Overview

Fracture blisters are fluid-filled pockets that form under the skin, usually near a broken bone or surgical site. They affect about 3% of all fractures, most often in areas like the ankle or forefoot, where the bone lies close to the surface and there isn’t much soft tissue or muscle for padding.
These blisters can form within hours to days after an injury or surgery—sometimes even weeks later—and take several weeks to fully heal.

1. Fracture Blisters After Elective Foot & Ankle Surgery

If you’ve had surgery for a bunion, flatfoot, or ankle realignment, your surgeon may have made bone cuts (osteotomies). These procedures naturally cause swelling, which in rare cases, can lead to fracture blisters.

Symptoms

• Clear (serous) or blood-filled (hemorrhagic) blisters near the surgical site
• Tight or loose skin covering the blister
• The blister itself is often painless, but the surgical site may be sore
• Usually appears 2–5 days after surgery

Causes

• Swelling puts pressure under the skin, separating its layers
• The fluid builds up and creates a blister
• These are more likely if elevation or icing isn’t done consistently
• ​​If swelling occurs and there is any bandage or splint/cast trauma

Treatment

• Do not pop the blister
• We often allow them to heal naturally
• In some cases, we drain the blister using sterile techniques
• We apply protective dressings to prevent infection
• If from a fracture and surgery is planned we may have to delay the surgery until the skin heals
• The fluid is from inside your body and skin and therefore it's typically sterile and does not need to be drained.

Complications

• Increased risk of infection if the blister breaks near a surgical incision
• Delayed wound healing
• Scarring if the blister is large or blood-filled

2. Fracture Blisters After Traumatic Injuries

Fracture blisters are more common after injuries like ankle fractures, crush injuries, or high-impact trauma to the foot.
Symptoms

• Blisters forming on or near the injured bone
• Can contain clear fluid (serous) or red blood (hemorrhagic)
• May occur within 6 hours or take up to 3 weeks to show up
• Common in the ankle, foot, and lower leg

Causes

• Sudden trauma triggers major swelling and inflammation
• Skin can’t stretch enough and separates internally
• Fluid fills the space, creating a blister

Treatment

• Elevation and immobilization to reduce swelling
• Blisters are left alone unless they pose a risk
• In some cases, as above, we must delay surgery until blisters resolve
• If drained, a sterile dressing and antibiotics may be used

Complications

• If untreated or popped, blisters can become infected
• Blisters can delay fracture repair or reconstructive surgery
• May result in skin scarring or wound dehiscence (wound reopening)

How to Help Prevent Fracture Blisters

• Elevate your leg above heart level as much as possible
• Use ice to control swelling in the first 48–72 hours
• Avoid walking or standing on the injured foot without permission
• Follow your surgeon’s post-op instructions carefully
• Call your doctor right away if you notice any blisters, redness, or drainage

What’s the Outlook?

Most fracture blisters will heal on their own within 2 to 3 weeks, although hemorrhagic blisters may take longer. If you do not need surgery, these can often be managed without any procedures. If you do need surgery, your care team may need to wait until your skin is healthy and safe enough for an incision. 

Many times fracture blister are an expected outcome of surgery and they most commoblty resolve without scars or complications. However, this can be a lengthy process for healing, require local wound care, have a slight discoloration. 

What do Patients say?

Any time in the first several weeks after surgery at one of their post op dressing changes or with dressing changes at home a patient can see a fracture blister(s) and become alarmed. Usually these are normal and nothing to be concerned about as they resolve quickly and do not cause pain. Recommend contact your surgeon and likely will reinforce the above however you would rather your surgeon know than not about anything going on that you are concerned about so they can make the best decision for each individual 

Final Thoughts:

While fracture blisters are rare, they are a sign that your body is under stress. As your foot and ankle surgeon, I want you to know that these blisters are manageable and, in most cases, not dangerous--if we catch and treat them properly. Communication and early care are key. patient. This blog entry is not a substitute for medical care between the patient and their provider. ​If you notice a blister after an injury or surgery, please reach out to your doctor or surgical team for guidance.

