fracture to 2nd metatarsal base not healing

by Carolyn
(Brooklyn, NY)

According to my MRI, I have a small, incomplete non-displaced fracture to the base of my 2nd metatarsal (3mm low signal focus) along with a subacute osteochondral injury. There was also a small subacute ostechondral injury to the head of the lateral cuneiform and mild generalized narrowing of the 2nd tarsometatarsal space. My ligaments all appear to be intact and there was no subluxation/dislocation found. So far I am being told that I don't have a lisfranc injury. I have osteopenia and hurt myself sleeping when my foot was held back a little far by sheets for several hours. My foot bones were "weakened" even more because I was 4 weeks non-weightbearing healing a stress fracture in my hip. I guess the bone gave out. Apparently, the fracture isn't a stress fracture but it isn't visible on x-rays either. My podiatrist said the osteochondral injuries could be incidental findings so I don't have a true understanding of what they are. Anyways,there is not much info out on the location of my metatarsal fracture that isn't related to a lisfranc injury. I was non-weightbearing with a cam walker boot for 3 weeks. My podiatrist told me I could walk again in sneakers at my followup because I didn't have any pain when he pushed on the bone or manipulated my foot. I also don't have any swelling or bruising. He x-rayed my foot as well but the fracture still didn't appear. I still have a sharp pain over the 2nd metatarsal shaft whenever I put pressure on the forefoot. My first concern is that the pain is there because the fracture isn't healed yet and my second would be that maybe I do have a undiagnosed lisfranc injury. I have had weightbearing x-rays and, according to my podiatrist, they don't show any displacement of the joints. I don't have a true mechanism for a lisfranc but the location of my injuries has me suspicious. Is it possible to have a fracture to the base of my 2nd metatarsal and not have a lisfranc injury? Since the fracture is at the 2nd metatarsal base, should I be walking at all if I don't have a real confirmation that it is healed?

Hi Carolyn,
I am not really clear on the time line here, but if you have only been in a cam walker for three weeks that may not be enough time if a fracture is suspected. Immobilizing the foot (with a cam walker) is an excellent way to allow the whole area to heal whether it be a fracture or ligament damage.
If you suffer from osteopenia and if you smoke those factors will delay the healing process. Discuss with your podiatrist the possibility of staying in the cam walker for a longer period of time.
I know nothing about your medical history or your size but I have to tell you from a conceptual standpoint I do not see how you could have sustained so much damage from sleeping in the wrong position; indeed at the very least I would have suspected possibly some soft tissue damage but not a fracture.
Your podiatrist might want to consider a bone scan to confirm the fracture.
But, as I said before perhaps a longer time frame of wearing the cam walker and even perhaps some physical therapy might move this problem along at a faster rate.
Marc Mitnick DPM