Walking with non-displaced 5th metatarsal fracture

by Barry
(Brisbane Australia)

I really badly twisted my ankle 6 weeks ago - with major bruising of my foot and swelling of the ankle. I was in a foreign country and could not have it looked at medically - but as I could walk on it with some limping , I thought that I had simply bruised the foot. I subsequently walked quite a lot with limping and finally after 3 weeks arrived back home and x-ray confirmed a 5th metatarsal fracture. I had been wearing solid leather walking shoes and continued to do so for the next 3 weeks . It is now 6 weeks since the accident and I am now walking quite strongly with no limping. I will be having another xray in a couple of weeks time. My GP basically told me how he "would have" treated me if i had seen him immediately after the accident - so am wondering how this will all end for me. Right now I am feeling confident.

RESPONSE

Hi Barry,

For anyone who treats fifth metatarsal base fractures the concern is always about the ability of the fracture to heal. The base of the fifth metatarsal is poorly vascularized and for that reason there can be a higher then usual non union, simply because without adequate blood flow to the area, the fracture may not heal.


I do not know what your GP would have done for you, but had you walked into my office right after twisting your ankle, I would have put you in a walking boot and started you with an ultrasound bone stimulator. Bone stimulators can be very helpful in healing this type of fracture.
Having said that, I looked at your x-rays and they do not look too bad. The fracture is just slightly displaced, and there is no way of knowing if that is how it was after the initial trauma, or has it worsened at all by the fact that you had been walking on it for three weeks before getting an x-ray.


In any event, foot fractures can be treated both clinically and radiographically to determine what if any, further treatment should be provided.
I would wait until the fracture is eight weeks old (from the date of trauma) to have another x-ray. Make sure the new x-ray can be compared to the old x-ray.


You may see on the new x-ray that the fracture is not completely closed, yet you have no pain both when walking and when the doctor presses around the base of the fifth metatarsal bone.
If that is the case, and there is a very fair chance that will be the case, then you may be considered clinically healed, yet radiographically still may exhibit a fracture.


In those instances a bone stimulator might not be a bad idea, in an effort to get the fracture on x-ray to close. The problem with being clinically healed, yet still have a fracture on x-ray, is that you are very prone to re-fracturing the metatarsal base, perhaps worse then the original fracture.


So in addition to a bone stimulator, you may want to continue to limit your walking to non-essential tasks, wearing a good support shoe (like you are already wearing) and avoiding any athletic activity.


If you happen to be overweight or are a smoker, that may further complicate the problem.


The takeaway point here is that just because the foot does not seem to hurt, don't be fooled into thinking that your problem is solved. If the bone were to further fracture, at that point you are almost certainly looking at surgery to fix the fracture.

Marc Mitnick DPM
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