stress fracture

by Liz
(Tx)

I fractured my foot ( 2nd metatarsal bone) and I believe there was some residual nerve damage. I dropped a 280 lb full keg of beer onto my foot that was on top of another keg. That was 9 months ago. I wore walking cast until 6 months ago. This past two weeks I have had a lot of pain not only in my foot, but feels like it is spreading through my ankle into my lower leg. It hurts to the point I am limping and having to take leftover pain medication for it. What could this be?

RESPONSE

Hi Liz,

The first thing I would be concerned about would be another stress fracture. The fact that you had one before certainly increases the chance of another stress fracture in the same spot simply because the healed fracture might not be as strong as the original bone.
If I did my math correctly, you were in a cast for almost three months which is kind of long for a simple non-displaced stress fracture. Were there issues getting the fracture to heal?
I know nothing else about your medical history but if you are a smoker for example, this can dramatically reduce the ability of the body to heal a foot fracture. If you are an older individual and suffer from osteoporosis, that too could result in a less than optimal healing process.
So if you lead an active life style and are on your feet quite a bit, AND, if the original fracture never healed properly you would be susceptible to re-fracturing the bone.
My other thought is if the bone was never completely healed but overall "better" so you were able to walk on it but because there was some residual discomfort, you started walking different from your normal gait.
In doing so, walking in a guarded gait, you could have strained soft tissue structures. In your case, I am thinking about the tendons that run down the front of your leg, over your ankle, to the top of the foot and into the toes. These tendons help bend the toes upward, but can be overworked when someone is not walking normally.
To me that could cause pain over your foot, ankle and into your leg.
So, unless this pain miraculously disappears I am afraid you are going to need medical attention from a local doctor. An x-ray would certainly be indicated, but if it comes back normal, a bone scan or even an MRI might be necessary in locating fractures that appear normal on x-ray but happen to be present.
As a side note, I doubt that the original trauma caused enough soft tissue damage, to cause your foot to begin to hurt this far down the road. If for example, you had damaged the tendons at the time of the trauma, chances are, once healed, they would not begin to bother you again.

Marc Mitnick DPM
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