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avulsion fracture at base of fifth metatarsal

by deborah
(italy)

I am almost 10 weeks out from a bad fall resulting in a 3┬░ankle sprain and a complete non displaced fracture at the base of the 5th metatarsal. Xrays at weeks 4 and 7 showed union occuring but still not 100%. The OS cleared me to put on tennis shoes and be walking without crutches by week 9. which I basically did. Around week 7 also began nwb rehab for ankle too. Now at week 10 I am still walking but with a limp with low mostly bothersome pain of and on at fracture site, plus I feel things pulling and pinching, as usual. What am I to do now?? I am not supposed to see this doctor again, his office is far away, and I am afraid this fracture is not healing and afraid to continue to walk on it and continue ankle reahb.

I live in a small village in Italy, but I'm from the USA. Is it normal to have intermittent pain of like 2-3 on a scale of 0-10 at fracture site after 10 weeks.

Thank you,

Deborah

Hi Deborah,
My concern is that the fifth metatarsal base fracture is not healed. This is a common problem with fractures in this site due to the poor blood supply to the area.
It may continue to heal, give it a couple more weeks, but if it is not any better than it is today, you will need to see a doctor especially one familiar with foot fractures. Read my section on foot fractures; it will explain fifth metatarsal base fractures.
Marc Mitnick DPM

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Continued chronic pain of "supposedly" healed 5th metatarsal

by Sonia
(Texas)

Podiatrist says fractured 5th metatarsal is healed after wearing boot cast for 12 weeks. The same pain I had before the boot cast & during its wearing is still present and becoming more chronic. I am seeing the podiatrist 3 weeks after the boot has been removed.
My question is, do I trust this guy to do surgery, if there is any needed, since he hasn't given the pain adequate attention? I just don't have a good feeling about this. Should I see an orthopedic physician instead?

Thanks,
Sonia in Texas

Hi Sonia,
Chances are after 12 weeks and still having pain, the fracture is not healed.
You have two options:
1. you could have surgery. Whether or not this podiatrist is the guy for you I cannot say, but if you do not have faith in him, you should seek a second opinion.
2. you might consider trying a bone stimulator which is designed to heal fractures that do not heal on their own. In most cases they work quite well.

Marc Mitnick DPM

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Sep 08, 2016
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Cuboid bone fracture. Various opinions
by: Kelly

On July 8th, 2016 I rolled my ankle and my foot basically folded. It was misdiagnosed by the first x-ray and an MRI shows the cubiod bone fracture but in 3 places.
I have had another podiatrist yesterday (September 8th) tell me he did an xRay and is saying that the MRI was wrong?
I am still in extreme pain especially if I try to walk.
I'm also very disturbed by the way the last doctor treated me as if I was just fine and he questions an MRI over his x-ray. He didn't even touch my foot.
I am very frustrated and don't know what to do.
Please advise as I also am in need of a knee replacement on the opposite side.
Crutches are very hard to manage.

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I would tend to lean towards the results of the MRI rather then the x-ray. Small fractures in small bones (cuboid) can be missed on x-ray. If there is a question in regards to the MRI report, you can either request that another radiologist read the films or consider having a bone scan which if "hot" would be highly suggestive of a fracture.
If none of these options appeal to you, then consider treating the foot as if it is fractured. At the very least the foot should be immobilized and if at all possible, the affected foot should also be non-weightbearing. If you cannot use crutches, there are mobile devices on the market that allow you to walk without putting weight on the affected foot.

Marc Mitnick DPM

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fractured baby toe at proximal phalanx

by vanessa navarre
(denham springs, la. )

About 8-9 weeks ago I fractured my left baby toe at the proximal phalanx. I have been seeing an orthopedic and as of yesterday, the fracture still hasn't healed. I have been given a bone stimulator to promote healing. It hasn't hurt in about 4 weeks. Is it okay to begin running again if the bone isn't healed all the way. I would like to start running as soon as possible.

