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Right 5th Metatarsal break healing time

Discussion in 'Ask your questions here' started by Vix, Oct 20, 2008.

  1. Vix

    Vix New Member


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    Hi there, apologies if this is already discussed, however on searching I did not find an answer relating to my situation so here goes.

    On 21 July, I rolled my right foot playing the sport of netball. After attending A&E, xrays did not show a break so I was sent home with crutches. Severe pain and inability to weight bare (although I tried each day) for 2 1/2 weeks prompted me to see another doctor, and insist on further x-rays. This time a fracture was seen - an avulsion (not Jones) at the base of the fifth metatarsal with a 5mm displacement. I was then put in a cast for 3 weeks. After 3 weeks I was given a walking boot for a further 4 weeks. I got a referral to see a private doctor during this time and when he saw me (3 September) and looked at the x-rays, said it was more than likely I would need surgery as the break was much larger than those he normally saw. He sent me for more x-rays and I saw him again the next day. He was surprised at the progress of healing and said perhaps I wouldn't need any surgery but he wanted to wait a little more time. I saw him again on 1 October (by this time I was able to walk again and had some sessions with a PT). He said he wasn't sure if the bone had healed with just scar tissue or proper bone and to come back in 3 months (the x-ray shows bone jutting out rather than properly healed). He said to resume my normal activities including running (he knows I was a very physically active person) and "see how you go". I slowly began walking again on a treadmill and built up to do some running. Please don't berate me for running as on his advice I thought it was ok to try and I felt confident. I must not have been ready because since a few days ago, I have pain right over the break area and swelling (the swelling has never really gone away due to the excess bone there), and also pain right up the side of my right leg. I am so very frustrated and disappointed and am not sure why this pain has come back. Obviously I have stopped running and have made another appointment with this doctor, but I was just wondering if it's possible I have reinjured myself or done some kind of damage. And what sort of time frame am I realistically looking at before the bone has healed?
    Thankyou in advance and sorry for the long post.
     
  2. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS- ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    As is commonly the case in forums where patients offer their interpretation of events based on their understanding which is non-medically orientated, the descriptions are not of the specificity which would be expected in a doctor to doctor correspondence which might be depended upon for an accurate review of a case.

    In particular, I am somewhat chronologically lost at the point where you go to the private doctor. I can't tell if the x-rays which he said showed a much larger break were the originally x-rays taken or ones taken subsequently, and then how much time elapsed between his sending you for additional x-rays, and his determination that there was unexpectedly good healing progress. Furthermore, I am unable to determine whether his statement that the x-rays showed a much larger break meant that the fracture line was more extended than had been originally reported or if it meant that the avulsion gap was greater than 5 mm, or both.

    Healing with scar tissue imposition is common with such avulsion fractures at the styloid press of the tuborosity of the 5th metatarsal, as that is the point of insertion of the Peroneus brevis tendon and the distraction by that muscle's tendon is not only the reason for the avulsion, but, in the absence of screw fixation (which is rarely initially employed in such fractures), it supplies unremitting counter force which prevents solid approximation of the fracture segments. In spite of this scar formation, which can generally be permanently seen on x-rays, clinical healing is generally good and effective. I do not know what you are describing as "jutting out of bone," and I would have to see the x-rays to offer an opinion on that aspect. There is no reason to berate you on having used the tread mill if the attending gave you permission as you have related. But any meaningful comment as to precisely what is going on, what it might mean as far as a prognosis is concerned and what sort of intervention, if any, is required cannot and should not be offered by one who has had no opportunity to make a physical examination and view the x-rays. Please do not go from forum to forum asking for advice which cannot be responsibly given. You are about to see your third doctor. Choose him/her wisely and rely only on opinions based on actual examinations.
     
    Last edited: Oct 20, 2008
  3. Vix

    Vix New Member

    Thank you for your response.

