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The response to the question below was authored by Marc Mitnick DPM
8 days post operative bunionectomy with 1 st and 2 nd toe osteotomy.
by jennifer
(HHDS,NY,USA)
I tripped and landed on my foot going from no pain to severe pain at the the top and bottom of the foot near the 3rd,4th and fifth toe. i saw my doctor today and had a xray . i had noted dark purple red bruising on the bottom of foot,lateral side and heel with increased swelling. the doctor stated the xray showed to much swelling to identify a fracture at this time but, it is very possible i developed a stress fracture. He then put me in a fiber glass cast. my question is when he did the surgery he told me i had severe arthritis in my toes and more than what a 28 year old should have. would this predispose me to easily obtain a stress fracture and do all my symptoms fit a stress fracture.i also was diagnosed with arthritis in my hands and was tested for rheumatoid 4 yrs ago and was negative. should i be retested? My dr states that it could be many types of arthritis???
RESPONSE
Hi Jennifer,
Not to split hairs here but a stress fracture occurs when there is no history of trauma. Typically a person will come into the office complaining of pain, usually in the forefoot, for no apparent reason. An x-ray will then show a fracture.
In your case if you do have a fracture it is a traumatic fracture, meaning you injured the foot and now perhaps there is a broken bone.
I agree with what your doctor has proposed. He cannot see any break in the bone, initially. However, not all fractures always show up on the first x-ray, but apparently because of all
Putting you in a cast is what I would have done as well with the stipulation that I would do another x-ray in about ten days. At that point, if there is a fracture, it should be visible. It should be pointed out, however, that sometimes fractures are so small that the only way to identify them is through the use of a bone scan or an MRI. In most cases it becomes a moot point, because if there is a fracture that small, chances are it will heal uneventfully while you are in the cast.
In answer to your question I am not sure I see a connection between your supposed arthritis and a possible fracture. As your doctor stated there are other types of arthritis in addition to rheumatoid arthritis that could occur in someone in your age, so those of course should also be ruled out.
On the surface at least it just sounds like you tripped and really hurt yourself and any arthritis you may or may not have is incidental and not a contributing factor.
Now, if the injury you sustained happens to be way out of proportion to the actual trauma and it turns out you did break a bone, I might consider investigating whether or not you have a metabolic condition of some sort that may be causing your bones to be more brittle than they should be in a 28 year old. This would be something your doctor might consider since he is more familiar with your situation than I could ever hope to be.
Marc Mitnick DPM
DISCLAIMER
ADDITIONAL REFERENCES
University of Rochester Medical Center
American Academy of Pediatrics
Columbia University Department of Rehabilitation
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