Toe stiffness after metatarsal fracture.

by Jen
(PA, USA)

Hello...

I am currently in the recovery process of a displaced (spiral?) fracture of my 5th metatarsal on my right foot. I was rushing one day, took a little leap down 2 stairs and my ankle twisted, gave out, and my foot rolled under...felt and heard a pop and tada, broken foot.

I had surgery 11/3/11 and had 2 pins placed in my foot...one that went straight down the metatarsal and one that went crossways. I had the crossways pin removed at 3.5 weeks as enough healing showed on the x-ray and I was put into a post-op surgical shoe (after being in a hard cast prior). At my most recent appointment (5 weeks post-surgery), I had the 2nd pin removed. Doc says the fracture is healing well, that it still needs to heal more but he's satisfied with the progress so far.

I've been advised to wear the surgical shoe for another week or so, but that I can start to walk more normally...I was heel walking before, after getting the surgical shoe. The injury is sore right now, still have swelling and bruising across the top of the foot, and some swelling in the ankle (due to a concurrent ankle sprain). I can weight bear to a certain extent on it...possibly more fully if a tried, but I'm a bit paranoid.

My question, though, is about stiffness and difficulty moving the corresponding toe on that foot. I seem to have very little ability to move it voluntarily. I get a little wiggle and bend if I try hard, along with some pain, but I have nowhere near the same range of motion as in my other little toe. It's hard to describe but at times it almost feels as if there is a bit of a disconnect between my toe and the rest of my foot.

Is this a normal part of my recovery from the injury? A permanent effect resulting from the injury? Or is this something I should be concerned about and contract my orthopedic doctor?

Thank you in advance,
JJN

RESPOSNE
Hi Jen,

My first bit of advice would be to always ask your doctor about any concerns after surgery as he or she is best suited to give an accurate response.
Having said that, the reason you are probably having stiffness in the little toe is due to two factors.
1. Immobilization. While you were wearing the surgical shoe or boot, the little toe is prevented from bending and of course that is by design. Once the toe stays in a fixed position for a period of time, it will tend to stay stiff for a while. This should eventually "work" its way out.
2. Swelling. Directly around the actual fracture site, inflammation occurs which helps the bone to heal. This inflammation will cause swelling in the area which in turn will make it difficult for the tendons that move the little toe to work effectively. This too will result in stiffness in the toes as you will have difficulty bending the toe because you cannot get the tendon to move freely in the swollen area. This too should subside over time.
A more obscure possibility which is probably not the case but is worth mentioning is that one of the K-wires (pins) pierced the tendon, probably the tendon on the bottom of the foot and did some damage to the tendon creating stiffness in the toe, once again, because the tendon is damaged and cannot freely move.
Another more obscure possibility is the tend is embedded in scar tissue near the incision and that too will prevent the tendon from moving.
On a probability scale, the first two items I mention are probably the cause for the stiffness and you could either just wait it out, or even consider physical therapy if it bothers you enough.
I am guessing it is more of a nuisance sensation than a painful condition that is preventing you from walking, as you do not really need the little toe to ambulate from point A to point B.
Like I said earlier, if you have any real concerns about the healing process, speak to your surgeon.

Marc Mitnick DPM
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