3rd metatarasal foot stress fracture- PAIN question?

by Paul
(Boston MA)

Hi! I was diagnosed with 3rd metatarsal foot stress fracture 3-4 weeks ago after an MRI.

What is of concern to me is my symptoms haven't diminished at all.
I have an aching pain that comes and goes depending on what I am doing(sitting/ getting around) I have been in a boot walker and using crutches the whole time.
The WORST seems to be when I stand up and stay standing for a minute. Seems the blood is flowing towards my injury and it becomes very painful after a few minutes. One example would be standing at an elevator waiting on crutches(without even weight baring)and the pain can be difficult to handle. Moving about isn't as bad.
IS this normal?
is this something different going than the stress fracture? Perhaps I need to stay patient and all my pain will diminish in time? just seems that I would notice at least some progress after almost 4 weeks. Paul

RESPONSE

Hi Paul,

I am at an obvious disadvantage because I do not have the luxury of examining you or even seeing your MRI. Generally speaking, if the stress fracture was picked up on MRI and not an x-ray, that tells me at the very least, that it must be a small "crack" in the bone, otherwise some evidence of the fracture would have been seen on the x-ray.
Also, in general terms, when a patient goes from normal walking to wearing a cast boot and using crutches there should be almost an immediate reduction in pain for the simple reason that you are no longer putting as much pressure on the third metatarsal bone as you were prior to immobilization. Taking this point further, even if there is an accompanying soft tissue injury of some sort, wearing the cast boot and crutches should have reduced that pain as well.
I do not know how old you are, nor do I know your weight, but those factors may also come into play. If you are an older individual or are overweight that may account for why you have had no reduction in pain. If you are diabetic or have some metabolic disease that may slow down the healing process, that too, may account for why you are still having so much pain.
May I also assume you are wearing a plastic cast boot with velcro straps? If you had an actual fiberglass cast applied to your foot, then there is always the possibility that the cast was applied too tight.
If you were my patient and called me 3-4 weeks after wearing a cast and using crutches, I would be somewhat concerned if you were still having the same amount of pain that you originally experienced. Even though the fracture may not yet be healed, it certainly should be well on its way and therefore should be less painful.
The smart move here would be to call your doctor's office and run this by them. They obviously are more familiar with your case and are in a better position to decide whether or not there is an issue here.

Marc Mitnick DPM
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