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The response to the question below was authored by Marc Mitnick DPM

Dull Ache beginning weight bearing in CAM boot with 5th metatarsal jones fracture.

by Meagan
(Virginia)

I rolled my ankle three months ago and sustained a jones fracture of my fifth metatarsal. I went to an orthopedic specialist, who put me in a non weight bearing short leg cast with crutches. I was in the cast and on crutches, non weight bearing for three entire months. Although it is very slow in healing, it is healing. The latest x ray shows good calcification and a bridge of new bone at the edge of the fracture. I wasn't in any pain at all. Dr. has put me in a CAM boot to use with crutches until my next follow up in 4 weeks. He has also prescribed a bone stimulator for me to use once it arrives in his office for pick up. I expected the stiffness and muscle pain in my foot and ankle after being immobilized for so long, but I also have a very dull ache at the site of the break. Is this normal when beginning to bear weight again? It's not agonizing, unbearable pain, but enough of a dull ache to be an annoyance. The area of the fracture doesn't hurt if I gently press on it with my fingers though. I just don't want to further injure a not quite healed fracture yet. Especially since my Dr. told me that surgery was the next step if it began to hurt.


RESPONSE

Hi Meagan,

Let me start off by saying that the person you should be directing these questions to is your doctor. He is the one most familiar with your case and is also the one who has personally viewed your x-rays, so knows the extent of your healing.

Most non displaced fractures (essentially fractures where there is a crack in the bone, but both ends are still fairly well aligned) will be healed in six to eight weeks barring any un-forseen problems.

I am making the assumption that you are relatively young, do not suffer from osteoporosis and do not smoke.

Taking all that into account, it is not uncommon
for fifth metatarsal base fractures to take longer to heal, or simply not heal at all, because there is such limited blood supply to that part of the fifth metatarsal bone.

Putting you nonweightbearing for three months was probably the proper thing to do; this gives the bone the best chance to heal.

So now it is three months down the road, the doctor is pleased with your progress, via x-ray but evidently he is not convinced that you are totally healed.

He is allowing you to bear weight in a CAM walker and is ordering you a bone stimulator to speed up the healing process.

Your problem is that when you place your foot on the ground, you feel some degree of discomfort and I would agree with you that it may be cause for concern.

One of two things may be happening.

The first is that the broken bone is not quite ready to accept weightbearing and the achiness you are feeling is pressure going through the fracture site.

The second possibility, and I see this alot, is that depending on your actual foot structure, the CAM walker may be too narrow for your foot. Most people exhibit a "flare" to their fifth metatarsal base, meaning the base of the bone flares outward, more so than the rest of the bone.

CAM walkers are not custom sized and so some of them tend to be too narrow in the area of the fifth metatarsal base and when you put them on, they essentially press into the fracture site resulting in discomfort.

Either scenario could result in pain in the fracture site.

I think your doctor has given you fine treatment up to this point and I do not want to get in the middle of this. My suggestion would be to call his office and see what they want you to do. Until you get in touch with them, you always have the option of going nonweightbearing with your crutches to avoid pressure on the fracture.

Marc Mitnick DPM
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Mayo Clinic

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Columbia University Department of Rehabilitation

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Illinois Bone and Joint Institute

Mount Sinai Hospital

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University of Florida Health

American Family Physician

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