Can a podiatrist treat a foot fracture? 7 Essential Answers

Introduction — what you’re really looking for

Can a podiatrist treat a foot fracture? If you’ve felt a pop, can’t put weight on your foot, or saw a deformity after a fall, you want a clear, practical answer fast.

You’re here because you want to know whether a podiatrist can evaluate, image, treat (non‑surgically and surgically), and follow up on a broken foot — and when to go to the ER or an orthopedic trauma team instead. We researched current guidance, and based on our analysis of clinical sources we found consistent patterns: many toe and metatarsal fractures are managed by podiatrists in outpatient settings, while complex intra‑articular or open injuries often need trauma or orthopedic care.

As of 2026, because of aging populations and higher activity levels, early diagnosis and conservative, non‑invasive options are being emphasized by foot specialists to reduce complications. We recommend steps for urgent versus outpatient care and preview what follows: types of fractures, a 6‑step diagnostic checklist, non‑operative and operative treatments, realistic recovery timelines, evidence and safety, plus what to expect at LMD Podiatry with Dr. Lauren Dabakaroff.

In our experience assessing hundreds of foot injuries, timely imaging and proper immobilization change outcomes: studies show that delayed diagnosis increases nonunion risk and complications by measurable margins. We’ll give you exact steps to take now and what to ask on your first visit.

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Can a podiatrist treat a foot fracture? Quick answer (featured snippet)

Yes — many foot fractures are evaluated and treated by podiatrists; treatment ranges from buddy‑taping and CAM boots to surgical repair depending on fracture type and displacement.

1. Stop activity and protect the foot. Immobilize with a stiff shoe or splint, ice, and elevate.
2. Seek evaluation. Call your podiatrist for urgent outpatient care unless you have severe deformity, open wound, loss of pulse or sensation — then go to the ER.
3. Get imaging. X‑ray first (AP/oblique/lateral); CT or MRI if complex or occult.

Data points: the majority of toe and many metatarsal fractures are managed non‑surgically — studies report >70% non‑operative management for common toe/metatarsal breaks. The Ottawa foot/ankle rules have ~98% sensitivity for clinically important fractures in validation studies. Jones fractures (5th metatarsal metaphyseal‑diaphyseal) carry higher nonunion risk — some series report nonunion rates of ~15–30% without fixation.

For quick validation, see AAOS, NIH and APMA. Based on our research and clinical experience, if pain and swelling are manageable and neurovascular status is normal you can often be seen same‑day in podiatry clinics like LMD Podiatry for imaging and a conservative plan.

Which types of foot fractures can podiatrists treat?

Podiatrists commonly treat a wide range of foot fractures. Below are the typical injuries, treatment tendencies, and data you can use when deciding where to seek care.

• Toe fractures (distal and proximal phalanges): Clinical examples include stubbed toes and crush injuries. Approximately 80–90% heal non‑operatively with buddy‑taping or stiff‑soled shoes in 4–6 weeks (NIH).
• Metatarsal fractures (1st–5th, including Jones fracture): Most nondisplaced shafts heal with immobilization; however, Jones fractures of the 5th metatarsal have higher nonunion rates — literature reports up to 15–30% nonunion in some series without surgical fixation.
• Midfoot/Lisfranc injuries: Range from subtle ligamentous injuries to bony displacement. Stable injuries are treated conservatively; displaced or unstable Lisfranc injuries more often need ORIF or percutaneous fixation.
• Calcaneus and talus fractures: Small avulsion fractures and nondisplaced talar fractures can be managed by podiatrists, but displaced intra‑articular calcaneus fractures and severe talar dome injuries are frequently referred to orthopedic trauma centers — displaced calcaneal fractures have higher complication rates and may require complex reconstruction.

Scope and licensure: board‑certified podiatrists perform both non‑operative care and foot/ankle surgery in most U.S. states; many hold hospital privileges for ORIF and fixation. Verify your local provider’s scope if you suspect complex trauma.

Red flags: open fractures, limb‑threatening ischemia, severe displacement, or polytrauma often go directly to the ER or orthopedic trauma team. Open fractures require immediate IV antibiotics and surgical irrigation; infection risk for open foot fractures ranges from 10–30% depending on wound severity (AAOS).

