5th Metatarsal Fracture - fracture/incision site hurts after stitches are out

by JP
(Arizona)

I broke 5th metatarsal bone mid-shaft, displaced fracture. Had surgery done, 5 screws and a plate inserted. While I was in a cast for 2 weeks after surgery, I felt pretty comfortable, no pain (except for the first 2 days), swelling at a minimum, foot would swell up only when I hang it down or occasionally for short periods of time.

I had my stitches taken out yesterday and put in a plastic boot (not-weight-bearing for the next 3 weeks). Late evening, my foot swelled up for some reason, it became hot and somewhat tight under the plastic cast (but no throbbing). As my swelling persisted for a couple of hours, the foot started hurting badly at the top of the incision site. I am not sure if the pain is only on the incision or if the bone is hurting. If I don't move my foot, I have no pain, but the slightest movement, such as standing up on crutches and letting my foot hang down causes pain. This morning my foot is not swollen, but I still have this same pain if I move my foot even slightly(again, pain is so deep I am not sure if it is incision or something deeper, bone?). It doesn't hurt if I don't move my foot.

What can it be? I was literally pain free for the first 2 weeks after the surgery, and now I am in pain. What's wrong?

RESPONSE

Hi JP,

Two things come to mind. One would be the possibility of infection. I do not know what the incision looked like when the sutures were removed, but most incisions are not completely closed when sutures are finally removed. Additionally, some times when sutures are in too long, they can start to degrade and they themselves can cause an infection to occur. An infection would certainly cause the foot to swell and and be painful.
A second possibility would be movement of the hardware that was placed in the foot. Sometimes a screw can begin to back out, or in some cases the screw may never have been properly placed and is now loose thus disturbing the metal plate that is holding the fracture site together. If the hardware is not in properly it will cause pain by itself, but will also cause movement in the fracture site which will also cause pain.
It would be safe to say the foot will not hurt much if it is elevated and you are at rest. But in either scenario there will be increased pain if the foot is placed in a dependent position, even non-weightbearing.
A less likely cause may be that the boot that was put on is putting too much pressure on the surgical site and that too would cause pain.
No matter what the source of your pain, this is an issue that requires the attention of your surgeon. He or she should look at the wound and decide if there is an issue or not. Do not delay contacting your doctor because a possible infection or movement within the fracture site are both issues that could result in a set back.

Marc Mitnick DPM
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