Thanks so much,
Vanessa Navarre

Hi Vanessa,
It depends how far along the healing has occurred. Many times you can return to activity without the bone being completely healed. The problem here is that I am not your doctor and you should go by the advice he or she gives you.
Marc Mitnick DPM

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if you brake your foot do you have to be in a cast

by bailey
(lagrange, ga.)

mycousin broke her foot at camp when she stepped on a curb. they went to the hospital and they put a boot on her but i thought if you broke your foot you wold have to be in a cast is that true?

Hi Bailey,
It depends on where the break is and how bad it is, but in many cases a boot is sufficient.
Marc Mitnick DPM

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fracture of third metatarsal

by Linda
(Georgia)

It has been 5 weeks since the break. I continue to feel some discomfort and swelling. I want to begin a walking program. Is it too early??

Hi Linda,
If it is still hurting then it is probably not healed and if it is not healed then doing a lot of walking on it will only make it worse. Speak to your doctor, he or she will tell you when it is safe to begin your walking program. Do not start too soon otherwise it will only set you back.
Marc Mitnick DPM

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broke right ankle -cannot put foot flat on floor

broke right ankle may 17 2008-surgery june 9 (2 long screws & metal plate) second surgery sept 8-2008-removed all of hardware-cannot put foot flat on floor .When i try to my heel will not touch floor.Is this normal?with some pt will this correct it self?

Hi Jennifer,
This does not sound normal to me. Have you had physical therapy? Speak to your doctor about your inability to put your foot flat on the ground; you may just need physical therapy to "stretch" every thing out.
Marc Mitnick DPM

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Burning in arch after breaking ankle

by SDickie
(Vancouver)

I broke my ankle on 16 June 08 and required emergency surgery with 2 screws inserted. The break was on the rounded part of the inside ankle bone. In the past week, i have been experiencing a burning sensation on the arch in the same foot...What is causing this and how can I deal with it?

Hi SDickie,
If the surgery was performed on the inside of the ankle bone there is a possibility that you have some nerve damage or nerve entrapment where the nerves come down from the leg thru the ankle to the foot.
This may be due to scar tissue formation, or perhaps one of the screws has moved.
You need to see your surgeon and let he or she know about your problem.
Marc Mitnick DPM

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FRACTURED MATATARSAL

by MONICA
(SPRING VALLEY CA.)

I FRACTURED MY LEFT MATATARSAL AND THE ORTHOPEDIC I WENT TO SEE DIDNT PUT A CAST OR NOTHING.IT JUST DOESNT SEEM RIGHT.ALL HE GAVE ME WAS A SHOE TO WEAR IM STILL IN ALOT OF PAIN.SHOULD I CONSIDER SEEING ANOTHER DOCTOR?MY FOOT IS VERY SWOLLEN AND PURPLE.

Hi Monica,
Go see a podiatrist where you will get the care you require.
Marc Mitnick DPM

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Jun 01, 2015
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Fractured Matatarsal
by: Linda

I twisted my left ankle and an xray showed that I fractured my fifth matatarsal in my left foot in december of 2014. I had a splint or soft cast put on my foot for a week and later an immobilation boot was put on by my doctor(podiatrist) and was given crutches and told not to put no weight on my foot at all. I wore the boot for about three months. After three months the doctor told me I could put weight on it with the boot on and without the use of crutches. By the fourth month I was told I can start wearing a shoe (preferably a sneaker) but I had pain in my foot at the ball of my foot and also the side of my foot where it flip over when I twisted my ankle. It's been five months and I'm still having pain in my foot (tender) when I walk at the ball of my foot(push off) and a tingling or numbing sensation and also pain on the side of my foot where it flip over but the pain is not as bad as it was preventing me from walking properly. From the xrays I've had (about five or six in total) the doctor told me that my foot was healing good. Should I worry about the pain and tenderness I'm still having?

RESPONSE

Since you were essentially non-weightbearing for three months and are still having pain in part of your foot away from the fracture site, I would certainly suggest you have your podiatrist investigate it.

Marc Mitnick DPM

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Broken Ankle

by Johnny
(san Jose)

Hello, I broke my ankle on both sides a few days ago. The doctor is having me wait 7-10 days before having surgery. I'm in a splint, and I've been elevating my leg as instructed for 99% of the day. However, when I do get up and move on my crutches, there is severe pain on each side of my ankle and my foot turns purple and feels tight. Once I rest or elevate my foot again, the purple goes away and my foot feels normal again. I do have feeling and full range of motion in my toes. Is it normal for my foot to be turning purple and feeling tight in the splint when I'm up and moving?

