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Should surgery be done for broken metatarsal bones?
Question: My problem: broke two metatarsal bones (4th & 5th) in one foot last Sunday, Xray showed clean breaks about 1/3 inch from each bone end, but with a few millimetres of displacement. Observation: Following icing and immediate trip to Emergency, which lead to a temporary cast, crutches, and instructions to keep weight off that foot (which I am doing), I've found that my worst pain was mild and on the day of the break. Pain sensation from touching the area is declining slowly but steadily each day, and there is no other pain unless I press on the foot slightly. Questions: (1) When I see an ortho. surgeon on Monday, if he says he needs to operate and apply pins would it be imprudent to ask for a delay to see if nature will realign bones while wearing a rigid cast? (2) What is the average waiting time before someone with this kind of break is able to walk without crutches or severe pain due to weight on the foot? NB. I am a XXXXXXX citizen but in great shape and have already started doing comprehensive diet change to try and speed bone healing. Thanks.
Brief Answer: Average waiting time 3-4 weeks. Detailed Answer: Hello, Thanks for your query. If the fracture ends is in contact and there is only few millimeteres of displacement in metatarsal bone, then it could be managed well conservatively in rigid cast. If it needs operative management, in that case there is very less possibility that it realigns naturally while wearing a cast. If you wish you can upload your xray so that I could comment better. Average time of immobilization needed for these type of fracture is 3-4 weeks. After this period you might be able to walk without crutches . I do hope that you have found something helpful and I will be glad to answer any further query. Take care
Apologies for this late response, Dr. XXXXXXX Your email got into my junk mailbox. I do not have the Xray; but as I recall the fracture end was in contact. I appreciate your prompt response. I take it that if I m wrong I should allow the surgeon to try to make the contact now rather than later. Apologies for coming back so soon, Dr, Gupta; but I forgot a couple of hopefully simple questions. Should I *always* keep the foot elevated above the plane of my heart, except when I have to walk? If your answer is no, I need to ask you if gentle leg-swinging from my wheelchair (for exercise) is bad? (I am being quite rigorous about keeping body weight off that foot.) Cheers, and thanks in advance for your attention. (I will be happy to pay more for your attention, as required.)
Brief Answer: No harm to do gentle leg-swinging for exercise. Detailed Answer: Hi, I am glad to know that I could address your concern. It is important to keep the foot elevated above the plane of heart to prevent the development of swelling. There is no any harm to do gentle leg-swinging for exercise. I hope this answers your query. I would be glad to help if needed. You can directly get to me at WWW.WWWW.WW Keep me updated about your progress . Wishing you speedy recovery... Warm regards.
You have indeed answered my query, Dr. XXXXXXX and your helpfulness has prompted me to sign up for the unlimited questions to specialists program. I will be going to my surgeon appointment tomorrow entirely posed to accept his judgment on what should be done now, as your view is well supported by what I heard last night in some podcasts of the American College of Foot and Ankle Surgeons. Thanks again.
Brief Answer: I would appreciate your reviews. Detailed Answer: Hope this discussion was useful. Please close this discussion, if you do not have any other queries. I would appreciate your reviews about this service.
Hello Dr. Gupta! I closed the discussion and tried to submit my review both here and at your web page. At this page thee is a message saying my comment is accepted. At your page Firefox says it cannot load your page when I click on Submit. Here is the review text: Dr. XXXXXXX XXXXXXX sent me a response that was timely and sophisticated, when I put it in the context of what I had already learned on the internet. His response to my follow-up questions was also helpful in framing reasonable expectations about an upcoming consultation with an orthopaedic surgeon, and was also timely. His courtesy is also appreciated, and I look forward to seeking more support from him as I go down this road that is unknown to me. I am hoping that HealthCareMagic will give me access to persons like Dr. XXXXXXX who are reasonably focused on clients' self-care needs and issues.
Hello Dr. Gupta! I seek your help, re. a burning sensation that started suddenly about 2 hours ago. It is on the bottom of my feet underneath the area where the breakage took place. A university web site says it is a warning and I should contact my doctor "immediately". He is not available, and so I turn to you. Is it suffiucient for me to put the foot on ice for a while and wait for my surgeon appointment which is about 17 hours away? (I have not put any weight on the foot opr banged it; but I did spend about an hour in the wheelchair with my foot down.) Thanks in advance.
