Dancer's Fracture - Boot Pain

by Ann
(Houston, TX)

I have an ankle sprain and complete non-displaced avulsion fracture of the 5th metatarsal. The orthopedist gave me a Bledsoe boot, but my foot and ankle hurt worse in the boot than without it.

The doctor said I didn't need to wear the boot for sleeping or just sitting around the house, so I only use it out in public, if I'll be on any uneven surfaces, and for longer distances than just between rooms in my house or office suite. I have a cane and I use it always. I also keep my foot wrapped with kinesio tape and I use compression socks and stockings for additional stability.

Is it okay for me to be going without the boot for short distances like this? Everything I read online says no, but the worst pain and swelling I had since the initial injury was the day I tried to spend all day in the boot.

I have also read that the correct treatment for a sprain is to keep the ankle mobile, so it seems that being in the boot would be counter-productive to healing from the soft tissue injury. I occasionally do some very slow and gentle ankle movements, but never to the point of pain.

If I'm not in pain or feeling any weird clicks or catches, is it okay for me to limit my boot use to situations where I truly need the extra stability? Isn't the flat carpeted surface of my office as good for my foot as the flat cushioned inside of the boot?

RESPONSE

Hi Ann,

Ok, so you have an ankle sprain and a fracture of the fifth metatarsal base. This combination is a very common finding as the fifth metatarsal base is subject to fracture when there is a severe ankle sprain.
The important point here is that the fracture trumps the ankle sprain in terms of priority. Yes, you are correct that the current thinking is to not immobilize an ankle sprain and to get motion and ambulation immediately to the ankle. This is what you would be doing IF, you had not fractured the fifth metatarsal bone.
The problem with fifth metatarsal base fractures is that they have a tendency to not heal if not properly treated; in fact sometimes even with proper immobiilization, the fracture will not heal. This is due primarily to poor circulation in the area which makes bone healing difficult.
I am not your doctor and therefore you should be listening to your own doctor, but I understand that in many instances people are uncomfortable bearing weight with the boot.
In my practice when that occurs, I DO NOT allow them to walk without the boot, but what I do instead is put them non-weightbearing on crutches. I personally think non-weightbearing as opposed to walking in a boot, give the patient a better chance of healing.
Of course, the obvious downside is getting around on crutches.
So, walking without the boot is not something I would recommend. I would suggest you speak to your doctor about the possibility of using crutches and being non-weightbearing on the foot, if wearing the boot is too painful.
Remember, if the fracture does not heal, you will be looking at surgery on the fracture site.

Marc Mitnick DPM
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