Broken Fifth Metarsal

by Sherri
(Lee's Summit)

I was having sciatic pain on my left side that went from my back to my big toe. I babied that side and put most weight on my right side. I stepped over a baby gate and came down on my right foot wrong. It twisted and I heard it break. It was immediately swollen and bruised.

This happened on March 15th. I went to an orthopedic surgeon the next week. He x rayed it and said that it was broken and that I could wear any shoes and put as much weight on it as I could stand. I had gone to the ER on March 16th because I had already scheduled an MRI on my back for that day. I had surgery on my back on March 31st.

Below are the notes that I have received from the doctor.

FINDINGS: March 21, 2014

Dr. has personally reviewed these images and formulated the
interpretations and opinions expressed in this report.

Comparison: Right foot radiographs dated March 16, 2014.

There is redemonstration of an oblique, mildly displaced fracture of the
midshaft of the fifth metatarsal with extension to the distal metaphysis.
No significant change in alignment the fracture. No new acute fracture
identified.

Findings: April 14, 2014

Dr. has personally reviewed these images and formulated the
interpretations and opinions expressed in this report.

Three views of the right ankle were obtained. There has been minimal
partial incomplete healing of the oblique fracture through the fifth
metatarsal which extends from the mid shaft to the distal metadiaphysis.
There is persistent mild displacement of the fracture fragments. . The
tarsometatarsal, metatarsal-phalangeal, and interphalangeal joint spaces
are maintained. The visualized tarsal bones and joint spaces are well
maintained. The visualized soft tissues are unremarkable.

Findings: May 12, 2014

Three projections were acquired. Comparison is made to the patient's
prior study of 4/14/2014. The oblique fracture involving the diaphysis of
the fifth tarsal is again noted. Alignment appears unchanged. There has
been partial interval healing at the fracture site compared to the prior
study. No new fractures are detected.

Findings: June 23, 2014

No progressive interval healing is seen of the oblique fifth metatarsal
fracture with unchanged alignment. No new fracture is seen. Lucency is
seen associated with the proximal fifth phalanx which is well defined and
may reflect an enchondroma.

Findings: September 15, 2014

There is redemonstration of old healed fracture deformity of the fifth
metatarsal with mild offset of the distal fragment, alignment is
unchanged compared to the prior study. Otherwise bony structures have
normal alignment with maintained joint spaces.

The ortho said it was healed and I shouldn't have any more problems. I told him that it still hurt a lot and he said he didn't know why.

I went to a new ortho. He took x-rays and said that it looked healed, but he wanted to get a cat scan. I had a cat scan done and it said that bone was healed, but he had concerns with the tendons. He wanted me to get an MRI. I had an MRI done and they said that it showed the bone wasn't completely fused. I go back on December 9th to discuss my options. I just wanted to get an idea of what to expect or what to ask.


RESPONSE

Hi Sherri,

The bottom line is that you have an unhealed fracture after approximately 26 weeks. That can be classified as a non-union. Normal nondisplaced fractures take on average six to eight weeks to heal; you are well beyond that. Your initial report described it as a mildly displaced fracture meaning there was a little separation of the fracture site.

The advice you received to walk on it with any shoe was probably not the best advice you could have received. Midshaft fractures in long bones have a higher propensity not to heal and a part of your fracture was midshaft.

That is all water under the bridge right now and so your question becomes one of what to do next.

Since the fracture is partially healed, that tells me the fracture has the potential to fully heal. If you were my patient, my next step would be to order a bone stimulator for you. This is a device that creates a "current" across the fracture site and helps the fracture heal.

It would also require wearing a cam walker for immobilization of the fifth metatarsal bone.

You are probably looking at a minimum of four to six weeks with this, but if it works, you are done with very little fanfare.

It is probably worth mentioning that things like smoking can delay fracture healing so if that is part of the equation, it should be eliminated.

Marc Mitnick DPM
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