How to Self Assess for a Foot/Ankle Fracture

Learn when you need an x-ray and when you don't

Feb 22, 2024

You just smashed your foot or rolled your ankle. Did you break it? How can you tell? Below are the criteria used to determine if you need an x-ray to rule out a fracture. These tests are not conclusive; they are just enough to determine if an x-ray is needed.

How to Know When you Need an X-ray

There is a simple cluster of rules to determine if an x-ray is needed. Its called the Ottawa ankle rules

Can you take 4 steps? I’m talking normal steps. If you can’t put weight on your foot and think that barely tapping your toes on the ground counts as a step, then you CANNOT take 4 steps. If yes, no x-ray needed
Is there pain on the medial malleolus (particularly the bottom 3 inches)? If yes, get an x-ray
Do you have pain on the lateral malleolus (particularly the bottom 3 inches)? If yes, get an x-ray
Do you have pain on the base of the 5th metatarsal? If yes, get an x-ray
Do you have pain on the navicular? If yes, get an x-ray

If you are more video inclined, here is a video to sum up the above text

So you got an x-ray and confirmed your foot is broken; now what?

Let’s get into some of the treatment options for a fracture. I’ll be honest, it’s not a lot but it’s definitely better than doing nothing and waiting to heal.

Supplements

There’s a few supplements I recommend to help with bone healing; Vitamin K, Boron and Inositol. This is not fully comprehensive list but is an excellent start

Vitamin K, 100mcg/day. Vitamin K helps bones heal by activating the proteins that osteoblasts (the cells that form bones) need to do their job. It also helps make sure that calcium is laid down in the right tissues like bones and teeth instead of your arteries. This is a win win because cardiac events are a touch out of our scope.

Inositol, 2g/day. Inositol helps with a process known as cell signaling. Simply, this is how different cells interact with each other. If this process does not work right, then bone can be broken down, which will delay your healing.

Boron, 6-12mg/day. Boron enhances the body’s ability to lay down calcium as well as stimulate osteoblasts. All of this leads to better bone healing.

Treatment

Blood flow restriction training is one of the best interventions for healing a fracture. Frankly, there aren’t a ton so there isn’t much competition.

I’ll do a full in depth post on BFR in the future; but for now I’ll keep it simple.

With BFR, you reduce the blood flow to an extremity (shocker). This causes metabolic stress to the area. The body then initiates the healing response to promote tissue healing. This allows us to get a better stimulus with very little effort.

This is key, as with foot/ankle fracture you can’t do much aside from some simple toe movements to promote the lymphatic system. To get the therapeutic benefit of BFR, you want to be at 80% occlusion pressure. This means only 20% of the blood gets to the foot and ankle.

The only proper way to do this is with a device that can calculate that for you. For this reason I suggest getting proper equipment. You can get a set here (this is NOT an affiliate link).

Here is a setup guide for a BFR Smart Cuff.

The protocol I’d suggest for BFR in a foot and ankle fracture would look like the following:

Place the cuff on the thigh, close to the hip
Set the occlusion pressure to 80%
For 2 minutes work on moving your foot and toes as much as possible, literally any movement you can do is beneficial in this stage. I’m partial to ABCs
Take the cuff off
Rest for 5 minutes to let blood properly refill
Complete 2 more sets

You know have the basics to assess whether you need an x-ray for your foot/ankle as well as the treatment guide while the bone heals. Once the bone heals, its time for rehab; which of course we’ll cover in a future post.