    Just to clarify somewhat, the doctor I am seeing again (the private doctor) is the fifth doctor I have seen. The entire experience with doctors (and perhaps this has more to do with my geographical location in Northern Australia) has left me flummoxed. I have learnt more about my injury from my reading on the internet than the information provided to me by doctors. The first doctor I saw in emergency on 21 July who did not see the break on the x-ray sent me home and told me to weight bare when I could. The second doctor who I took myself to on the 6th of August told me that it was "not possible" my foot was broken, the x-rays (from the first visit to A&E) showed no break, and it was simply a bad sprain which may take 6 weeks to heal. Only at my insistence did he order further x-rays which showed the break (the 5mm displacement - the exact fracture you describe with medical terminology here). Then I was sent back to A&E as this doctor was not familiar with bone breaks of this kind and was not sure what to do (his words). At A&E (with the third doctor), I was put in a plaster cast and told not to weight bare, but come back and see the fracture clinic doctor in 3weeks. On the 28th of August, I saw my fourth doctor at the fracture clinic who authorised a walking boot, took further x-rays and said my fracture was healing well and that I should be walking in another few weeks. It was at this time, when I saw the fourth doctor )who then consulted another doctor on the x-rays as she was learning), I became frustrated with the whole process and made an appointment to see the fifth doctor, a private doctor. When I saw this doctor (the fifth and final doctor, the private doctor) I took the latest x-rays and he was the doctor who had immediate concern that my fracture would not heal on it's own - a different diagnosis to the fourth doctor who said it was healing well. As described, further x-rays alleviated these fears somewhat however he has not guaranteed that I won't need surgery as he would like to give it a bit more time.

    I have been so frustrated by this entire experience and have lost a great deal of faith in doctors misdiagnosing my injury and then not knowing what to do with me. As I said, I literally learnt more about it from reading myself on the internet than in a doctor's surgery. So if there is anyone out there who cares to read this, I encourage you to ask questions and pursue second opinions for your own sake as doctors can and do get things wrong. The medical system in our country is under extreme pressure and the pressure put on doctors is enormous. It is no wonder they are running from one patient to the next and sometimes do miss things.

    With all due respect to you FootDoc, I have not gone from forum to forum asking for advice. I have read a great deal of information and yesterday was the first time I posted something due to my belief that perhaps I could learn even more this way. I am concerned that my foot has still not healed properly due to the pain I am experiencing and my inability to run without pain, 3 months after the fracture. The "jutting out of the bone" is how I would describe (in layman's terms) the look of the most recent x-ray. When I try to move my foot in an anti-clockwise circle, I feel the bone "jutting out" (for want of a better description) at the fracture site. The pain I feel up my leg is obviously related to the peroneus brevis tendon (the doctor did describe this to me).

    Thank you for the time you took to provide me with a response. Hopefully this thread will assist a patient with the same injury in future.
     
  4. FootDoc

    FootDoc New Member

    Take note that, as I could not possibly have had evidence of it, I did NOT accuse you of going from forum to forum to ask for advice. Instead, I simply advised that you not do that. But, though we only have your side of the story, if your description and characterization of events was entirely accurate, I would have to conclude incompetence in your evaluation and/or treatment. That certainly should further dissuade you from either solicitation of information from others on the Internet who have not examined you and/or thoughts that you might achieve a sufficiently competent education in the matters of diagnosis and treatment through web pages such that you might effectively treat or direct your own care. I fear that in moving in that direction for the "care and feeding" of your problem, you might likely be further compounding the inadequacy of your treatment. As you have already opted for the private route, key to successful treatment is the wise vetting and selection of an experienced and competent doctor. I would suggest that you put your efforts in THAT direction.
     
    Last edited: Oct 21, 2008
  5. Vix

    Vix New Member

    I went for my next appointment with the private doctor today. Upon examination, he informed me that my foot appears to be worse, not better, than the last time he saw me.

    He said that it is possible the bone is moving within my foot (it feels like it is moving and I expressed this to him).

    He said in his father's day, (his father was a specialist also in the same field), his father would have instructed me to have an operation now, insert a pin, and go from there, with a 3 month approximate recovery period.

    He said nowadays, doctors give choices, and he gave me a choice to contemplate for a week and let him know my thoughts. Either opt for surgery now, or continue to wait until February, and then reasses whether surgery is required.