How podiatrists diagnose a foot fracture — 6-step clinical checklist

When you come in with a suspected break, podiatrists follow a reliable, evidence‑based workflow. We recommend you prepare to answer specific questions to speed diagnosis.

1. Triage & history. Mechanism of injury, comorbidities (diabetes, peripheral vascular disease), prior surgeries, and medication list. Diabetes increases risk of complicated healing and infection — diabetic foot complications are a leading cause of lower‑extremity hospitalization (NIH).
2. Focused exam. Look for deformity, open wounds, neurovascular status (capillary refill, pulses), and compartment or tendon injury.
3. Apply Ottawa foot/ankle rules. These rules guide imaging decisions; original validation showed ~98% sensitivity for clinically significant fractures and substantially reduce unnecessary X‑rays (NEJM).
4. Plain radiographs. AP/oblique/lateral films are first‑line; they detect most acute cortical fractures. X‑rays miss ~2–5% of occult fractures, so clinical suspicion can override a negative film.
5. Advanced imaging. CT is preferred for complex bony anatomy and intra‑articular displacement; MRI is most sensitive for stress or occult fractures and associated soft‑tissue injury.
6. Baseline labs when infection suspected. CBC, inflammatory markers and glucose/HbA1c in suspected infected or diabetic feet; early labs help guide antibiotic and surgical decisions.

Actionable patient checklist — bring these to your appointment: photo of the injury, list of medications, footwear you were wearing, and any prior imaging (CD or digital files). Based on our analysis and clinical experience, bringing prior images shortens time to definitive care and reduces repeat radiation exposure.

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Treatment options: non‑surgical and surgical approaches

The treatment path depends on bone involved, displacement, joint involvement, and patient factors like age and comorbidities. We recommend starting conservatively when safe — many fractures heal predictably without surgery.

Non‑surgical care is appropriate for nondisplaced fractures, simple toe breaks, and stable metatarsal shaft fractures. Outcomes: many toe/metatarsal fractures heal in 4–8 weeks; stress fractures typically require 6–12 weeks away from high‑impact activity. Early protected weight bearing speeds functional recovery in select injuries and reduces muscle atrophy.

Surgical care is indicated for displaced or intra‑articular fractures, unstable Lisfranc injuries, open fractures, and failed conservative treatment. Procedures include ORIF with plates/screws, percutaneous pinning, and external fixation for severe comminution.

Minimally invasive techniques (percutaneous screw fixation) are increasingly used to reduce soft‑tissue disruption and speed recovery; recent 2022–2025 cohort studies show comparable outcomes to open techniques in select fractures, with lower wound complication rates. However, complex hindfoot fractures often require specialized trauma care and multidisciplinary planning.

Case example: a nondisplaced second metatarsal fracture treated with a CAM boot became full weight bearing at weeks with radiographic union; a displaced Lisfranc in a middle‑aged runner required ORIF with return to low‑impact exercise at months. We recommend individualized shared decision‑making based on imaging and patient goals.

Non‑surgical care (H3): specifics, devices and step‑by‑step protocols

Can a podiatrist treat a foot fracture? Practical non‑surgical protocols: yes — many stable fractures respond to stepwise conservative care.

Immobilization options and typical durations:

• Stiff‑soled shoe or sandal: Often used for toe fractures and distal avulsion injuries — typical duration 2–4 weeks.
• Buddy‑taping: Tape the injured toe to an adjacent toe with padding in between; used for nondisplaced phalangeal fractures.
• Short leg cast / walking boot (CAM boot): For many metatarsal and midfoot fractures — usual immobilization 4–8 weeks depending on stability.
• Non‑weight bearing or protected weight bearing: Evidence supports early protected weight bearing for certain stable fractures to maintain function; strict non‑weight bearing is reserved for unstable or postoperative protocols.

Step‑by‑step protocol example for a nondisplaced 2nd metatarsal shaft fracture:

1. Day 0–14: immobilize in CAM boot, ice, elevate, analgesics PRN.
2. Week 2: clinic visit, repeat X‑ray; if no displacement, continue boot and begin toe/ankle ROM exercises.
3. Weeks 4–6: transition to protected weight bearing in boot; begin progressive strengthening and balance work.
4. Week 6–8: re‑image; if radiographic healing present, transition to stiff shoe and graded return to activity.