Hi Johnny,
The reason your doctor is waiting to do surgery and the reason your foot turns purple is because you have too much swelling in the ankle. Once the initial inflammation is over and the swelling goes down, you will be able to have the surgery and your foot should stop turning colors.
Having said that, a call into your surgeon's office describing your symptoms may not be a bad idea. Remember, I have not actually examined your foot.
Marc Mitnick DPM

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Stress Fracture

by Devan Hauck
(Orlando, Florida)

I was diagnosed with a stress fracture in my lower left leg appriximately ten weeks ago. For the most part the pain has gone away. However I have been feeling a pinching sensation after biking. The sensation is not exclusive to the area of the fracture. It is not painful but I am not certain what the feeling means. What sort of sensations are normal, when recovering from a stress fracture? It has been ten weeks and I am anxious to start running again. Thank you for your suggestions.

Hi Devan,
For the most part ten weeks is still not that long a period of time for a person to still have some kind of abnormal sensation post stress fracture.
Your best bet might be to have the leg re-xrayed (or an MRI if that is how it was originally diagnosed) to make sure that the fracture site has healed.
If so, I do not consider the "pinching" sensation to be anything to worry about and will eventually subside.
You should be able to start running again, BUT, you need to address why or how you got the stress fracture in the first place. Orthotics may become part of your running equipment.
Good luck.
Marc Mitnick DPM

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Tri Malleor Fracture

by Nuala
(N. Ireland)

I am recovering from a tri malleor fracture to the left ankle I sustained a year ago after falling on black ice. One year on I visited a house doctor re removal of plate and pins as they have all worked loose. He pointed out to a student that the reason the surgeon put a screw on a pin originally (he also said the screw was off the pin)was because I had soft bones and a tendency to have osteoporosis. This was checked 2 years ago and my doctor is having the dexta scan repeated as I am post menopausal. A fortnight later I saw a consultant who has made the decision to remove the pins on the inner side of the ankle as they are annoying. The area becomes swollen and hard as the day progesses. He claimed that I don't have soft bones and that the screw was at the end on the pin not off! He wanted to leave the plate and screws in on the outside of the ankle as they were not annoying although they are of no benefit.
The consultant said that the pins had not worked their way out,that they were always there to be seen but were only noticeable when the swelling reduced. However one screw was prominent literally after the plaster was removed at 6 weeks which is why I was given a referral 1 year on. On further questioning he said they worked loose because of movement.I am quite confused and feel I have been fobbed off. What do you think?
I received no physiotheraphy but went privately.I the last 6 months I had a fallen arch and recently metatarsal pain for which I was given anti inflammatory painkillers. Again I went privately to a podiatrist who discovered that I was totally flat footed. I now wear orthotics and with a lot of experimentation have the mentatasal pain under some sort of control.
Finally getting out of bed last week I felt something pull just to the right of the Achilles tendon on my right foot. First thing in the morning I feel it when walking on bare feet. I am wearing the orthotics and well padded Eco shoes so it really doesn't annoy me much but scrambling over a few small rocks at the weekend I felt it give, with a bit of pain. Do I need to get this checked out?? By whom?

Hi Nuala,

Two main reasons screws and pins are removed is when they either become loose and so are no longer doing what they intended to do and if they happen to be in a position that annoys the patient. This can be done after enough time has passed and the fracture appears healed. The problem with osteoporosis is that it takes longer for bones to "mend" because they are decalcified.

In answer to your question about the pain in your other foot, pain, is always a reason to go to the doctor. Since it occurred while walking over some rocks, you may wait a couple of days, if the pain does not improve, then I would recommend you see a doctor.
Marc Mitnick DPM

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Does a facture to the metatarsal hurt while walking?

by Olivia
(MI)

I dropped a 15 lb detergent bottle on my foot. It is a swollen and pretty bruised. It doesn't really hurt to bend my toes but I can't bend them bend them very far. most of the tenderness and swelling is above the third metatarsal. It doesn't really hurt too much when I walk. Could it be a fracture?

