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fifth metatarsal recovery

I fractured the base of my fifth metatarsal, not jones fracture, approximately 8 weeks ago. I went for an MRI yesterday, because my doctor thinks I may have a stress fracture now. I have pain under the metatarsal head when pushing off. The original fracture was down when I rolled my foot in a pair of wedge type shoes. I don't know the results of the MRI. All the tech would tell me is that I had bone marrow edema at the original fracture site. Is that normal to have this after 8 weeks?


RESPONSE
Hi,
I would not be surprised to see bone marrow edema at end of eight weeks. This does not mean you are not healing, actually it is a sign that you are healing.
At this point, in my mind, healing is based more on clinical signs than radiograph findings. Many times when people have metatarsal fractures either from trauma, or physician induced such as in surgical procedures, the x-ray eight weeks down the road may still show incomplete healing, however, the patient has no pain when ambulating and in most cases I tell my patients to wear a stiff soled shoe and avoid excessive athletic activity for another couple of weeks. If the patient does not notice any real pain for another two weeks or so, then I consider them healed and they can resume their normal activity.
Factors such as your age, weight, overall health, smoking habits all influence the rate at which a broken bone will heal.
I am assuming you had been in some kind of cast or splint for the last eight weeks, so I am not sure how you might have developed a stress fracture in the same metatarsal bone, but I suppose anything is possible. If the pain is directly under the metatarsal head and not just behind it, then I am not so sure you have a fracture at the end of the bone, but then again I do not have the luxury of actually examining you.
If it turns out that you do have a second fracture then obviously that is going to set you back because you will now have to be immobilized again for another period of time to allow this second fracture time to heal. In general the stress fracture should heal more quickly than the original fracture. Again factors such as whether or not you smoke, your age, weight and health will all come into play in determining how long healing should take.

Marc Mitnick DPM
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