    I understand his giving me a choice, but unfortunately I now feel as confused as ever about the next step. I will certainly consider it carefully over the next week. I just don't know what to do. :confused:
     
  6. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS- ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    You have not clarified in what respect your doctor found the situation to have worsened, but I would assume from your comments that there has been neither primary bony union nor the firm fibrotic pseudo-union which is many times adequate in this area. In just about all situations, other than those which are time sensitive in the respect that delay of prompt action might irrevocably taint the outcome, waiting to see if things improve on their own is frequently a choice. But I don't see that as progress from the days of your doctor's father as seems to have been suggested. It sounds more to me as if your doctor is uncertain as to what the best course of action is to take, and that he prefers to send the ball into YOUR court for a decision. Not having any of the details needed for me to offer a meaningful opinion, I will not. But I would recommend that, if you are uncomfortable making the decision, that you have a second opinion from an unquestionably respected specialist for guidance for the both of you.
     
    Last edited: Oct 22, 2008
  7. Vix

    Vix New Member

    Thankyou FootDoc. The doctor said there is some evidence of the firm fibrotic pseudo-union you mention, however the area around the fracture and right along the bone to my little toe is so tender that he feels it is "worse" than before - ie less stable. Also the area of the peroneus brevis tendon (sorry my spelling is wrong most likely but I think you know the area I'm speaking of) is very tender and painful and generally swells a little each day.

    I think your advice to seek another opinion from a respected specialist is very fitting. It is certainly not my preferred course of action to go through with the operation, however as you suggest the Doctor wants to put the ball in my court so that any outcome is of my own doing.
     
  8. Unregistered

    Unregistered Guest

    did you ever get a CT scan to see if there is anything else going on with this?

    I had a very similar situation. July 28, 2008 I suffered an inversion/twisting of my right foot while fishing. First orthopaedic surgeon diagnoses the fracture as a jones fracture (keep in mind that it is actually an avulsion fracture and not a jones as it turns out) tells me to wear a walking boot and it should heal. By October 15 and many more visits with Doctor #1 I am still experiencing trouble, pain and tenderness, aching, despite radiological evidence of "healing."

    By October 30 I tell doctor- "your treatment plan is not working." He says, keep waiting, see me in late November. I say ok/bye and promptly transfer file to different orthopaedic for a second opinion. Second orthopaedic first sees me in November 15, orders a CT scan.

    CT scan reveals rotation of the avulsed piece of bone, roughly 100-150 degrees of rotation. By now this bone is completely surrounded in scar tissue, non-union is confirmed. He explains this is rare (which it is) and he has only done 2 of these surgeries ever. I say ok/bye, and off to a orthopaedic surgeon trained in foot and ankle fellowship.

    By December I am literally going crazy. December 10 is my first visit. Review of CT scan and new X rays confirms second doctor's diagnosis. Says he sees it quite frequently (despite being rare) and is experienced with this. Have surgery on December 11 (yes the next day!) and am now healing. A bone stimulator is being used as well.

    Based on what I have read on many different forums, this is my opinion if I could go back and do it all over:

    1- After the first 8 weeks, if he knew it an Avulsion and not a Jones Fracture, I would have stayed with him because Avulsions generally heal. Unfortunately, he diagnosed it as a Jones on the medical records and treated it as an Avulsion. At this point I would have inquired about a bone stimulator as well.

    2- After 12 weeks, I would have demanded further management/inquiry of my injury, i.e. get a CT SCAN.

    3- After 12 weeks, if surgery was likely, I would seek a second opinion regardless of qualification, its my foot.

    4- Surgery no later than 14 weeks IMHO.
     
  9. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS- ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    Although it is not clear to me your description as to "the bone completely surrounded in scar tissue," as the typical 5th metatarsal styloid process avulsion fracture is resultant from the pull of the peroneus brevis, the tendon of which inserts into the area that is avulsed, because there is continued distraction of the fracture segment by that very pull, it is not uncommon that such fractures do not show direct bony union on x-ray. Most, however, become adequately stable, even though they will continue on x-ray to demonstrate a fibrous scar interface between the two segments. I would have to see a rotation of 100-150 degrees (which would be somewhere between a right angle and a contra-directional spin of the avulsion segment), especially while in a walking boot before I would believe it.
     