Hi Olivia,
It certainly could be fractured, but the only way you are going to know for sure is to have the foot x-rayed; you cannot tell if a bone is broken by looking at the foot nor by the amount of discomfort you may or may not have.
Marc Mitnick DPM

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broken toe

by michelle
(basingstoke, hampshire)

I broke my toe last week and just fell and hurt it again! it looks ok because its taped to my other toe but it is very painful! Should i go back to the hospital to get it checked out ?

Hi Michelle,
It would be a good idea to have someone look at the toe to make sure you did not do any further damage.
Marc Mitnick DPM

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OBLIQUE FRACTURE OF THE BIG TOE

by sheri
(canada)

My son (15) suffered a oblique fracture of his big toe. First two weeks he was not given a boot cast and at our first follow up the toe showed no signs of healing. He was then put in a boot cast and we had another x ray and follow up 2 weeks later, Dr. noted a very slight improvement but not much, my son was told to keep the boot cast on another 2 weeks, we just had that follow up today(6 weeks since injury)The Dr. was very happy, the toe is looking good, seeing the fracture line on the xray is now difficult. My son was advised he can take off the boot cast and start walking in regular shoes,as the big toe joint is very stiff, Dr also advised to start bending the joint each night to regain some mobility.My son is a lacrosse player and is missing his season, he wants to get back to it asap. The Dr says start with walking,move up to a jog and then you should be able to resume sporting activites.....he did not really give us a timeline, basically take it day by day and judge yourself. Thats good advice but maybe not to 15 yr old who wants to get back on the team asap! What do you think is a reasonable timeline to get back in the game after this type of injury??

Hi Sheri,
Your son's doctor is being cautious and in these cases this is a good thing. There is a fine line between doing too much too soon and then refracturing the toe which of course would further set your son back.
I would think once your son is able to jog and assuming there is no pain, he would be eligible to return to lacrosse.
Lacrosse is a rough game and he will have to be careful with his toe. I would think taping the toe would be a good idea when he plays in an effort to give him a little more stability.
Marc Mitnick DPM

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stress fracture in my foot

by Lisa
(Maryland)

About two weeks ago I went to my chiropractor for pain in my foot. I thought a couple of the joints in the bones were stuck. He said, that one of the arches had locked in my foot. After, he had adjusted my foot pain started in a different area of my foot and it continued to get worse. The pain is along the fourth toe and down the top of my foot. He has had me come back for x-rays in which nothing has shown up. He has done a vibration test which caused pain. At this point he told me I have a stress fracture which was most likely caused by the adjustment. The doctor has also told me to wear tie shoes the entire time to help support my foot and that it would take a few weeks to heal. I am wondering if I should get a second opinion to see how bad the break is and if I might need something more done or give him another week? (he has me coming back in 5 days to check me again)

Hi Lisa,
I think a second opinion by a podiatrist would be a very good idea. If the fracture does not show up on x-ray then a bone scan or even an MRI would be an option. I am not so sure this "vibratory" test is the best way of making a diagnosis of stress fracture.
Marc Mitnick DPM


Thanks-

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ankle and foot pain after wearing walking boot ( I have 5th metatarsal facture 8 weeks now)

by Radhika
(CMH)

I have 5th metatarsal facture 8 weeks.
I wear walking boot now. Dr says healing has started.
My ankle and toes pain after 4/5 hours of wearing boot
how long do you think I will need to wear the boot and when will pain go away
Thank you

Hi Radhika,
Unfortunately you will have to wear the boot until the fracture heals, anywhere from 6-8 weeks barring complication.
It is not uncommon to have foot and leg pain from the boot as it does change your gait. Discuss this with your doctor.
Marc Mitnick DPM

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2 possiable broken toes

by PEARL
(HIALEAH,FL)

well almost two months ago i dropped some weights on my toes i could not move them i was in so much pain i threw myself on the floor of pain i paired them up like instructed on the web site i iced it i tried to relax but of course after awhile i couldnt i have three kids but they feel much better i could walk normal again but when i walk for a certain amount of time or stand for a certain amount of time one of the toes that got injured gets dark and swollen and it starts to hurt and i cant bend those two toes normally like the others they are stiff what can i do for that or what does mean did it not heel right?

