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Avulsion Fracture

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Icon not found What is an avulsion fracture?
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Icon not found Are avulsion fractures serious?
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Icon not found When avulsion fractures are left untreated
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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.

What Causes Avulsion Fractures?

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.

Who's At Risk Of Avulsion Fractures?

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.

Are Avulsion Fractures Serious?

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.

What Are The Symptoms Of Avulsion Fractures?

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:

• Swelling in the area
  
• Bruising
  
• Muscle weakness or pain that radiates or around the foot or leg, depending on the location of the avulsion fracture
  
• Difficulty walking or bearing weight on the affected foot
  

How Are Avulsion Fractures Diagnosed?

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.

How Are Avulsion Fractures Treated?

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. 

Home treatment

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.

Podiatry treatment

Across our Brisbane clinics, our podiatrists offer a wide range of treatment options to best suit your unique needs and circumstances. This may involve:

• Moon boots, walkers or other immobilisation devices to offload the broken bone and best support the healing and repair process
  
• Footwear review to ensure your footwear is offering you the best support throughout your recovery, and will not slow your progress
  
• Footwear modifications to help make your gait smoother and easier while you recover
  
• Custom foot orthotics to keep your feet supported in an optimal position or alignment to help your healing and repair
  
• Physical therapy including range of motion exercises, strengthening, gait training, proprioceptive recovery and more. These have shown to be beneficial in recovering from an avulsion fracture, particularly when staged with different levels of progression as you continue to recover and progress.
  

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.

Can Avulsion Fractures Get Worse If Not Treated?

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.

FAQs

What is the difference between an avulsion fracture and a regular fracture?

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.

Can you walk on an avulsion fracture?

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.

Can avulsion fractures come back after treatment?

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.

How long does it take to recover after an avulsion fracture occurs?

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.