I'm fortunate to have presented cases, research, and surgical techniques at numerous local and national conferences. Recently I've helped published two articles that I'm particularly proud of with a host of great co authors. I asked the website team to add a Publication section under Education for articles and posters which you can access here www.ohiofootandanklesurgeon.com/dr-thomas-publications.html

Through the Grant Medical Center Foot & Ankle Surgery Residency Program we started a national collaboration with Podiatric training centers all over the United States for a lengthy data collection and research initiative. What started as an idea to compare with other surgical sub specialties on education, or didactics, revolving around journal clubs turned into a tireless team work effort to set a national benchmark for residency training academics.

For those not familiar with this topic the Journal Club is a long standing tradition of all residency training programs in which new, innovative, and historic peer reviewed journal articles are analyzed and presented to the group for discussion. This is the hallmark of evidence based medicine and practice and allows us as practitioners to achieve better outcomes based on research. We were able to assess what a standardized Journal Club means in the Foot and Ankle training environment and see just how valuable this one teaching tool can be and published this in the JFAS. Click the journal picture below for a link to the article. 

Another article that was published this month which I'm especially proud of was co authored with my former medical assistant, Lindsey Luffy. This was a project she wanted to pursue during her education in Physician Assistant school. She did a great job working in my practice for a couple years and I was proud to see her pursue her dreams of becoming a PA and fortunate to help her with the application and admission process. She has done great academically and is a valuable asset to the local healthcare community. 

Lindsey had a personal connection to plantar fasciitis and felt that heel pain was a difficult condition to treat, and education regarding diagnosis and treatment options was lacking to the majority of the medical community. We were tasked to author an article that would provide a broad spectrum of information and treatment options for plantar fasciitis. This article was published by the JAAPA and is now offered to PAs and PA students as an article to review and get continuing medical education credits which all providers must do throughout the year. 

Lindsey took a fellowship here in Columbus for PA advanced training and we wish her well in the future. To see our article please click on the journal picture below for a link.  

Many providers throughout the country are achieving great outcomes and helping patients with innovative techniques and thoughts. Unfortunately most of these providers do not publish their techniques and pearls. Hopefully this will continue to change as more information ultimately will help our patients and further the profession. 

A Resident Physician I work with through OhioHealth asked me the other day when was I going to update the blog. Hard to believe two years have passed since I last posted an entry! A professor in college used to say "the days take forever but the weeks fly by." As I have moved away from social media and surfing the internet I've delved into practice, surgery, teaching, research, etc... unfortunately I've haven't had time to write for enjoyment. That being said lets recap at least the following year. Many thanks to all of my patients, office and hospital staff, colleagues, residents, administration, friends and family, and so on.

American College of Foot & Ankle Surgeons Annual Conference. I was honored to have four case studies selected for presentation. Pictured, Dr. Nathaniel Preston, Chief Resident at Grant Medical Center and co author on several studies. I appreciate his hard work and efforts in teaching.

Next up...pleased to accept an invitation to speak at the American Podiatric Medical Association Annual Conference in 2017 and hopefully keep updating the blog!

I've found in my practice I often get asked about appropriate shoe gear. This question is usually brought up after we address the primary compliant for the office visit. Occasionally patients bring all of their current shoes to the appointment and asks for me to take a look. I'm always happy to look at the shoes and offer some advice.  Here are some of the most common questions related to shoes I'm asked:

  "What shoes should I wear before and after surgery?"
  "How do I know if I'm buying a good pair of shoes or not?"
  "Should I purchase sport-specific shoes?"
  "Are there shoes made for my condition?"

REMINDER: Every person has a unique foot and ankle structure and gait. The below are general recommendations which can vary based on patient foot and ankle types and current problems. I recommend everyone be evaluated by a licensed professional for patient specific recommendations. 

Whether a professional athlete, weekend warrior, young athlete, or child if you participate in a sport routinely I recommend sport specific shoes: 

I have no shoe brand affiliation and shoe price does not always correlate with quality. For a basic evaluation of the quality and structure of a shoe look for two things:

1. From the side with force the shoe should bend just behind the toes in the forefoot. A shoe without support with force will bend throughout and may even fold on itself. 