Hi Pearl,
It means you need to have an xray to determine if the toe is actually broken along with proper care in treating it, otherwise it may continue to hurt indefinately.
Marc Mitnick DPM

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Stress fractures in metatarsals

by Lenore
(Scottsdale AZ)

Eight years ago, when my son, Matthew, was 10, a large boy stepped hard on his left foot. An x-ray confirmed a fracture of the second metatarsal which, we believed, healed without incident.
Four months ago he began experiencing pain in his left foot. Our GP diagnosed a soft tissue infection (a diagnosis we now feel to be in error) and prescribed antibiotics. A month later Matthew experienced an onset of severe pain in his left foot and an x-ray showed a complete fracture of the third metatarsal and a "lump" on the second metatarsal (the bone broken 8 years ago).
A bone scan ruled out osteosarcoma and recent x-rays showed that the areas on the second and third metatarsals were resolving themselves in a way that would be consistent with healing bone.
The conclusion our orthopedic doctor came to was that the second metatarsal developed a stress fracture at the site of the eight year old break. The callus of bone put pressure on the third metatarsal causing it to fracture.
My son was in a cast for 5 weeks and then was instructed to wear a supportive "boot". He was relatively pain free for about a week and then experienced pretty severe pain. An x-ray today showed that now the fourth metatarsal has a hairline fracture.
I have several questions-

Is a previously broken metatarsal more prone to stress fractures?

Is it likely that the callus forming around the healing bone could put sufficient stress on the bone next to it to cause a stress fracture?

What tests would you consider to be most helpful in figuring out why his bones are breaking?

Any insight and direction you can give us will be very appreciated.

Hi Lenore,
Yes, a previously broken bone can refracture.

I have doubts that the bone callus on the healing fracture of the second metatarsal could cause a stress fracture on the third metatarsal.

Although it is very curious that he has broken three adjacent bones in different time periods, it may be nothing more than coincidental. I have no information on his past medical history, nor his activity level, nor his weight. You also do not mention if he has had any other musculo-skeletal problems.

My thought would be to allow the fourth metatarsal to heal and if there are no longer any problems hopefully that is the end of it.
However, if he continues to be susceptible to broken bones (for no apparent reason) I might consider taking him to an endocrinologist and investigate any metabolic disease that might be causing bone fragility.

Good luck.
Marc Mitnick DPM

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jones fracture and osteoporosis

by susan morton
(vero beach florida)

Hello,
I am a 49 year old female, I am diabetic, and I have osteoporosis of which I am being treated for. This is my third fracture. In my right foot I have a jones fracture and it has been six months and it has not healed. What will the doctor do now? I go for another xray on the 16th of this month. Would surgery be a better way to handle this? My left foot healed in four months. I am also wondering if the osteoporois complicates things, I know being a diabetic does. Could you please give me some idea of what the doctor might do?

Hi Susan,
Jones fractures historically can be tough fractures to heal because of the poor blood supply in the region of the fracture. Add to it osteoporosis and your diabetes and you obviously have a problem.
Your next step would be to try a bone stimulator which is a device you wear that attempts to heal the bone by running a small charge in the fracture site. It is a painless endeavor. If that does not work then surgery would be your last option.
If your blood sugars are controlled and you have adequate circulation running into the foot, there would be no reason not to have the surgery if it comes to that.
Marc Mitnick DPM

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Foot Fracture

I fractured my foot a month ago falling down stairs. it was late at night, thought i just twisted my ankle.. and since i was in a lot of pain, just went to bed. i woke up the next morning, to my foot black and blue and hardly able to walk on it. i went to the doctors and the result was a frature. a month later im still haveing sharp pains in my foot. they dont last very long, maybe 10 sec. the pain travels up my leg.. is this normal?