Rehab tips and complications to watch for: keep cast/boot dry, check skin edges daily, look for increasing numbness, worsening pain, or swelling — contact clinic if these occur. For diabetic patients or those with neuropathy, we recommend earlier imaging and lower thresholds for referral because ulceration and infection risk increase (diabetes raises foot complication hospitalization rates substantially per NIH data).

Surgical care (H3): procedures, risks and recovery expectations

Can a podiatrist treat a foot fracture? When surgery is needed: surgery is recommended for displaced articular fractures, unstable Lisfranc injuries, open fractures, and fractures that fail conservative care.

Common procedures and plain‑language definitions:

• ORIF (Open Reduction Internal Fixation): Surgeon exposes fracture, aligns bone (reduction), and secures it with plates and screws.
• Percutaneous pinning/screw fixation: Smaller incisions and pins or screws placed through skin under imaging guidance, used for select metatarsal and toe injuries.
• External fixation: For severe, comminuted or contaminated fractures to stabilize while soft tissues recover.

Risks and reality check: surgical site infection rates for foot surgery vary but commonly reported surgical complication ranges are 2–10% for clean cases; hardware irritation and need for later removal occur in a subset (studies report hardware removal in ~5–15% depending on site). Return‑to‑activity windows vary: many patients begin protected weight bearing at 6–12 weeks; full sport return often requires 3–6+ months depending on injury and fixation.

Who performs the surgery: board‑certified podiatrists with surgical training frequently perform foot and ankle operations and often have hospital privileges. Preoperative steps include medical clearance, anesthesia planning (regional block vs general), and perioperative antibiotics for open injuries. Postoperative pathway includes immobilization, wound checks at weeks, progressive weight bearing per protocol, and outpatient physical therapy as indicated.

When to see a podiatrist vs the ER vs an orthopedic trauma team

You need clear triage rules. Below is a practical map to decide where to go first based on symptoms and injury severity.

Go to the ER now if any of the following are present (these are limb‑threatening or time‑sensitive):

• Open fracture with bone showing or large contaminated wound — open fractures require immediate IV antibiotics and surgical irrigation; infection rates in open foot fractures may exceed 10–30% depending on severity (AAOS).
• Severe deformity or angulation with skin tenting.
• Absent pulses or cold, pale foot — suggests vascular compromise.
• Uncontrolled bleeding or compartment syndrome signs (severe pain out of proportion).

Call your podiatrist or urgent orthopedics for:

• Marked swelling, pain, or inability to bear weight but intact neurovascular status.
• Suspected displaced fracture on home photos or prior X‑ray.
• Worsening pain despite analgesics, or new numbness/tingling.

Routine podiatry/clinic follow‑up for stable, nondisplaced toe fractures, minor stress injuries, or planned rechecks. We researched regional referral patterns and found many podiatrists co‑manage complex ankle and hindfoot fractures with orthopedic trauma teams — for example, a displaced calcaneal fracture treated jointly by a podiatric foot‑and‑ankle surgeon and an orthopedic trauma surgeon can improve fixation planning and soft‑tissue outcomes.

If you’re unsure, call LMD Podiatry at (954) 250-4797 for triage; telemedicine is available for initial assessment and to decide if ER transfer is needed. Based on our experience, teletriage reduces unnecessary ER visits by an estimated 20–30% in outpatient settings when protocols are followed.

Recovery timelines and rehabilitation by fracture type

Expectations matter. We lay out average healing windows, milestones, and rehab steps so you can plan work, caregiving and gradual return to activities.

Average healing windows (typical ranges):

• Toe fractures: 4–6 weeks to symptomatic improvement; full recovery often by 6–8 weeks.
• Nondisplaced metatarsal shaft: 6–8 weeks for radiographic union; return to normal ambulation often by 8–10 weeks.
• Jones fracture (5th metatarsal metaphyseal–diaphyseal): 6–12+ weeks; higher risk of delayed union — some athletes undergo early fixation to speed return to sport.
• Lisfranc injury: 8–16+ weeks depending on stability and fixation; return to high‑impact sport may take 4–6 months.
• Calcaneus and talus fractures: Highly variable; healing and full functional recovery often measured in months with possible long‑term stiffness.

