5th and 4th metatarsal fracture healing advice

by Irene
(Covina)

hi......I am a 36 year old female normally very active long distance runner outdoors for 16 years. Four weeks ago I fractured my 5th metatarsal minimally displaced at the proximal shaft on my left foot while running. I was put in a fiberglass cast for 3 weeks NWB by my orthopedic surgeon...well at my 3 week follow up he said it was healing but it turned out I also had an old fracture of my 4th metatarsal that had been healing so he just gave me a ugly thick soled shoe and told me he wants me to bear weight gradually every week. When I see him in 6 weeks I should be full weight bearing and able to go in my own shoes...well the second week of weight bearing I added more weight and felt pretty good walking in the ortho shoe I didn't even need crutches although I had a slight limp and minimal pain more like a weird feeling I guess from not using my leg in a month and my gait felt weird.

Well I felt fine until the night time I started getting a bad pain in my calf that lasted until the next day with pain in my foot also so I went back on my crutches just barely putting any weight off and on. What gives? the Ortho told me to bear weight, but it seems like it made it worse. I don't understand this fracture its so frustrating one minute I feel decent the next in pain. Now the calf pain subsided a bit but foot is still sore especially the middle bottom part and the spongy part on the bottom under my toes. So my question is do I keep weight bearing even though it hurts or just stay on the crutches? I rather get off these dang crutches my whole body aches and my gait feels horrible....but I don't want to make my injury worse? they say usually this heels in 6 weeks but im almost at 5 weeks with pain still at the site. I also continue to workout just not putting pressure on my foot and I range of motion exercise to but not sure if they are helping. :-(

RESPONSE

Hi Irene,

I am not sure what you mean by an "old fracture of my 4th metatarsal". I do not want to split hairs here but does old mean something that happened last year or does old mean a fracture of the fourth metatarsal that occurred perhaps two months before the fifth metatarsal fracture?

The reason I ask is because in many instances "old" fractures that are clinically healed will still show up on x-ray, even though there is no pain or swelling associated with them. I will assume you had no pain in your foot until you actually fractured the fifth metatarsal and the fourth metatarsal fracture is just an incidental finding on the x-ray.

I can't find fault with the orthopedist's treatment regimen, but I tend to be more conservative in fractures of the fifth metatarsal since depending on the exact location of the fracture, there can be a propensity for delayed healing and worse than that, non-healing.

I would have kept you non-weight bearing for a longer period of time then three weeks. Additionally, I would have ordered a bone stimulator for you, which is a device that, as the name implies, helps stimulate the bone to heal the fracture site. Most insurances will pay for them on fresh fractures (whereas years ago, they would only pay for them on fractures that were delayed in healing).

My advice to you would be to go back to the crutches, since your foot is hurting. Contact your doctor and see if another x-ray is necessary, since your pain has worsened. Have your calf checked out especially if your foot and ankle have increased in swelling since the calf started to hurt.

If you do have a new x-ray and further improvement is not noted on the x-ray, then ask your doctor about the possibility of a bone stimulator.

I understand your desire to get off the crutches, have your foot healed, and get back to your normal activities, but you can only do what you can do, based on the progress of the healing process.

Marc Mitnick DPM
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