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The response to the question below was authored by Marc Mitnick DPM

Delayed diagnosis of matatarsal stress fracture

I broke my middle toe a year ago, and because of continued soreness and occasional swelling they took another x-ray that showed a partly healed metatarsal stress fracture that was missed before. They are considering having me wear an Aircast for 6-8 weeks to see if it can heal better. Is that possible after walking on it for a year? Also, can a metatarsal stress fracture effect the way a toe moves and would it effect the toes on either side of the toe it's connected to? Or are these issues more likely due to the broken toe that has already healed...like an arthritic side effect after healing?

Thanks for any light you can shed on these kinds of issues. I have x-rays on CD, but don't know how to send them...anyway, the stress fracture can't been seen easily without blowing it up to 400% and then zooming in with a magnifying tool. It runs the center third lenghtwise of the middle metatarsal.

Hi,
A few things worth mentioning. I doubt a stress fracture of the metatarsal would in any way affect the pain in your toe, unless the fracture was severely displaced in which case you would have had a lot of pain in the area of the stress fracture. That leads to my next point. If the stress fracture does not hurt you can probably leave it alone. Many times when we surgically break a bone, down the road we will take an x-ray and although there still may be a "crack" in the bone, if there is no pain, we discharge the patient.
Lastly, at this point I do not think immobilization will heal the fracture. If you are interested in healing the fracture you would have to try a bone stimulator.
Marc Mitnick DPM

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Apr 04, 2009
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Thanks for the reply and this info
by: Anonymous

It's good to know these things. They are assuming the stress fracture is the cause of my problems because there is enough pain and inflammation to keep me from being able to walk comfortably. In fact, I'm in a post-op shoe now, because the only way I can bear to walk is if my foot does not bend at all. It does get better when I sit around for a few days, but then it always becomes irritated again quite easily.

They are telling me that if the stress fracture is not the problem, an MRI will be needed to discover nerve entrapment or vascular issues caused by the injury.

Th thought is that the stress fracture was not immobilized properly in order to heal well, but I insist that it was plenty immobile for the three months that I was on crutches for the broken toe.

Though I do have a lot of discomfort in the metatarsal that shows fracture, I personally believe that the toe just healed so badly (it slid down on the lower half of the break and is now 2 cm shorter)that it no longer works right. When it's forced to work as it should is when it becomes testy and flares up again. I do know there is a small bone spur formed at the back/bottom of the healed break. Is that cause for so much swelling and pain do you think? Maybe it's as simple as that.

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Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!

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Wonderful advice

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a mom

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Delayed diagnosis of matatarsal stress fracture

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