broken foot

by Rochel
(Baltimore)

About 10 weeks Go while at lunch, the person sitting next to me went to scoot in their chair and set it on my foot. My foot swelled and bruised, I followed R.I.C.E. and continued to walk on it. about a week later the pain was so bad that I couldn't bear weight and i went to urgent care. They did xrays, diagnosed it as sprained and put me in a post op shoe and gave me crutches. They told me to stay off of it until the pain went away. 3 weeks later I was at pcp for physical and i was still in alot of pain. She said to go to podiatrist. So I did. That was about week 4 when he first saw me. He took fresh xrays and looked at the old and told me I fractured I think the 4th or 5th metatarsal and to keep doing what I was doing. Of course just a side note at week 2 I started walking with crutches bc my job required it. 3 weeks later I went for a follow up. He said foot was almost completely healed but the pain was terrible so he put me in a boot. 3 weeks later I followed up and was still in pain and he said that bone is slow to heal. He couldn't take more xrays bc I was pregnant. Since then I have miscarried, so I can have xrays again. And im going friday for a follow up. I deff have healed some bc I am not able to wear sneakers. But im still in alot of pain and only survive day to day bc of the 3 diff pain meds prescribed. Does this make sense? I keep thinking maybe it's not the bone but it's something else. Or maybe pt would help, should I ask? Im just so frustrated. I've broken bones before and never did it take 10+ weeks to heal.

RESPONSE

Hi Rochel,

If you are still in a lot of pain ten weeks post simple fracture, then I would think there is a good chance something is wrong.

I have no problem with the treatment you have had up to this point as I think it has been appropriate, so that is not the problem.

The first thing that comes to mind is that you mention you may have fractured your fourth or fifth metatarsal fracture. As you may have read on this site and others, fifth metatarsal fractures that occur at the base of the bone can take a long time to heal simply because of the compromised blood flow to that particular area of bone.

So even though the bone appears to be healing on x-ray, it may actually be a delayed healing. I am also making the assumption that the bone alignment is adequate as I have seen cases over the years where technically speaking the fracture is healing, but the resulting bone alignment is poor and that leaves the possibility of ongoing pain.

The other possibility is that you may have done some soft tissue damage to the foot in the same area where the chair rolled over your foot. The problem with that is I would have thought that being in a boot for a few weeks would have remedied that problem, unless you tore a tendon or something else more severe.

If I were treating you, I would not bother with another x-ray. At this point, since your pain is inconsistent with the time that has passed, I would opt for an MRI instead.

The MRI will be more specific as to how much of the broken bone has healed (or not healed), and will also give more information as to whether or not there is soft tissue damage of any significance.

If the MRI reveals there is still a fracture of some significance, particularly in the area of the fifth metatarsal base, then I would ask your doctor about using a bone stimulator which is a device that you wear, that helps promote healing at a fracture site.

If the bone is completely healed and there is soft tissue damage, and even if there is no identifiable soft tissue damage, then I think physical therapy would be your next best option.

Marc Mitnick DPM
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