Hi,
Since it takes normal bone, without complications, six to eight weeks to heal it would not be surprising to still be having pain, although the intensity of pain should be diminishing.
I am assuming you are in some kind of cast. If you are not noticing a gradual reduction in your discomfort level, you may want to check back with your doctor.
Marc Mitnick DPM

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jones fracture

I was told I have a jones fracture and the break didn't appear to go all the way through. I was given a a half leg walker, my question is should I also use crutch's?

Hi,
That's a question better left to the doctor treating you. Although Jones fractures can be difficult to heal, I for one, rarely put people on crutches unless they are in a lot of pain bearing weight.
Marc Mitnick DPM

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I smashed my foot- a small tree fell on top of it

by Patti
(Oklahoma City, OK)

The right foot was injured by the stump of a small tree falling
on top of it. It hurt a lot, and had a hideous bruise, but nothing was sticking up- I thought I was home free. I waited a couple days and continued my exercise- a bicycle that doesn't go anywhere, and a stepper. When I washed my hair, I sort of turned
my foot onto the injured side (near the edge of the foot) and it
hurt, so I stopped doing that. Then I noticed it hurting when
I crossed my ankles at church (putting a bit of pressure on that
side again) so I tried to reposition my feet so as not to hurt it
again. But it began to hurt worse, and today was itching on
top. So I removed my sock, and where the itching was, there was
a very hard knot, not huge or anything but very hard. Sort of
immobile. I wondered could it be bone? It was just a hard lump
under the skin and the skin on top was itching a lot. I never
saw a doctor for the bruising since it seemed minor. The pain is much less today, though it's still tender. It lies along
and is in line with the area of the longest and darkest colored
bruising, which is only faintly visible now. It is about
one third distance of the length of my foot from my toe area.
I think there are some tiny bones inside there- the ones that
control the toes right? At the original time of the injury,
the area just below several of the toes (on top of the foot) was also bruising a little. Thank you.

Hi Patti,
I have a short answer for a long question. If there are any abnormal lumps since your injury your best best would be to have the foot x-rayed to make sure there is no fracture, not necessarily a major foot fracture but even a little chip fracture where as the name implies a small piece of bone chips off from trauma (particularly in injuries where something falls on the foot).
Good luck.
Marc Mitnick DPM

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Potential 4th Metatarsal Stress Fracture

by Richard Back
(Nr London, UK)

Hi,

I've had a problem on the top of my left foot for about 3 months now and have been told that its likeley I have a stress fracture in my 4th metatarsal though have been referred for an MRI scan to be safe.

I will explain how the problem arose in the first place:

Basically I believe the cause to be a combination of 2 things. The first being a holiday (vacation) to New York at Christmas where as you can imagine I did a fair bit of walking. The second being that I bought a pair of new trainers at the turn of the year that in hindsight were slightly too small which aggravated it.

After about a month of wearing these trainers (just for general wear, no exercise or sport was played in them) for about a month I noticed a dull sort of pain on the top of my foot. I ignored this at first and continued to wear the trainers but the pain didn't subside culminating in a day of shopping that left me in absolute agony ... it was at this point I suddenly realized that it could well be the trainers.

I stopped wearing them immediately and the pain decreased but was still there slightly and it increased considerably with exercise (in particular playing Cricket) and I went through a cycle wear i'd play on a sunday, the pain would be at its worst the next day and after a period of rest and ice the pain would subside only to return the following sunday when playing again.

After 3 weeks I seeked physio but I think the damage had been done and was told to seek specialist advice, unfortunately due to the British Health system its taken me 2 months to see a specialist.

During this period I had been treating it as possibly Tendinitis of the Extensor Tendons as the thought of a fracture seemed inconceivable, I was also icing and elevating regularly as well as taking Ibuprofen daily. I was also wearing loose shoes/trainers which seemed to help.

After a period of almost complete rest the pain was still there slighly when the area was pressed or any sudden movements to foot was made leading up to my appointment which I had yesterday. They took X-rays but it didn't show up anything, the consultant is sure its a small stress fracture and though an MRI as been planned to be double sure he's advised me to wear an Aircast boot for a couple of weeks (or until pain goes completely) in mean time.

I wondered what your take on this was? Do you think that they are right to diagnose this as a stress fracture?