2. From the top of the shoe twisting from side to side there should be minimal movement. With force the shoe should not simply twist on itself. 


Anatomy of a Shoe!

I hope this post helps patients look beyond advertising and style when purchasing shoes. Feel free to contact me by office appointment or email for any specific questions. Now get out there and enjoy this nice Spring weather! 

Lebron James brings his talents back to Cleveland! With Ohio welcoming back one of their own I'd like to take a minute to discuss athletes and foot and ankle deformities. Since starting in practice I've had a steady influx of young patients accompanied by their parents with the common question of "is this condition going to hurt my child's athletic performance?"

Being a former collegiate basketball player myself I admit I look at my two young children and wonder if they will have any interests in sports and how will they perform. At least in Central Ohio there is a large focus on young athlete development and this is becoming a national trend.

Parents are rightfully concerned about any lower extremity deformity/condition from a functional standpoint, socially amongst other kids, and athletically. So when a parents asks me is this condition going ot hurt my child's athletic performance, and sometimes I'm asked if this condition will impact the chance of an athletic scholarship, I always refer to King James himself. Please see the below pictures:

Normal feet? Better yet lets take a look at how LBJ stands/runs with his lower extremities rotated out. He does not have a normal heel to toe straightforward gait as he remains with his lower leg and feet rotated externally.

It is known that Lebron James has a podiatrist and wears custom orthotics, or inserts, in his shoes. Arguably one of the best NBA players and possibly one of the greatest athletes of all time, meanwhile he has multiple foot and ankle deformities. How can that be?

I tell young patients, and their parents, who have athletic aspirations that we can relieve their foot and ankle pain and deformities however they should let nothing keep them from their goals.  Determination, preparation, positivity in adversity, discipline, and luck are involved in reaching your athletic goals. Try to enjoy youth, fitness, and comradery with teammates. Goodluck to all young athletes and remember despite his foot and ankle problems LBJ made it to the NBA and back to Ohio!

Hopefully the parents are able to enjoy watching their child play youth athletics and the children aren't pushed too hard and suffer overuse injuries early in their life. There is a difficult balance of playing a sport the child enjoys enough to be successful and stopping them from overplaying.

Unfortunately, I'm currently seeing young patients in my office with foot and ankle problems that are a result of over training. For an excellent article on the state of youth athletics and these overuse injuries  please see the below link from an interview with Dr. James Andrews:

http://www.cleveland.com/dman/index.ssf/2013/02/noted_surgeon_dr_james_andrews.html

I enjoyed meeting with Medical Staff Services as well. Rounding and surgery went great. They arranged one surprise for me that I'll never forget. One of the Attending Surgeons when I was a resident, a mentor to me when I was training, was my scrub tech and surgical assistant. I was both surprised and honored to have this well-known surgeon be my assistant and I enjoyed his company. Thank you to everyone at Grant Medical Center for the warm welcoming. I also received my Ohio Health badge!

If you haven't already please check out the website www.ohiofootandanklesurgeon.com

Thank you to the website developer and author, and thank you to all of my family and friends for your support during my Residency training and practice.

Foot and Ankle Care - more accessible!

My overall goal for the website is patient centered, as a source for information and a way to communicate with a physician through this media. This will allow patients to become more engaged in their care. Now more than ever patients are turning to the internet for information and discussions with other patients regarding their conditions and experiences. New websites on medical tourism exist as well as platforms for patient and physicians to bid on the cost of needed surgeries. Even though this is an exciting time for the advancement of healthcare there is a lot of misinformation on the internet so please be careful.

I also wanted to start a platform where I could update my professional experiences, and happenings at the practice I've joined (Clintonville and Dublin Foot and Ankle in Central Ohio) as well as connect with the community. You'll find links to contact me through the website, email, and LinkedIn. Plans for the website include sections with Surgery Before and After Pictures, Healthy Lifestyle and Foot & Ankle Health Strategies, Advancements in Conservative and Surgical Care, Additional Blog Posts, etc....

Whether you're a current patient or not please don't hesitate to contact me with any questions or concerns.