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Jones Fracture/ 8 weeks and still have significant pain

by Mia
(Canada)

Hello.

I am at 8 weeks with a confirmed Jones Fracture/ nondisplaced / not separated.
I have had an aircast from the beginning and crutches. Because it was very painful I did not weight bare for 4 weeks ( I was not told to be non weight baring); at week 5, I started placing my cast to the ground with very light weight baring; week 6 I was encouraged by doctor to begin more weight baring and to try using a cane or one crutch ( xrays at week 4 showed " no significant healing", at week 6 there was some faint indications of 'calcification'. The weight bearing at week 6 caused me significant discomfort/pain ( causing me to go back to non weight baring for 2 days until the pain subsided). At week 7 I saw the doctor again: I felt a bit better by then, and was encouraged to progress with weight baring ( doctor explained weight is important for healing; and non weight baring causes problems itself with bone loss ). He said another xray would not be a good indicator of healing or not. I have tried more weight bearing and again this resulted in significant pain/discomfort at the fracture site. I am now anxious (and a bit depressed frankly); I don't know if I am getting proper treatment or not. I'm confused ( having read so many controversial things on the internet about treatment of this sort of fracture). Please help me understand if I just keep on as is ( at what point is this unacceptable in healing and time frame), or should I be pushing/asking for something else? Thank you for your time. Most sincerely, Mia

RESPONSE

Hi Mia,

A simple fracture in an otherwise healthy individual should take 6-8 weeks to heal. The problem here is that you have hit the eight week mark and apparently are still in a lot of pain.

This could be due to a number of reasons. The most common reason is the location of the fracture.

A Jones fracture is a fracture of the fifth metatarsal base and as you may have read in your research, the fifth metatarsal base is poorly vascularized meaning the blood flow to the bone is poorer than it is to other bones in the foot, and the body for that matter.

Blood supplies the nutrients by which fractured bones heal themselves. So, if you are not getting enough blood to your fracture, there is a good chance it will not heal.

The care you have been receiving up to this point sounds reasonable. I would have not done anything more than immobilize the area and have you nonweightbearing as well for the first six to eight weeks, keeping in mind that people do get better.

Your real issue is what are you going to do now? You essentially have two options. You could speak to your doctor about a bone stimulator which is a painless device that you wear and has two electrodes that "sit" on either side of the fracture site to help the bone to heal. The other option would be surgery where the fracture site is fused together with a surgical screw.

If the gap, or the space between the two bones is not too large then a bone stimulator might be indicated, but if there is a wide enough gap (although your description does not sound like there is a wide gap), then a bone stimulator would probably be a waste of time.

The problem for most people is how long do you want to drag on with this problem. A bone stimulator could drag on for upwards of ten weeks and you still may find yourself with a problem.

Although no one looks forward to surgery, the procedure is not a very complicated procedure and recovery is fairly quick.

This is a discussion you will need to have with your surgeon because if the foot is not feeling better at eight weeks, chances are it will not heal on its own.

I do not know how old you are of what health issues you may or may not have, but certain metabolic issues may also delay bone healing and lastly if you are a smoker, that too will delay your ability to heal a broken bone.

Marc Mitnick DPM
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Aug 31, 2016
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8 weeks after screw fixation
by: Marie

I am also at 8 weeks and still pain at outside of foot.
I chose to have the screw fixation immediately since I am a runner and hoped to get back faster.

However, at week 6 no healing. Bones are separated even though the screw is there.

I was using a knee walker but doctor told me to start using crutches and heal walk. I am doing some of this but still very worried about hurting the foot further.

Information on internet - NWB for long periods of time even with screw fixation have me wondering if I have been given good advise.

First doctor took stitches out in 14 days and told me to start weight bearing as tolerated. I could not tolerate and went off balance on crutches causing issue with left foot.

There really needs to be more available on screw fixation and recovery if you choose this surgery.

Thanks
Marie

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Hi Marie,

With screw fixation, in the majority of cases, healing is virtually complete at eight weeks. This obviously is not the case with you and one can assume there is a problem.

If the bones are separated then it suggests there is not enough compression from the screw. I have no access to your xrays nor do I know exactly what your surgeon is thinking, but going NWB is the choice most specialists would make at this point, particularly if you are having pain bearing weight.

By going NWB one hopes that new bone formation will bridge the gap. The problem here is the screw. If it did not create compression to bring both ends of the broken bone together, then it may actually become detrimental in allowing the fracture to heal.

I would also suggest you ask your doctor about a bone stimulator. This is a device, as the name implies, that helps the body form new bone and can be very effective in closing over difficult fractures.

The problem for you is time. You chose immediate surgery in order to get this ordeal over with, you are now at eight weeks, with no end in sight. NWB even with a bone stimulator may stretch this out another two months.

If the fracture does not resolve then you may be faced with a second surgery which might include a bone graft and another screw. This is something you should discuss with your surgeon.

If you are uncertain about what you are being told, the the smart money is to always get a second opinion.

Marc Mitnick DPM

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