If thats the case do you think the gradual decrease in pain is because its sort of been healing itself? Will the Aircast boot be what I need to finally get rid of of all the pain and heal the fracture??

Alternatively do you think i'm making a grave mistake wearing this boot? Could it cause me more problems in the future??

Many thanks in advance,


Richard (Nr London in UK)

Hi Richard,
If you were my patient and the xray was questionable for stress fracture then I certainly would order an MRI.
Aside from revealing a fracture, the MRI will also show any damage to the soft tissues on the top of the foot.
Indeed it may be an extensor tendonitis but they are fairly simple to diagnose, so if your doctor is not sure, then by going into a boot and having an MRI, you are helping yourself get over this problem in the shortest period of time.
Marc Mitnick DPM














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Normal to have some pain while stress fracture heals?

Two-and-a-half weeks ago I was diagnosed as having a "subtle fracture involving the distal daphysis of the second metatarsal" of my left foot, due to overexercising. At that time the doctor had me begin wearing a Bledsoe boot and put me on crutches. For two more weeks I will be wearing the Bledsoe boot and be on crutches. What worries me is that from time to time I feel some generalized pain just behind my toes near the ball of my foot. Is it normal to have some pain during the healing process? Or am I doing something wrong? Is it possible that the boot is causing this, since it keeps my foot in a locked position that is not normal? I have been careful to ice the foot several times a day and have kept off it, but since I live alone, I do have to get around to fix meals and take care of some things as best as I can, using the crutches, or hopping on the good foot from the fridge to the stove. I want to get this over with so I can get back to walking again.

Hi,
Quite simply.....a broken bone should hurt; what you should be noticing, however, is a diminishment in the pain as time progresses. If for some reason the pain seems to be getting worse then you should let your doctor know this.
Marc Mitnick DPM

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Fifth Metatarsal Break

by HM
(Houston, TX, USA)

Hello Dr.
I broke my left foot's fifth metatarsal on November 3rd (it was a displaced mid shaft break towards the little toe). The doctor said that there is no need for surgery and that he anticipates the bones to heal. I was given a removable boot cast and crutches so that I don't put any weight. One month later, I went back to see my Dr. He did an X-ray and there was no sign of callus growing. He suggested that I stay on crutches for 2 more weeks and then to go and see him again. I didn't have any pain so he did not give me any medication from day 1. I just wanted to know the following: 1-is it normal for the bones not to show signs of callus in 4 weeks? 2- how long until I start putting some weight on my left foot. I really need to walk. Also, 3- usually, how long will it take until I can walk with regular shoes (without the boot cast).
Female, 27, 140 lbs.
Thanks,
HM

Hi HM,
Usually, but not always, the bones will start to show some signs of healing by four weeks. I would take his advice and have it x-rayed again in two weeks.
In general terms I treat fractures by clinical symptoms, in broad terms this means that in theory the fracture line may not be completely closed, but if there is no pain, or swelling, I will let the patient bear weight in a rigid laced shoe. I would also limit activity for a period of time such as no exercising.
Perhaps in a months time I would then x-ray the foot again. Assuming the fracture line is now closed the patient may resume all activity and shoe wear.
These are just general guidelines, every situation is different.
Marc Mitnick DPM

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Stress fractures of the metatarsals not healing, still in presistent pain after months.

by Karen S.
(Eugene, OR)

I injured my left foot almost five months ago either from a long rocky hike in snow in regular shoes or by slipping on ice and jamming my toes into a post. It felt like a bad bruise on the bottom of my foot, mostly on the ball of my foot around my third and forth toe. After a month of limping I went to the local orthopedics/sport injury clinic. An xray showed nothing, but I was told I had a stress fracture and was given a walking cast. It started to feel better but a couple of weeks in I walked into something in the middle of the night with the same foot. (light burned out, industrial sized bleach bottle left in middle of bathroom). Hurt horribly, like lightning hit me.
Fast forward in time, go back to clinic still in pain. Xray still show nothing. Have an MRI that shows my second, third, and forth metatarsals have 'micro' fractures and the bones are swollen. Another month, back at clinic. There has been some improvement and pushing on my foot in most places no longer hurts, but honestly it's only moderately better than when I first came in. Xray shows nothing, what a surprise. I was told to transition to a post-surgery shoe.
A month later: My toes are still swollen, still don't want to move and hurt when I try. I swear my outside three toes are pointing a little to the left (outside). My foot is still too swollen to fit into almost all my shoes. It still feels like there's a lump on the bottom of my foot. I can only walk slowly in my post-surgery shoe and only wear it in the house. I still wear the walking cast most of the time. I have not functionally improved since I first went to the doctor and I'm getting pretty desperate. Both myself and my dog are now fat from lack of activity. My right knee is starting to give out from all the limping, uneven shoe heights, and going up and down my three story house in the walking cast. I have another appointment with the doctor, and I suspect all that will happen is another Xray... which will show nothing.
Please help!