    Last edited: Dec 16, 2008
  10. Unregistered

    Unregistered Guest

    I agree- I may post a picture of the CT scan that revealsed signifacant rotation of the avulsion of the turberosity of the 5th metatarsal.
     
  11. jirvin

    jirvin New Member

    are you able to view these images?
     

    Attached Files:

  12. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS- ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    It appears questionable to me that yours was ever a typical inversion avulsion fracture of the 5th metatarsal's styloid process. Do you have the initial and subsequent flat x-rays?
     
  13. jirvin

    jirvin New Member

    Wish I had X ray images to post. Guarantee they dont show the rotation. Thats why I am a fan of the CT scan after 12 weeks of continued pain.
     

    Attached Files:

  14. Unregistered

    Unregistered Guest

    I have bilateral 5th metatarsal breaks. It has been 6 months and they are still not healed. Should I insist on surgery or will they eventually heal on there own?
     
  15. FootDoc

    FootDoc New Member

    Sorry, but I cannot understand how you might think anyone without specific first-hand knowledge of your situation could possibly offer a meaningful response and why you would possibly even entertain any opinion based on such lack of knowledge. Here's a thought though . . Why not check first with the doctor who is treating you, or if you no longer have confidence in him/her, seek another hands-on opinion by another doctor chose after through investigation of his/her credential and reputation.
     
  16. Unregistered

    Unregistered Guest

    Vix - The "right" healing time is the time that is right for you and your body, not someone else. I'm recovering from a nondisplaced transverse 5th metatarsal fracture that was treated with crutches and a walking boot, I only put weight on it if it didn't cause pain. I used crutches for about 2 weeks. I'm now about 9 weeks post injury and just beginning to return to some of my normal activities. In my opinion you should not have been running until your healing had further progressed and yes you could have made matters worse by running on it. If walking caused you pain, you should not have continued to try and it is possible that you made things worse by not staying off of your foot. If there is a lot of soft tissue swelling, a fracture might not show up on the initial films. In other words, listen to your body! Stationary cycling or swimming would have been better choices than running, also some stretching exercises for your toes and ankle. In regard to the swelling, it can last a long time, my doctor said up to a year in my case, even though healing has occurred.

    I know this didn't answer your question but I just wanted to share my experience. I understand your frustration and wish you luck with your healing process.
     
  17. Unregistered

    Unregistered Guest

    Maybe you didn't notice but you are replying to a post from last October. If it isn't healed by now I'm afraid it will need more than wishes of luck.
     
  18. Pam

    Pam Guest

    I was wanting your opion on a slightly displaced fracture of 5th metatarsal. I have been wearing a boot for six weeks went back for xray - was no change from original xray. I then saw a specialist and he said it would be healing with grissel was how he described it. I asked him how he knew that and he stated well I can do a biopsy if you like(i think he was joking) He then said take the boot off and just walk with shoes. It is very uncomfortable and I can only walk short distance. Do you think I should get another opinion.
    Thank you for your time
    Pam
     
  19. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS-ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    You don't state the location of the fracture on the 5th metatarsal, but, especially if it was an avulsion fraction of the styloid process of the base, it is not uncommon for healing to take place with at least some fibrous union. That might be what your doctor is talking about as "grissel." But, as I have no way of examining you or determining the true nature of what has occurred, I cannot advise you on the appropriateness of your doctor's decision. A second opinion is always wise when a patient has concerns with his/her doctor's treatment, if only to give one peace of mind.
     
  20. texas111

    texas111 Guest

    Reading this forum has been interesting. Labor Day of last year (2009), I turned my ankle and later had a cramp in my foot that got worse. The closest available appointment with my Podiatrist was 2 weeks later. He had been ill in the hospital.

    During those weeks the pain worsened. It was mostly when I beared weight on it as one has to in order to walk. When I saw the doctor, x-rays were taken and a fracture was revealed. It was on the fifth metatarsal very near the area called a Jones fracture. It was a horizontal fracture. He said it began as a stress fracture. I was fitted in a walking boot with air compression. I was told not to bear weight for at least 6 weeks. Follow-up appointment in 3 weeks.

