Trauma (Fractures) Foot, Ankle & Toe
A fracture, and what people commonly refer to as a “broken bone”, actually mean the same thing. There are multiple types of fractures/breaks. The subtype of fracture often dictates what treatment plan is utilized.
Broken toes, feet, and ankles are not uncommon. Fortunately many times surgery is not necessary. In the instances it is, Dr. Adams will provide a very detailed plan where the x-rays are examined with the patient, and his recommendations are provided including the after care, and healing timeline.
Doctor Adams is a Fellowship Trained Foot and Ankle Surgeon who completed specialty training in trauma. Dr. Adams takes call with the emergency room, and at local urgent care centers. He has treated everything from power washer injuries, gunshot wounds, to open fractures.
Dr. Adams is a firm believer in the idea that patient’s know their bodies best. Every treatment plan needs to be uniquely tailored to each individual patient’s needs.
If you have an issue and have questions or concerns, please feel free to call Doctor Adams at (317) 477-6683 or schedule a consultation online.
Dr. Adams is a born and raised Hoosier. He attended Indiana University-Bloomington where he met his wife Allison. He got degrees in Nutrition Science, Biology and Chemistry. Dr. Adams then got his doctorate from Kent State College of Podiatric Medicine where he was a Dean’s List student. He then came back to Indianapolis to do his residency surgical training and was Chief resident. He stayed in Indianapolis and completed a specialty Fellowship focusing on Adult and Pediatric Reconstruction. During his Fellowship Dr. Adams helped launch the first foot and ankle dedicated surgical practice at Hancock Orthopedics, and has been employed there since.
Dr. Adams enjoys teaching as he helps educate and train the surgical residents at Community Health Network, and the Fellows at American Health Network. He actively participates in research and editing for national peer reviewed journals.
He is also a consultant for orthopedic device companies where he is afforded the opportunity to help train and design with other surgeons across the country.
Dr. Adams has special interests in the following areas:
Dr. Adams is a father of two and resides with his family in Fishers. He enjoys the short commute to Hancock Health in Greenfield.
When most people think of an ankle fracture they are traditionally referring to what is considered in medical terminology as a “rotational fracture”. This simply means the fracture was sustained during a twisting injury, i.e. a fall on icy pavement, an awkward step off a curb, or potentially a car crash. However, the term ankle fracture can encompass much more than rotational fractures. An ankle fracture is a general classification that can broadly refer to fibula, talus, and tibial fractures, each, and in combination. Whether surgery is necessary or not is based on the severity, and location of the injury. The general rule of thumb used to determine if surgery is necessary is based upon bony alignment, and whether there is gapping (+2mm) between the bones.Request Trauma (Fracture) Consultation
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Heel Bone (Calcaneus) Fractures
Fractures of the heel bone as a result of trauma can be devastating injuries. There are generally two types of fractures that occur with the heel bone – intra-articular fractures that involve the subtalar joint, or fractures that are extra-articular, and do not involve the joint.
Most commonly we see heel bone fractures that involve the joint. These are most common in injuries that involve someone falling from a height. This drives the hard Talus bone into the heel causing it to widen, and disrupting the joint surface. Ideally when a patient is healthy enough the heel bone is surgically put back together through a minimally invasive technique referred to as the “Sinus Tarsi Approach”. Many surgeons were classically trained to use a much more invasive point of entry by raising a large flap on the outside of the heel and causing a lot of trauma to the soft tissues. This technique has fallen out of favor by many surgeons due to the litany of associated complications that often occur such as Sural neuritis, skin healing problems (wounds), infections, difficult hardware removal, etc….
Unfortunately due to the traumatic nature of heel bone fractures that involve the joint often times down the road if the joint becomes chronically painful and arthritic, patients will need a subtalar joint arthrodesis or fusion procedure. This is another reason the sinus tarsi approach is superior to the lateral extensile. The same incision that is used to fix the calcaneal fracture can also be used down the road to fuse the joint if it becomes chronically painful. Read more about Subtalar joint arthrodesis procedures here.
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Metatarsal fractures come in all shapes and sizes. Many of them can be treated conservatively. Surgeons are most likely to recommend surgery when there is considerable displacement (gapping), are multiple metatarsals fractured at the same time.
One of the most talked about and discussed metatarsal fractures is the Jones fracture. It is a fracture of the junction of the 5th metatarsal where the bone starts to taper and become more narrow just before the shaft. These fractures are notorious for healing slowly due to a questionable blood supply to the area. People with very high arches (cavus feet) also have the propensity to suffer from these fractures more often than other other populations aside from athletes.
Jones fractures are unique in that even though they are not always impressive on x-ray, we often recommend fixating them with a single screw down the canal of the bone. This offers an almost rebar type support, and more reliably offers healing. There is much debate whether these fractures should be operated on in all patients or not. A very small incision can be used to place the screw down the bone. There are certainly many examples in which conservative care is successful to heal this fracture type, but literature does show there is a higher percentage of healing when a screw is used to stabilize the bone.
Midfoot Fractures and Lisfranc Injury
When surgeons are generally determining whether or not a fracture/break needs surgery, they use the rules of displacement (gapping) of 2+ mm, or angular deformity as a yardstick. A fracture that extends into a joint surface is another cause to necessitate surgical care. However, the midfoot tends to have more intricate joints, and some important ligaments that can cause exceptions to the general rules we use.
This type of fracture involving the ankle joint is a devastating injury. It occurs when an axial (downward), high energy force is applied to the tibia. The tibia is impacted onto the talus causing the tibia, and “roof” of the ankle joint to break, with multiple fracture lines, and often comminution (shattering) of the bone. Due to the high energy levels associated with this type of injury, the surrounding soft tissues get excessively swollen, and make these injuries very challenging to deal with. The first step of care is often to place a patient into an external fixator to immobilize the fractures, and allow the soft tissues to “cool down”. Once the swelling is under control, the surgeon will then usually provide definitive fracture care. This generally involves long plates and screws to fixate the bone. Stabilizing the bones, and restoring the structural integrity of the joint helps prevent angular deformity, and excessive arthrosis. However, often times despite best efforts, ankles following a pilon fracture become very stiff, and painful.
The talus is a unique bone in that it is mostly covered by cartilage, and has no muscular attachments to it. It is the ball bearing of the leg to the foot. It is a very hard bone, and when it is traumatized it often breaks into unique fracture patterns. It has a somewhat tenuous blood supply, and can at times be challenging to get healed. Accurate treatment of these fractures is important to prevent long term dysfunction of the ankle joint, subtalar joint, and talonavicular joints.
The vast majority of toe fractures are more of an inconvenience than anything. They typically do not need surgical care as the phalanges, or small bones in the toes generally heal well even with mildly displaced (gapped) fractures. The instances where a surgeon may consider surgically correcting the fracture is when there is obvious deformity to the toe. “Pinning” the toe can often prevent excessive angulation, and deformity. Otherwise a surgical shoe, or boot for 4 weeks is often ample care that will allow healing.