Hi Karen,
Your doctor needs to start thinking "outside the box". Your symptoms this far down the road are not proportional to the original injury.
Do not bother having another x-ray, what is it going to show? Nothing! If anything I would order another MRI with contrast and look for a soft tissue growth like a neuroma, or damage from all the accumulated trauma over the last few months.
If the MRI is normal other than the small stress fractures (which should be healed by now), I would request physical therapy in an effort to rehab the foot quicker.
Marc Mitnick DPM

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Dec 30, 2014
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Gait and stride problems after 5th metatarsal fracture healed?
by: Beth

I am a 60 year old woman who suffered an oblique 5th metatarsal fracture on my right foot on June 17, 2014 after dancing and a lot of extended exercise walking. I was told I did not require surgery. I wore a cam walker for two weeks and the fracture started to separate. This was followed by a cast for six weeks and then two more weeks in the boot. Supposedly my fracture realigned and healed (I went to three separate podiatrists and they all confirmed my fracture is healed). My original DPM recommended physical therapy because I was concerned that I still had lingering pain and my stride and gait were off. I went to two separate physical therapy facilities and did range of motion exercises and strengthening exercises at both places, and at the second P/T facility the physical therapist also has been giving me the T.E.N.S. treatment, which felt wonderful and took all the swelling down. I am still seeing this physical therapist.

My problem is that I still have pain in my foot, which gets worse during this colder weather. Most important, my stride is much shorter and my gait is off. It feels as if one leg is shorter than the other and my pelvis and hip feel like they are out of alignment and displaced when I walk outside for more than one block. My right leg also feels rigid at times. I land heavier with my left leg and left foot than my right when I am walking down the steps, and also when I walk outside. The most I can walk is about 1 block, and my gait and stride prevent me from going further. I also have complications from severe scoliosis and a metal rod in my spine. The weight and raised heel of the cam walker boot made my back feel worse during my recovery, and I am wondering if that could have impacted my gait and stride.

I still have to step carefully on my healed foot without full pressure, although some days are better than others. I can walk around my house without shoes without much problem. My main concern is when I walk on the hard sidewalk, why my gait, stride and why that seems so off. I also am not driving yet because it is my right foot that was broken. This has impacted my life in a very negative way.

Last month I also suffered a hamstring stretch on my right upper thigh and when I exercise my leg muscles do not stretch out like they did before, but feel rigid and stiff.

Please advise on what can be causing these problems if I am supposedly healed. Now my DPM is saying I should continue with P/T and the next step if that doesn't work would be pain management. I am disheartened by my progress, or lack thereof, and would really appreciate some feedback and help. If there are specific exercises or treatments that can improve my strength, gait and stride, please let me know. And thank you for your help!


Hi Beth,

At age 60 there is certainly the possibility of osteoporosis and/or poor circulation going into the foot which would impact the ability of the fracture to completely heal. You may want to consider an MRI to see if the fracture is totally healed, compared to an x-ray which may not tell the true "story".

If an MRI shows that the fracture is completely healed, then you may want to speak to your podiatrist about the possibility of some kind of insert for your shoe, to better distribute your body weight in the area of the fifth metatarsal. This will take pressure off the metatarsal and make it easier to walk.

If the MRI reveals that the fracture is not completely healed, then you may want to consider a bone stimulator to help move the process along.

Marc Mitnick DPM

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