Chip (Avulsion) Fractures of the Foot and Ankle

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Chip fractures (also called avulsion fractures) are injuries that occur when tiny fragments of bone are chipped or pulled away from the bone’s main structure. The tendons and ligaments connecting the musculoskeletal structures will detach a portion of the bone as a result of excessive force generated during a fall or pull. Athletes can also exert this type of force during training or competition.

Chip fractures usually occur in children due to the weak, undeveloped skeletal growth plate. In adults, chip fractures occur as a result of sudden, stressful physical activities. Avulsion fractures are most common among athletes when they engage in bursts of intense physical activity.

In podiatry, chip fractures are most commonly observed in the fifth metatarsal, a mid foot bone that extends to the little toe. This condition is also known by other terms, including: “pseudo-Jones fracture”, “Dancer’s fracture”, or “tennis fracture.”

Chip fractures are also seen in the ankle, where they are sometimes mistaken for ankle sprains. Both conditions are the result of a tendon or ligament pulling on the bone. In a sprain, the connective tissue itself is damaged, while in the avulsion fracture, the bone is compromised. It’s possible for both to occur simultaneously, and MRI or X-rays are used for verification.

Causes of Chip Fractures

Any movement that can generate sufficient contraction on the soft structures of the foot and ankle can cause an avulsion fracture. These can include:

  • Excessive stretching of joints
  • High-intensity sports and training
  • Strong muscular contraction
  • Slip and fall

Other normal activities that can lead to a chip fracture are hiking, climbing stairs, or stepping on a curb.

Types of Chip Fractures

There are 3 types of Chip fractures, graded on severity:

  • 1. Type I – Occurs when the fragmented bone is only minimally removed from the main bone mass. It often does not require surgery and can be treated with simple cast immobilization.
  • 2. Type II – Occurs when the injury causes a change in the structure (lesion) of adjoining tissues but the chipped fragment(s) remain less than 2cm away from the main bone structure. This requires surgical correction.
  • 3. Type III – Occurs when the chipped fragment is more than 2cm from the main bone. Surgery is required to remove or re-attach the fragmented bone back to the main bone mass.

Symptoms of Chip Fractures

Chip fractures in the foot or ankle have obvious symptoms – Pain is the most common symptom. You may experience the pain in an area different from where the fracture occurred. Swelling can occur in the case of a fractured foot or ankle. Swelling is as a result of damage to soft tissues or possible blood around the joint or fluid within the joint itself. Bruising is also common. These symptoms will make it difficult to stand or walk.

Because of the possibility of incorrect self-diagnosis, you should see a board certified podiatrist to confirm the type of injury you’ve sustained. You can expect him or her to order diagnostic imaging. Based on findings, your foot doctor will be able to steer you toward appropriate non-surgical treatments (if applicable) or recommend surgery if necessary.

Conservative Treatments for Chip Fractures

Treatment depends on the location and severity of the injury. Most of the time, the RICEapproach will help manage pain and swelling effectively. It is also advised that you keep weight off the injured foot or ankle until it heals so you don’t do further damage to it.

Medical Treatment

In Type II and Type III cases, where the bone fragment is sufficiently large and detached, surgery will will be required. Portions of the chip may be removed, or the structure will be re-attached to the the main mass.

At Houston Foot and Ankle Care, our focus is on helping patients get back on their feet after a foot or ankle injury. It’s common to experience temporary pain, but chronic or severe pain really should be addressed by a medical professional. Gabriel Maislos, DPM, FACFAS, is a leading Houston podiatrist, with over 14 years in private practice. As a Fellow in the American College of Foot and Ankle Surgeons, he is especially experienced in treating complex injuries from diagnosis to surgery and recovery.

Call (713) 541-3199 if you experience:

  • pain on the outside of the mid foot area
  • pain or swelling in the ankle
  • inability to stand without pain or discomfort
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Houston Foot and Ankle