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Pain and swelling in the right foot 16 weeks after a Jones fracture

by Mike
(London,Ontario,Canada)

I broke the bone in my foot on June 26,2012.I am still undergoing physiotherapy.The problem is during activity I feel pain at the fracture sight.The foot turns purple and swells up big time on weight bearing.In the morning the musclel on the bottom of the foot are as tight as a drum and the foot is stiff.


RESPONSE

Hi Mike,

A Jones fracture which is a fracture of the fifth metatarsal base can be a very difficult fracture to heal. The base of the fifth metatarsal is a very poorly vascularized portion of bone. Most bones through the body have blood vessels and thus blood supply directly into the bone. This is not the case with the fifth metatarsal base. This portion of bone derives most of its blood supply from the surrounding soft tissue.
Because of this a fracture to this particular bone can create problems.
The problem you have as stated in your narrative is that it has now been 16 weeks since your fracture and you are still having pain. You do not mention what the most recent x-ray revealed but because you are still undergoing physiotherapy and having pain, I have to assume the fracture has not healed.
Since most fractures, on average, take six to eight weeks to heal and you are now over 16 weeks, it is safe to assume that your fracture will not heal based on the treatment that you are undergoing.
What happens in a fracture that does not completely heal is that the fracture site undergoes what is known as healing with scar tissue and not actual bone. This is known as a pseudo-arthrosis, which means a false joint. Because the site has healed with scar tissue and not actual bone, there is still movement within the site and thus the pain.
In my opinion you could have physiotherapy for the next ten years and the problem will not get any better.
Many people can live with a pseudo-arthrosis if there is no pain, but that that does not seem to be your case.
You have two options at this point. One would be to consider a bone stimulator, which is a device that creates an electrical current across the fracture site that helps lay down fresh bone. This is a painless device that you wear on your belt that has two electrodes that are placed on either side of the fracture site. It can be very successful in a large amount of the cases it is used in, the only drawback is if the gap of the fracture site is too large. However, if the gap in your fracture site is too large, you should have never had a course of physiotherapy in the first place as the treatment was destined to failure, especially considering the type of fracture you have.
Your other option is surgical fixation, where a screw is placed in the bone to forced the two ends together and eventually allow the bone to heal.
This is not an especially long and involved procedure and the success rate is very high.
I am not sure what your options are in your health care system, but I would recommend you speak to your doctor about another course of therapy, as 16 weeks is way too long to still be bothered with pain.

see related article....fracture

see related article....bone stimulator


Marc Mitnick DPM
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