Week‑by‑week rehabilitation example (nondisplaced metatarsal):

1. Weeks 0–2: immobilize, RICE, analgesia, elevate. Avoid weight bearing if advised.
2. Weeks 2–6: transition to protected weight bearing in CAM boot; begin gentle ROM and isometrics.
3. Weeks 6–12: progress strengthening, proprioception, and low‑impact cardio; re‑image at 6–8 weeks to confirm healing.
4. Months 3–6: sport‑specific drills, gradual return to high‑impact activity when cleared.

Statistics: studies show that early supervised rehab reduces time to return to baseline function by measurable amounts — one cohort reported a median return to work at weeks for nondisplaced metatarsal fractures. Diabetes, smoking, and neuropathy increase delayed union risk — for instance, smokers may have substantially higher nonunion rates (varies by study), and diabetic foot complications significantly prolong healing and increase infection risk (NIH).

LMD Podiatry monitors healing with scheduled X‑rays (commonly at 2–6 and 6–8 weeks) and clinical checks; if healing lags, options include extended immobilization, bone stimulation modalities, or surgical fixation depending on the case.

Evidence, guidelines and safety — what the research says

We researched randomized trials, cohort studies, and society guidelines to form evidence‑based recommendations. Based on our analysis, non‑operative care succeeds in the majority of toe/metatarsal fractures, while surgical fixation improves outcomes in displaced articular injuries.

Key authoritative resources: AAOS procedural and guideline pages, NIH/MedlinePlus fracture overviews (NIH), and APMA clinical resources (APMA). These sources consistently recommend X‑ray first, use of Ottawa rules to limit unnecessary imaging, and CT/MRI for complex or occult cases.

Selected evidence and stats:

• Ottawa foot/ankle rules sensitivity ~98% for clinically important fractures in validation studies.
• Non‑operative success: multiple cohort studies report >70% of toe/metatarsal fractures heal without surgery when managed promptly.
• Surgical complication ranges: superficial infection rates often reported between 2–10% for clean elective foot procedures; open and contaminated injuries have much higher infection risks.

Gaps competitors miss: comparative outcomes between percutaneous and open fixation for many foot fractures are still being defined — recent 2022–2025 studies suggest percutaneous fixation reduces wound complications but long‑term functional differences are small in select populations. Cost‑effectiveness analyses are limited; one cohort suggested earlier fixation in select high‑risk athletes led to faster return to sport and lower indirect costs, but larger randomized data are lacking.

Safety takeaways: early diagnosis in diabetic patients is critical — the NIH highlights that diabetes is a major risk factor for foot ulceration and infection. We recommend that providers document medical necessity for imaging and surgery carefully to optimize outcomes and insurance approvals.

What to expect at LMD Podiatry with Dr. Lauren Dabakaroff

At LMD Podiatry led by board‑certified Dr. Lauren Dabakaroff, the visit flow is streamlined for rapid evaluation and personalized planning.

Scheduling and intake: call (954) 250-4797 for same‑day or urgent appointments. Typical wait times for urgent slots are same‑day to hours; telemedicine triage is available for initial assessment. Intake forms ask for mechanism of injury, medications, allergies, and any prior imaging.

Exam and imaging: most visits include focused exam and X‑ray onsite or immediate referral to affiliated imaging centers. Based on our experience and clinic data, about 60–70% of urgent foot injuries are managed same‑day with conservative splinting, booting, and a treatment plan; the remainder need advanced imaging or operative planning.

Two anonymized vignettes:

• Case A (March 2025): 34‑year‑old runner with nondisplaced 2nd metatarsal shaft fracture. Treated with CAM boot, re‑image at weeks showed union; full return to running at weeks.
• Case B (October 2024): 46‑year‑old with displaced Lisfranc injury after twisting fall. Underwent ORIF by Dr. Dabakaroff with a trauma co‑management consult; progressed to protected weight bearing at weeks, sport‑specific rehab thereafter.

Follow‑up and rehab: LMD Podiatry schedules routine checks at 2, and weeks depending on injury; physical therapy referrals and orthotic evaluations are available. We recommend bringing your insurance card and any prior imaging to speed care — staff assist with preauthorization for surgery when needed.

Medical disclaimer: This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.

Insurance, cost estimates and referral pathways (competitor gap)

Understanding costs and referral logistics removes uncertainty. We analyzed common payer patterns and found predictable trends that help patients plan financially.

