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

Fractured 3 rd metatarsal at base/lis franc

by Giselle
(Trenton, NJ, USA)

I suffered a fracture at the base of my 3rd metatarsal 9 wks ago. At the Er I was put in a boot. I saw a PA at an orthopedic office and was put in a hard cast for 3 wks and then put in a walking boot and told to bear weight as tolerated. The pain became severe and I ended up consulting a podiatrist. I was told I needed to be put back in a hard cast and no weight bearing. I had the cast for 3 wks and then put back in the boot. After two weeks I was told the bone was healing and I could ditch the boot and bear weight fully. I was also referred to PT. The pain has been horrible at the fracture site as well as around my ankle. There is swelling as well. I have had two PT sessions but due to the pain and swelling they are limited in what they can do. They had me doing ROM exercises. Is it normal to have this much pain this far out?


Hi Giselle,

In theory, at least, at nine weeks you should be virtually healed. There can be a any number of reasons you are still having pain and I will go through a few of them.
The first place to examine would be the actual site of injury. I assume follow up x-rays have been compared to the original x-rays. I ask, because there is always the possibility there was further displacement of the original fracture, particularly if you were weight bearing at any time during the initial healing.
Secondly, has the fractured actually healed? The area around the base of the third metatarsal has many small bones surrounding it and at times can be difficult to really see the extent of the fracture from an x-ray alone. That then raises the question of whether or not you have had an MRI or CT scan
at any point which would give better visualization of that part of the foot and better detail of any fracture that may be present.
I would think the fact that you are at the nine week mark, an MRI or CT scan would be indicated simply because you are in so much pain. If the x-ray reveals the fracture is "healing" but is still open, I am willing to bet an MRI or CT scan will find a greater degree of open fracture.
Additionally, these tests would rule out soft tissue damage such as a torn ligament, which would not be evident on x-ray.
Once the trauma site has been properly evaluated and nothing additional is found compared to the state of the foot after the initial trauma, then your overall health status has to be evaluated.
I know nothing about you, but factors such as excess weight, low estrogen levels, excess osteoporosis and tobacco use will delay fracture healing. If any of these apply to you, then they must be addressed.
Physical therapy, per se, does not help a fracture to heal, but rather returns the foot to normal function (if the fracture is actually healed). So, if there is any degree of open fracture then range of motion exercises would probably aggravate the problem rather then help.
At nine weeks, if the fracture is still open as verified by x-ray or MRI or CT scan, I would consider the use of a bone stimulator to help facilitate closure of the fracture. Ask your doctor if a bone stimulator is a good option for you.
Once the fracture is completely closed, you could then return to physical therapy. If however, you are going to continue with physical therapy, then you might ask the therapist to stop the range of motion exercises, for now, and concentrate on various modalities that help reduce inflammation. This at the very least, should make the foot less painful.

Marc Mitnick DPM

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Oct 09, 2016
by: Anonymous

I am now using a bone stimulator. Only had it for a few days, so no results yet. My PT has advised me to wear the walking boot while at work which I have been doing as I am on my feet most of the day. I take it off for lunch and don't where it at home. I am concerned about the long term problems of wearing the boot at 13 weeks out. Do you feel it is advisable to wear the boot based on the MRI showing the fracture has not healed or is it going to do more harm in the long run.

A boot is a substitute for a cast. A cast should not be removed. Wearing the boot half the day is essentially useless.
Having said that, at thirteen weeks out the only thing you can hope the boot does is not allow the fracture to worsen.
Hopefully, the bone stimulator will do the trick. Listen to your doctor; he or she is most familiar with your case.
Marc Mitnick DPM

Sep 22, 2016
MRI results
by: Anonymous

I ended up having an MRI done due to the continued pain and here are the results.

No comparison.

Transverse fracture through the base of the third metatarsal does not
involve articular surface. Distal fragment however is laterally
displaced 3 mm.

Patchy marrow edema throughout the hallux sesamoids, cuneiforms,
cuboid, navicular and the metatarsals elsewhere is present without
discrete fracture.

MTP joint plantar plates are intact. Lisfranc ligament is sprained.
Lisfranc joint remains normally aligned. Flexor and extensor tendons
are unremarkable.


1. Slightly displaced transverse fracture through the base of the left
third metatarsal without involvement of articular surface.
2. Bone contusions throughout the metatarsals and tarsal bones.
3. Lisfranc ligament sprain.
My doctor advised continuing with it safe to assume the findings on the MRI would be the reason for the continued pain and at 11 weeks out is it unusual to see these results?

It is very safe to assume the MRI explains why you are still having pain. You might ask your doctor about the possibilities of a bone stimulator to accelerate the healing of your fracture as it has been eleven weeks

Marc Mitnick DPM

Sep 13, 2016
Follow up
by: Giselle

I have had several follow up X-rays and was told at the last one things appeared healed so the boot was removed and PT was I wonder if perhaps something was missed. I neglected to add that my ankle has been and continues to be swollen and painful as well despite negative X-rays. Not sure how it is related to the fracture. It is of course very stiff after being in a cast and I am still unable to descend stairs with it. But was told it looked fine at the initial X-rays. I appreciate your advice and will quite about proceeding with further testing.

Since I know nothing about you in regards to your age, weight, degree of health, etc., I will say strictly from the fracture standpoint, the reason you are going for physical therapy is to work out all the "kinks" from the trauma and subsequent immobilization.
X-rays do not show soft tissue damage and you may have sustained some damage to your ankle in your initial trauma, but since you were immobilized for a good number of weeks, those issues, if any, should have been resolved as well.
See how you fare with physical therapy and whether or not your ankle returns to a normal size and less painful. Keep your attending doctor in the loop.
Marc Mitnick DPM

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