Worsening pain in fifth metatarsal fracture

by Shawnee
(Las Vegas )

Hi, I broke my fifth metatarsal. Prior to the x-ray, I wrapped it in an ace bandage, elevated & iced regularly for several days. It only hurt if I attempted to walk on it. Therefore, I didn't. As the days passed, it increasingly got better. Pain aside from putting weight on it, was very tolerable. It wasn't until It was confirmed it was broke & the Podiatrist put me cast so loose, my foot to float around & each time I moved the weight of the cast would push down on the fracture.

I felt I needed a second opinion & chose to see a different Podiatrist who suggested a double wrap bandage & boot, rather than a cast. He encouraged me to remove my foot 3-4 times a day to ice.I believe the in & out of the boot irritated the area.. Now after two weeks, I have a significant amount more pain & a large egg over the break, that wasn't there prior to the boot. Is it common to suffer more pain weeks after injury, or should I reach out to the Dr for an alternative?

RESPONSE

Hi Shawnee,

One would expect that with proper treatment, the pain from your fifth metatarsal fracture should be lessening, not getting worse.

The first podiatrist who put you in a loose cast essentially wasted your time and set you back whatever time period you wore that cast. The purpose of a cast is to immobilize the broken bone, in this case the fifth metatarsal bone, so that adequate healing can begin.

A loose cast does none of that and one could argue perhaps even make matters worse, because you think it is safe to walk on, where in reality it is not.

As you may have read on this site or other sites that you have visited, if the fifth metatarsal fracture you sustained, is at the base of the metatarsal, then you have to be concerned about its ability to heal. Without proper immobilization, that ability is compromised.

The problem I have with the second podiatrist is the notion of removing the cast and boot to ice the area. Once the foot is immobilized, it should stay that way 24/7. If he was having you ice it because you were in a lot of pain, there are better ways to approach the pain.

Icing does nothing to facilitate healing, it just reduces inflammation, which can help reduce pain, but the argument here is that reducing inflammation also increases healing time, because you need inflammation (the increased flow of blood to the area) in order for healing to take place.

I realize I do not have the luxury of actually examining you and am only getting your side of the story, but I think the treatment you have received so far could have been better.

As far as the "egg" over the fracture site, my first thought would be it is the result of the bone callus that forms over the break in an effort to heal the fracture. It is not uncommon for the "bridging" of bone to form a palpable lump over the fracture site, that is noticeably simply because there is virtually nothing but skin and some small muscle around the fifth metatarsal bone.

This "egg" may also be something else, so it would be worth your while to have a doctor take a look at it.

If your foot still continues to hurt when you put weight on it, you might want to consider going non-weight bearing with the use of crutches. You do not mention how long ago you broke the bone and that would have been helpful to me in evaluating your progress. Your age and whether or not you are a smoker would have also been helpful.

I will sum this up by saying this. If you are still suffering significant pain and you have had this issue for at least four weeks, you might want to consider seeing another doctor.

Marc Mitnick DPM
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