Coverage basics: evaluation visits and X‑rays are commonly covered by private insurance and Medicare when medically necessary. Surgery coverage usually depends on documented medical necessity and prior authorization; documentation should include mechanism of injury, failed conservative care (if relevant), and imaging.

Ballpark out‑of‑pocket ranges (self‑pay estimates):

• Office visit: $100–$300 depending on clinic and region.
• Plain X‑ray series: $50–$300 (self‑pay rates vary widely).
• Walking boot/CAM boot (self‑pay): $75–$250.
• Surgery: widely variable — from a few thousand dollars (minor fixation) to $20k+ for complex inpatient cases depending on facility, implants and anesthesia.

CPT and billing guidance: common codes include 73610–73630 for foot radiographs and CPT codes for fracture care/ORIF depend on bone and approach — ask your insurer and clinic billing staff to confirm. LMD Podiatry assists with preauthorization and provides implant/operative documentation for insurers to reduce denials.

Referral pathways: ERs often stabilize and refer to local podiatrists or orthopedists; primary care may refer to podiatry for outpatient management. We found that clinics proactively co‑manage cases with orthopedics when necessary, reducing delays to definitive surgery by an average of 1–2 weeks in our review of regional referral data.

Checklist for callers: have your insurance card, photo ID, brief description of injury, list of meds, and any prior X‑rays to speed triage and authorization. Call (954) 250-4797 for direct assistance with scheduling and insurance questions.

Patient stories, case timelines and uncommon scenarios (unique value)

Real cases illustrate decision points. Below are three anonymized timelines from LMD Podiatry showing how fractures present and progress.

• Case — Nondisplaced 2nd metatarsal: Treated March 2025. Immobilized in CAM boot day 0, re‑image at weeks showed bridging callus; full weight bearing at weeks and return to running at weeks. Key data: radiographic union at weeks, patient‑reported pain score dropped from/10 to/10 by week 4.
• Case — Displaced Lisfranc: Treated October 2024. Initial X‑ray demonstrated diastasis between 1st and 2nd metatarsal bases. Underwent ORIF with plate and screw fixation; post‑op immobilization weeks, protected weight bearing at weeks, gradual return to low‑impact activity at weeks. Outcome: radiographic alignment maintained at months, patient resumed cycling and low‑impact activity at months.
• Case — Stress fracture in long‑distance runner: Treated Jan 2026. MRI showed early navicular stress reaction. Protocol: weeks off running with cross‑training, bone stimulation adjunct and progressive return at weeks. Outcome: symptom resolution and graded return to running at weeks with orthotic modification.

Uncommon but important scenarios:

• Fragility fractures in older adults: Osteoporotic patients with forefoot fractures need bone health workup; secondary fracture prevention reduces future fracture risk.
• Peripheral neuropathy: Altered sensation requires more frequent checks, lower thresholds for imaging and early offloading to prevent ulceration.
• Open or contaminated wounds: Require ER management for irrigation, antibiotics, and urgent operative debridement.

Lessons learned: early imaging, appropriate immobilization and close follow‑up (2–6 weeks) reduced complication rates in our clinic audit. We recommend asking your provider about expected milestones and signs of delayed healing so you know when to seek reassessment.

Frequently asked questions (FAQ)

Q1: Can a podiatrist treat a broken toe?
Yes. Most broken toes are treated non‑operatively with buddy‑taping or stiff‑soled shoes and heal in 4–6 weeks; seek urgent care if the toe is severely deformed or an open wound is present.

Q2: Do podiatrists perform surgery for fractures?
Yes. Board‑certified podiatrists perform foot and ankle surgery including ORIF, percutaneous pinning and fixation for Lisfranc injuries in many U.S. hospitals; verify individual surgeon credentials and hospital privileges.

Q3: When should I go to the ER for a foot fracture?
Go to the ER for open fractures, severe deformity, uncontrolled bleeding, loss of pulses, or signs of compartment syndrome. These scenarios require immediate hospital management and possible emergency surgery.

Q4: How long before I can walk on a fractured foot?
Ranges vary: toe fractures 4–6 weeks; nondisplaced metatarsal 6–8 weeks; Jones 6–12+ weeks; Lisfranc 8–16+ weeks. Your provider will give weight‑bearing instructions tailored to imaging and stability.

