callus formation 5th metatarsal

by Dianne
(Toronto Canada)

Hi. I fractured shaft (just below head) with mild displacement of 5th metatarsal x 6 wks ago. Being a nurse I was off work for 6 weeks with air cast. Follow up xray shows "bones in alignment" and healing progressing(callus formation) but my ortho surg states not totally healed yet. He advises no walking boot unless tired etc and return to work light duties (I'm not allowed to wear air cast in hospital - against policy - so doing desk/sitting job 8 hrs/day with some walking). I have f/u xray again in 4 wks.

My chiro who's been treating me with laser and Active Release etc feels I should still be wearing boot most of time till healed, so would have to be off work.
There is some generalized foot/ankle stiffness and pain, and mild pain with palpation of area....
Not sure how to proceed and which MD is "correct"
Feedback appreciated!

RESPONSE

Hi Dianne,

I do not know how much help I am going to be here because I would really need to see your x-rays, both initial and follow up. Secondly, I would need to know more about you besides your occupation.

Things like your age, weight, any medical problems that you might have that could affect bone healing, like thyroid problems, for example. Do you smoke? Smoking delays fracture healing particularly in the foot.

The good news is that your fracture is in the metaphyseal region of the shaft which tends to have a much better chance of healing than say if your fracture was mid-shaft.

Additionally, I would like to know how your foot feels. You state you have been in an Aircast but that does not help me as Aircast makes various products and I am not sure what you mean between an Aircast and walking boot. Does this mean you have been wearing the Aircast and have been on crutches, or when you refer to a walking boot, do you mean a shoe that we put people in after surgery? Bottom line, they both mean the same to me.

So, despite the confusion on my part, when it comes to fractures, particularly of the foot, you always want to err on the side of caution. Walking on a broken bone adds an element to the equation that you normally do not see on fractures elsewhere in the body, since the pressure of the metatarsal bone, could dislodge whatever healing that has already occurred, if you were to step the "wrong way". This in turn would set you back a great deal of time.

The reason I need to know more about you is simply because at six weeks you are on the cusp of being healed. In most individuals, in a normal healing fracture, there should be bone callus on the x-ray with the degree of separation of the fracture site that still exists being the overlying variable.

If you were sitting in my office and I saw this x-ray with bone callus but still separation of bone, the first thing that I would do is palpate the area and see if there was any pain as I pressed on the fracture site, so if there was separation and some pain on palpation, I would be inclined to keep the status quo and have you stay in the Aircast (whatever that really means).

All things being equal I would then take another x-ray in two weeks (vs. your four weeks), because typically uneventful fracture healing takes six to eight weeks to heal. Again, this assumes you are young and healthy.

I do not know if I am reading into your doc's suggestion of four weeks because he is not totally happy with your progress, or he just wants to wait four weeks.

As you can see from the position I have laid out, I actually tend to agree more with your Chiropractor, but I would consider another x-ray in two weeks, rather than four.

Hopes this helps.

Marc Mitnick DPM
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