avulsion
fracture is unique because the piece of bone that fragments is attached to a tendon or a ligament.
Avulsion fractures can occur in many places across the body. As podiatrists, the most common site of an avulsion fracture that we see and treat is called a Jones avulsion fracture. If you run your fingers along the outside edge of your foot, you’ll be able to feel a bump around the midfoot called the styloid process. This bony bump is where this specific fracture occurs due to the connection of a muscle (and its tendon) to this bony prominence.
Avulsion fractures are caused by strong forces that pull on a ligament or tendon that is attached to a bone, causing the bone to fracture at its attachment site. Think of it this way: when we use and move our feet and legs, it is our muscles that power the movement, transferring this power through the tendon that attaches to the bone to move the foot accordingly. When our muscles put more strain and pressure on the bone than it can safely handle, avulsion fractures occur.
We see the highest rate of avulsion fractures in those that are physically active, because of the great power produced by the muscles during
sports to produce movements like powerful kicks, jumps, sudden changes in direction, and other manoeuvres. Dancers are also at risk due to
their intricate and powerful footwork, as are children due to the growing nature of their bones and muscles, and having vulnerable growth
plates that lack the strength of fully formed bones. Other documented at-risk populations include those recovering from surgery, as well
those with osteoporosis who have weak and fragile bones that are more prone to breaking.
For Jones avulsion fractures, any activity that causes the foot to forcefully roll inwards is enough to cause the injury. This may be as simple as stepping awkwardly off a curb, stepping into a hole, twisting your foot during sports activities, or falling off a step. We also see Jones avulsion fractures occurring at the same time as ankle sprains.
Yes, because avulsion fractures are breaks in the bones, they are considered serious injuries that require prompt care to understand the severity of the injury and start the healing and repair process. Without the right treatment, it may become painful or uncomfortable to walk, exercise, or perform certain movements, making daily life difficult.
Avulsion fractures occur suddenly, so are typically accompanied by sudden, sharp or severe pain, occasionally with a popping or cracking sound. Additionally, you may experience:
As avulsion fractures can share similar symptoms to severe muscle strains, it’s important to see your podiatrist who can carry out several examinations to better understand the extent of the injury. Alongside learning about the movements that were occurring at the time of injury which can highlight a possible specific avulsion fracture when paired with the right clinical symptoms, an x-ray may also be used to confirm a fracture. If sprains or strains are suspected alongside avulsion fractures, MRI may also be used to confirm your injuries.
The best treatment approach for an avulsion fracture depends entirely on the location of the fracture, its severity, and if any other
structures have also been damaged.
Before you can get in to see your podiatrist, you want to avoid any movements that cause you pain. This includes resting your foot where
possible, applying ice to the area for up to 15 minutes through a towel or cloth three to four times per day to help with the pain and
swelling. For further pain relief, you may take non-steroidal anti-inflammatory medications. If walking is unavoidable, ensure your feet are
enclosed in good, supportive shoes and use a pair of crutches if you have them handy. The goal here is to not create any additional pulling
forces on the fragmented bone until you’re able to see a health professional.
Across our Brisbane clinics, our podiatrists offer a wide range of treatment options to best suit your unique needs and circumstances. This may involve:
In severe cases, often where there has been a notable separation of the fragmented bone from the original fracture site, surgery may be indicated. Your podiatrist will discuss this with you, and refer you appropriately if needed.
Delaying treating your avulsion fracture may lead to the bone taking longer to heal, or may lead to it healing in a suboptimal way that may either cause discomfort for you in the future, or may require surgical correction that could have been avoided.
While both types of fractures involve a broken bone, regular fractures can occur anywhere on a bone due to high forces or stress, whereas avulsion fractures only occur at the point where tendon on ligament attaches to bone, where the bone fragment is ‘pulled off’ by the soft tissue.
Yes, in some cases, you will still be able to bear weight on an avulsion fracture, though it may feel uncomfortable or painful. We recommend reducing any weight-bearing on a suspected avulsion fracture as much as possible.
Just like how you can break a bone several times, you can also sustain avulsion fractures several times. This is why part of your management includes reviewing the cause, and how to prevent it from recurring in the future.
This depends on the location and severity of the fracture, but can take anywhere from 3-12 weeks for most of the cases we see.