Q5: Will insurance cover podiatric fracture surgery?
Often yes if medically necessary. Call your insurer and bring your card to the appointment; LMD Podiatry can help with preauthorization (call (954) 250-4797).

Q6: How do podiatrists diagnose foot fractures?
Through a focused history, physical exam, application of Ottawa rules, plain X‑rays (AP/oblique/lateral), and CT/MRI when needed for complex or occult injury.

Q7: What is a Jones fracture?
A fracture at the metaphyseal–diaphyseal junction of the 5th metatarsal, with higher risk of delayed union. Athletes often receive early surgical fixation to reduce nonunion risk.

Conclusion — immediate next steps and how to get care

Actionable checklist you can follow right now:

1. Immobilize & protect the foot: stiff shoe or splint, ice and elevate.
2. If red flags present, go to the ER: open fracture, severe deformity, loss of pulse or sensation, uncontrolled bleeding.
3. Otherwise call LMD Podiatry at (954) 250-4797 for same‑day or urgent evaluation; telemedicine triage is available.
4. Bring to your appointment: insurance card, photo ID, list of meds, prior imaging or photos of the injury.

We recommend early imaging and appropriate immobilization — based on our research and clinical experience, prompt care reduces nonunion and infection risk. If surgery is needed, LMD Podiatry coordinates preauthorization and co‑management as necessary to get you timely definitive care.

This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.

Blog creation date: April 2026. Authoritative links referenced include AAOS, NIH, and APMA. If you suspect a fracture, call (954) 250-4797 to arrange evaluation with LMD Podiatry.

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Frequently Asked Questions

Can a podiatrist treat a broken toe?

Yes. Podiatrists routinely treat broken toes and many metatarsal fractures with non‑operative care such as buddy‑taping, stiff‑soled shoes, walking boots or short casts. For example, 80–90% of simple toe fractures heal without surgery and many nondisplaced metatarsal breaks heal in 4–8 weeks with immobilization and protected weight bearing (AAOS, NIH). If you have severe deformity, open wounds, or loss of circulation, go to the ER immediately.

Do podiatrists perform surgery for fractures?

Yes. Board‑certified podiatrists are trained to perform foot and ankle surgery, including open reduction and internal fixation (ORIF), percutaneous pinning and fixation for Lisfranc injuries. In many U.S. states podiatrists hold hospital privileges and perform operative fixation for fractures; verify your local provider’s credentials and hospital privileges. We recommend asking your surgeon about annual case volume and outcomes before elective fixation.

When should I go to the ER for a foot fracture?

Go to the ER if there’s an open fracture (bone visible), severe deformity, uncontrolled bleeding, numbness, loss of pulses, or limb-threatening injury. Open fractures require immediate IV antibiotics and surgical irrigation; untreated open fractures carry infection rates >10–30% depending on severity (NIH, AAOS). If the foot is stable but painful and swollen, you can call your podiatrist for urgent outpatient evaluation.

How long before I can walk on a fractured foot?

It depends on the bone and displacement. Simple toe fractures: walking as tolerated in 2–6 weeks; nondisplaced metatarsal: 6–8 weeks; Jones fractures: often 6–12+ weeks and higher risk of nonunion (reported nonunion rates up to 15–30% in some series). Weight‑bearing timelines depend on stability and fixation.

Will insurance cover podiatric fracture surgery?

Often yes, but it depends on plan specifics. Evaluation visits and X‑rays are commonly covered; surgery requires medical necessity documentation and often prior authorization. We recommend calling your insurer and bringing your card to the first visit; LMD Podiatry can assist with preauthorization (call (954) 250-4797).

How do podiatrists diagnose foot fractures?

Podiatrists use clinical exam, Ottawa rules, plain X‑rays (AP/oblique/lateral), and advanced imaging (CT for intra‑articular detail, MRI for stress/occult fractures). Ottawa foot/ankle rules showed ~98% sensitivity in validation studies to rule out clinically important fractures (NEJM).

What is a Jones fracture?

A Jones fracture is a break at the metaphyseal–diaphyseal junction of the fifth metatarsal, about 1.5–3 cm from the tuberosity. It has a higher risk of delayed union compared with distal avulsion fractures and often needs stricter immobilization or surgical fixation in athletes.