Brief Answer: Do not worry , do icing and elevate the limb. Detailed Answer: Hello sir, Sorry for late reply. Burning sensation you had felt could be due to temporary compression of superficial nerve fibres by the swelling itself which might developed due to prolonged foot down. Do not worry , do icing and elevate the limb to reduce the swelling and get it examined by your surgeon at your appointment. I hope the things go well. Please keep me updated about your progress. You can directly get to me at WWW.WWWW.WW
Thanks Dr. XXXXXXX and apologies for my late reply. Based on what I read on the internet about that sudden "hot foot" sensation, I panicked and called the provincial tele-nurse who told to get to Emergency -- a horrible but instructive experience (waiting there 6 hours). Later that day I saw the orthop. surgeon, and the Xray results lead him to put me into Moon Boots rather than a cast. You can imagine how happy I was, and as of today I am making slow progress. I am to continue using the crutches for 5 weeks; but start trying to put some weight on the foot week after next. Thanks. PS -- I am using hot-cold pads and long periods on my back with the leg greatly elevated to try to dissipate the edema, and this morning shows much improvement in the extent of morning swelling.
Brief Answer: Glad to know that everything going well. Detailed Answer: Hi Sir, Welcome and sorry for late reply. I am glad to know that everything going well. Continue using moon boot as advised by your doctor. Elevate your leg as much as possible to reduce the edema. You are most welcome for further queries.
Hello Dr. Gupta! I hope that this message finds you in good health. I am seeking some new consultation concerning the broken bones in my left foot. When I no longer have a marked swelling on going to bed at night, does this mean that the only remaining issues, as healing moves forward in the coming weeks, are whether the fractured part is properly aligned and whether the rate of healing per week is unduly slow? I will be x-rayed again on March 17, and I am assuming that there will be enough evidence at that time to allow the surgeon to decide whether these issues are problematic in my case. Is that a reasonable anticipation as regards what that X-ray will show? Tonight, for the first time, the notable swelling is only above the area where the breaks took place. Almost all puffiness of skin the foot (bone marrow edema, I have read) is now gone. Today is the second day of the third week since the accident on February 2.
Brief Answer: Everything is going well Detailed Answer: Hello sir, Thanks for query again. Do not worry. It seems that everything is going well. You had read correctly. By this time bone marrow edema settles down. It generally takes 6 weeks for fracture of metatarsal to heal. So by that time (17 march), when xray will be done again, we would anticipate good callus formation on xrays. You are most welcome for further queries. Warm regards.
Thanks for your helpful guidance, Dr. XXXXXXX Sorry to be back so soon; but I need your help regarding safe commencement of specially selected exercises now. Please review the three items below and tell me which ones I should not do until week after next (when I am allowed to start putting weight on the foot). None of these exercises will be done to the point where I feel pain, and I am still rigorously keeping weight off the foot with wheelchair and crutches. I got these at a sports injury web site. 1. Ankle range of motion -- Start by moving the ankle through its full range of motion, you can do this using ankle circles or by writing the alphabet with your toes! 2. Toe range of motion -- Point your toes up and then down as far as possible. Hold each position for a few seconds and then reverse. Try to spread your toes apart as far as possible and then to scrunch them up as well. Hold for a few seconds, before reversing the movement. 3. Calf stretches -- Stretch both calf muscles regularly every day. Sit in a chair and roll a can of soup back and forth on the floor with your foot. You can also use a small ball. Comment: Regarding the calf stretch, I would like to lie on my back in bed and practice raising both legs and flexing the knees until I feel my tummy muscles hurt, and repeat that several times each day. Thanks in advance Dr. XXXXXXX
Brief Answer: You can delay ankle range of motion exercises Detailed Answer: Hello, It's nice to hear from you. Among these three exercises, you can delay ankle range of motion exercises until week after next. Best Wishes.
Thanks a lot, Dr. XXXXXXX I'll follow your guidance and hope to not have to bother you for more guidance until I start a new set of exercises week after next. Your support and the facilities built by the three Indians who started the company (HealthCareMagic) are helping to fill a **massive** hole in the N. American health care system -- access to expert guidance in developing intelligent self-care. The design of our system and its economics have built a troubling wall between consumers and health care practitioners, so far as this kind of guidance is concerned. Cheers!
Brief Answer: It's my pleasure. Detailed Answer: I am very glad to know that I could address your concern. It's my pleasure to help you in difficult situations. Have a good day. Warm regards.
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