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

Healed fifth metatarsal with swelling five months later

by Barbara
(Dingmans Ferry, PA)

broke my fifth metatarsal five months ago. Was in a boot for 10 weeks. Started therapy but had to quit because of foot swelling. Have been elevating foot and applying cold packs. When I get up in the morning my foot is almost normal, but as soon as I start walking around the swelling begins on the top of my foot, ankle, and up my leg. Should I see a vascular doctor? I am 73 years old.


RESPONSE

Hi Barbara,

Not sure of what to make of this. You do not mention experiencing any pain and I suspect if the fifth metatarsal still hurt, you would have mentioned pain.

It is probably safe to say that your swelling is the result of the fracture AND possibly the boot that you were wearing.

I mention the boot because if there is actually no more pain at the fracture site then there is a possibility that the boot may have aggravated some of the veins that bring blood back up to the heart from the foot.

What happens is classic venous insufficiency. While you are standing and walking during the course of the day, the veins are no longer able to adequately pump blood back up to the heart and so what happens is the blood begins to "pool" in the foot and ankles. Probably by the time you go to bed the foot and ankle is its most swollen.

Then, during the night while you foot is no longer in a dependent position, the blood is finally able to drain out of the foot
and ankle and by the morning the foot is normal looking again, only to begin to swell once you start walking on it again.

My dilemma from the other side of the internet is whether or not this is from the cast you wore or related to the actual fracture.

I have already discussed how irritation from the cast may have aggravated your superficial veins and causes this problem, but, if there is still an issue going on with your fifth metatarsal, either an incomplete healing of the fracture of even an accompanying soft tissue issue like a tendonitis of the tendon that attaches into the base of the fifth metatarsal, then this can also cause inflammation which in turn would then cause swelling. But, as I said earlier I would suspect that there would also be some degree of pain associated with the swelling.

So, I would take this approach.

If there is still pain with your foot, then I would go back to the doctor who treated the fracture in the first place and let he or she come up with a reason why the foot is still hurting. It may require more than an x-ray. Once you solve that problem, the swelling should diminish.

However, if there is no pain at all at the site of the fracture, it does not hurt to walk on it and it does not hurt when you press around the area, then this might be a venous insufficiency problem and a trip to a vascular specialist may be in order.

Marc Mitnick DPM
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