    Since I am an elementary school teacher, it was impossible to follow those orders. We had 3 teachers out already on medical leave and my principal said he couldn't afford to have another one out. So, I was told to use a wheel-chair at work. And I did.

    Three weeks later, no improvement. An MRI was ordered and the radiologist wrote

    "Exam CPT 73720
    MRI right foot pre & post IV contrast enhancement: 11/13/2009
    History: Multiple right foot fractures. Fifth metatarsal pain.
    FINDINGS:
    There is moderate bone edema within the fifth metatarsal proximal metadiaphysis.
    This is associated with mild periostitis and slight cortical irregularity. A healing
    fracture is suspected. Stress reaction or contusion in an area of previous healed
    fracture is also possible. Bone signal and enhancement pattern do NOT suggest the
    presence of osteonecrosis/avascular necrosis. There are multifocal small joint
    effusions. There is a moderate amount of fluid tracking along the flexor hallucis
    longus tendon at the plantar aspect of the foot; this is a nonspecific finding and
    probably represents extension of tibiotalar joint fluid along the tendon sheath of the
    flexor hallucis longus. There is mild to moderate edema of the subcutaneous fat
    about the ankle. No articular cartilage defect identified. As visualized, ligamous
    structures and neurovascular structures are intact.
    IMPRESSION:
    Healing traverse fracture of the fifth metatarsal proximal metadiaphsis. No MRI
    evidence of osteonecrosis."

    My follow-up exam was Dec. 7th. My doctor told me of the findings. I might add that last year I had very early uterine cancer and at the time was suspected of having thyroid cancer. However, thyroid cancer turned out to be negative. In any event, I was found to have a treatable thyroid disease. I was also informed that thyroid problems can cause fractures.

    Anyway, on the MRI report, my doctor wrote, "let know show healing fracture only.
    So, a bone stimulator was ordered and a new wheel chair was ordered as well. I was also sent to Physical Therapy three times a week. Then, my school would not allow me to work and said it was against school policy to have restrictions or light duty.

    So, disability began in late December. Regular check-ups with my podiatrist in the months following. I continued on the bone stimulator, which I was told helped and the area was beginning to show signs of union.

    I had to have a radical hysterectomy in May. I recovered quickly. In June and July I was trying to resume my old routine of walking and going places. I still had pain when bearing weight on the outer part of my foot. I figured it was arthritis developing in the fractured area. Continued with Physical Therapy. I always left there with more pain. I had (and still have) to use two different balance boards to work on the range of motion. Counter-clockwise is still painful.

    Anyway, in late July, I went back to my doctor for a medical release. He wanted me to have a CT scan and x-rays at a hospital with the latest imaging devices. The x-ray technician told me my foot looked like a "big mess."

    A week later, I saw my doctor again for CT results, I don't have a copy to report the technical information. However, he said the bone still indicated a healing fracture. However, the interior part of the problematic bone showed a fracture with no union.

    So, the result is no medical release. Surgery will not help it heal. I am back using the bone stimulator for 10 hours a day (the cost was $4500.00 for the unit). I am also using a surgical shoe or athletic shoes with special orthotics. It is now September 9, 2010. An entire year later.

    So, my non-professional opinion on healing time for fifth metatarsal fractures is that it varies from individual to individual. Some people may have a medical condition which causes union delay. Usually, it doesn't take a year. However, at physcial therapy, I have met some people who are still with non-unioned fractures and wearing walking boot for a year.

    I was told the area of my fracture is in a place that doesn't receive a good blood supply. Without good blood supply, the injury heals very slowly. It takes time.

    I guess the reason for my long post is due to my frustration of the delayed union. I sorted wanted to vent. Honestly, I feel that it is difficult to ask a doctor for his/her opinion when they have not examined the patient. Most of the time, important information from the patient is not communicated to this internet doctor.

    So, my suggestion is also to see a specialist. If you don't like what he/she tells you, get another opinion. I think it is important to remember that everyone's case is unique. Do what your doctor tells you. Advice from forums is risky and many times not related to other simular cases.

    Fifth metarsal fractures are special and can take time. Patience is required!
     
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