Edema/pain in foot

by Joanna
(Augusta ga)

I broke my 5th metatarsal may 26; the doctor said it was in an area with decreased blood flow so it would possibly be slow to heal and there was a risk of non-union. I was non-weight bearing for 8 weeks then progressed to weight bearing in a cam boot. My most recent appt was in August and the dr said the fracture was still visible but looked like it was in healing process and to wean from boot as tolerated while letting my body "be my guide". I had some edema at that appt but the pa said he thought it would resolve as I walked more without the boot and fluid re-absorbed. My next follow up is in October -about a month from now. I am still having pitting edema in my foot. I am walking with my boot when I'm at work and trying to use regular shoes all other times. I have some pain at the fracture site when walking in shoes and just wonder if the edema and pain are part of the normal healing process or if I might be doing damage to my foot.

RESPONSE

Hi Joanna,

Here is the problem as I see it. You are over twelve weeks since fracturing your fifth metatarsal base and you are still having pain walking.

By twelve weeks, even a slow healing site like the fifth metatarsal base should have been healed if it is going to heal on its own. Believe it or not, but it is possible for a fracture line to still show up on x-ray and NOT have any pain.

Since you mention you have pitting edema in the affected foot I would take that to mean the whole foot is swollen rather than just the site around the fracture. I agree with the PA that it should start to resolve once you are out of the boot but that is predicated on the assumption there are no other issues to deal with such as you being over weight or perhaps having varicose veins in your legs, being diabetic, having overall poor circulation, metabolic disease etc. While we are on the subject of "other issues" I would also hope you are not a smoker as that definitely delay bone healing.

I think at this junction, since apparently you are getting better, albeit slowly, you might want to ask your doctor about the possibility of ordering you a bone stimulator. This is a device that you wear on your person that has leads that attach to either side of the fracture site and work to help the fracture line further close.

The reason you would want to consider this is two fold. The obvious reason is you want to move this process forward and have it resolved as quickly as possible.

Secondly, one of the problems with slow healing fractures is that given enough time, they may not end up totally healing at all. This results in what is known as a non-union where the two broken ends cannot quite come together to create a healed site. Essentially, weeks, then months pass, the fracture line shows no sign of further improvement. Basically what has happened is that instead of forming bone callus between the two broken ends, you have fibrous scar tissue forming which is nowhere as strong as bone, so there is ongoing movement in the fracture line and thus pain along with some degree of swelling.

At three months you are starting to approach that possibility. That is why I think a bone stimulator would be a good idea, because if the site does not totally heal you will then have constant pain and your only option would then be surgical intervention where you would require a bone graft and hardware to fix the problem.

If you at all unsure what to do, then I would suggest you get a second opinion from a doctor in your area.

Marc Mitnick DPM
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