Bone Healing

How Does a Bone Heal?
All broken bones go through the same healing process. This is true whether a bone has been cut as part of a surgical procedure or fractured through an injury.The bone healing process has three overlapping stages:inflammation, bone production, and bone remodeling.
- Inflammation starts immediately after the bone is fractured and lasts for several days. When the bone is fractured there is bleeding into the area, leading to inflammation and clotting of blood at the fracture site. This provides the initial structural stability and framework for producing new bone.
- Bone production begins when the clotted blood formed by inflammation is replaced with fibrous tissue and cartilage (known as "soft callus"). As healing progresses, the soft callus is replaced with hard bone (known as "hard callus"), which is visible on x-rays several weeks after the fracture.
- Bone remodeling, the final phase of bone healing, goes on for several months. In remodeling, bone continues to form and becomes compact, returning to its original shape. In addition, blood circulation in the area improves. Once adequate bone healing has occurred, weightbearing (such as standing or walking) encourages bone remodeling.
How Long Does Bone Healing Take?
Bone healing is a complex process. Speed and success differ among individuals. The time required for bone healing can be affected by many factors, including the type of fracture and the patient's age, underlying medical conditions, and nutritional status. Bone generally takes 6 to 8 weeks to heal to a significant degree. In general, children's bones heal faster than those of adults. The foot and ankle surgeon will determine when the patient is ready to bear weight on the area. This will depend on the location and severity of the fracture, the type of surgical procedure performed, and other considerations.
What Helps Promote Bone Healing?
If a bone will be cut during a planned surgical procedure, some steps can be taken pre-and postoperatively to help optimize healing. The surgeon may offer advice on diet and nutritional supplements that are essential to bone growth. Smoking cessation, and adequate control of blood sugar levels in diabetics, are important. Smoking and high glucose levels interfere with bone healing. For all patients with fractured bones, immobilization is a critical part of treatment, because any movement of bone fragments slows down the initial healing process. Depending on the type of fracture or surgical procedure, the surgeon may use some form of fixation (such as screws, plates, or wires) on the fractured bone and/or a cast to keep the bone from moving. During the immobilization period, weightbearing is restricted as instructed by the surgeon. Once the bone is adequately healed, physical therapy often plays a key role in rehabilitation. An exercise program designed for the patient can help in regaining strength and balance and assist in returning to normal activities.
What Can Hinder Bone Healing?
A wide variety of factors can slow down the healing process. These include:
- Movement of the bone fragments; weightbearing too soon
- Smoking, which constricts the blood vessels and decreases circulation
- Medical conditions, such as diabetes, hormone-related problems, or vascular disease
- Some medications, such as corticosteroids and other immunosuppressants
- Fractures that are severe, complicated, or become infected
- Advanced age
- Poor nutrition or impaired metabolism
How Can Slow Healing be Treated?
If the bone is not healing as well as expected or fails to heal, the foot and ankle surgeon can choose from a variety of treatment options to enhance the growth of bone, such as continued immobilization for a longer period, bone stimulation, or surgery with bone grafting or use of bone growth proteins.

Tarsal Coalition

What is a Tarsal Coalition?
A tarsal coalition is an abnormal connection that develops between two bones in the back of the foot (the tarsal bones). This abnormal connection, which can be composed of bone, cartilage, or fibrous tissue, may lead to limited motion and pain in one or both feet. The tarsal bones include the calcaneus (heel bone), talus, navicular, cuboid, and cuneiform bones. These bones work together to provide the motion necessary for normal foot function.
Causes
Most often, tarsal coalition occurs during fetal development, resulting in the individual bones not forming properly. Less common causes of tarsal coalition include infection, arthritis, or a previous injury to the area.
Symptoms
While many people who have a tarsal coalition are born with this condition, the symptoms generally do not appear until the bones begin to mature, usually around ages 9 to16. Sometimes there are no symptoms during childhood. However, pain and symptoms may develop later in life. The symptoms of tarsal coalition may include one or more of the following:
- Pain (mild to severe) when walking or standing
- Tired or fatigued legs
- Muscle spasms in the leg, causing the foot to turn outward when walking
- Flatfoot (in one or both feet)
- Walking with a limp
- Stiffness of the foot and ankle
Diagnosis
A tarsal coalition is difficult to identify until a child's bones begin to mature. It is sometimes not discovered until adulthood. Diagnosis includes obtaining information about the duration and development of the symptoms as well as a thorough examination of the foot and ankle. The findings of this examination will differ according to the severity and location of the coalition. In addition to examining the foot, the surgeon will order x-rays. Advanced imaging studies may also be required to fully evaluate the condition.
Non-surgical Treatment
The goal of non-surgical treatment of tarsal coalition is to relieve the symptoms and reduce the motion at the affected joint. One or more of the following options may be used, depending on the severity of the condition and the response to treatment:
- Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation.
- Physical therapy. Physical therapy may include massage, range-of-motion exercises, and ultrasound therapy.
- Steroid injections. An injection of cortisone into the affected joint reduces the inflammation and pain. Sometimes more than one injection is necessary.
- Orthotic devices. Custom orthotic devices can be beneficial in distributing weight away from the joint, limiting motion at the joint and relieving pain.
- Immobilization. Sometimes the foot is immobilized to give the affected area a rest. The foot is placed in a cast or cast boot, and crutches are used to avoid placing weight on the foot.
- Injection of an anesthetic agent. Injection of an anesthetic into the leg may be used to relax spasms and is often performed prior to immobilization.
When is Surgery Needed?
If the patient's symptoms are not adequately relieved with nonsurgical treatment, surgery is an option. The foot and ankle surgeon will determine the best surgical approach based the patient's age, condition, arthritic changes, and activity level.