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Suggest treatment for soft tissue damage and associated muscle spasm

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Posted on Thu, 21 May 2015
Question: Hi - my son had a screw inserted into his fifth metatarsal on Nov 10 (Jones fracture after stress fracture in same area) and was recovering nicely. Then on March 16 he did box jumping at the gym and ever since the following day he has pain under the fifth metatarsal (he points to the sole of the foot beneath the base of the fifth metatarsal) when walking. Xray that week showed nothing unusual, mri the following week showed nothing unusual and xray on April 14 showed nothing unusual. The bone is healed and the screw looks fine. His surgeon arranged a steroid shot April 14, and it doesn't seem to have made any difference. The strange thing is that the pain is much worse in the morning, and eases as the day goes on. The surgeon said that the next step would be screw removal, but he plays soccer at a high level, and I understood that the screw should really stay in until he finishes playing. The surgeon is a man of few words, and I mostly contact him through his secretary, so we have no idea what his thinking is as to what the issue is. Is it possible this is unrelated to the screw, and soft tissue damage from the box jumping? Or could it be scar tissue? Any insight would be extremely helpful. Normally my son wore orthotics to help with flat feet but he finds they aggravate this pain so he is not using any arched support currently. He has tried stretching the calf out, nothing seems to relieve the pain in the morning. He says when he tries to run it does seem that the pain goes away (while running) but comes back with a vengeance in the morning. Is it possible the shot needs more time to work? Also, what happens when the shot wears off in a few months?
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Answered by Dr. Saurabh Gupta (1 hour later)
Brief Answer:
It could be due to soft tissue damage.

Detailed Answer:
Hi,
Thanks for your query.

It could be due to soft tissue damage. More pain in morning could be due to associated muscle spasm. Some time screw removal might be helpful in these cases. There is no any harm in removing the screws after fracture healing.
Steroid shots are given locally to reduce pain and inflammation in the area. Sometime it take more time to work.

I do hope that you have found something helpful and I will be glad to answer any further query.

Take care

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Saurabh Gupta (2 hours later)
thanks for your speedy reply.

if it is soft tissue damage - how long does that take to heal, and what can he do to speed up healing? are there exercises? should he see a physio?

what can he do to stop the morning pain if it is muscle spasm - he has pain only when planting the foot or rubbing the area, not when he is sitting.
doctor
Answered by Dr. Saurabh Gupta (16 hours later)
Brief Answer:
Physiotherapy will be helpful.

Detailed Answer:
Hi,

Usually it take 3-4 weeks for healing. Sometimes it takes more time. Physiotherapy will be helpful for speedy recovery. Do hot fomentation and stretching exercises to reduce muscle spasm.

Warm regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Saurabh Gupta (2 hours later)
hello again - thanks for your response - I just have a few last questions:

(1) should he refrain from training? the soccer team trains in the evenings and he finds his foot pain free now in the evening. He ran on it Tues night and it felt fine, but very sore Wed morning. Last night he did not run, and it was sore this morning but not as sore as yesterday morning. He seems to think the pain goes away when the foot is loosened up, so maybe it is predominantly a tight muscle?

(2) he attends physio tomorrow. the surgeon asked that he wear a night splint for a week, but we live remotely in XXXXXXX and its hard for me to get one quickly. Do you think a night splint would be helpful, or perhaps that the physio will be enough?

(3) My last question - is it possible that the shot will wear off in a couple of months and the pain will be back as bad as before? He is going out to USA in August on soccer scholarship and August will be intensive pre-season training. I am worried about the timing. He also has exams until 3rd week in XXXXXXX so if the screw was removed after that he could not run for 3-4 weeks I am told. Also really bad timing for this scholarship, which we are really dependent on financially. Hence all my worries...

thanks so much for your help
doctor
Answered by Dr. Saurabh Gupta (20 hours later)
Brief Answer:
He should refrain from training for some time.

Detailed Answer:
Hello again,

He should refrain from training for some time.
Physiotherapy would be enough.
I don't think that he would need shot again.

Warm regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Saurabh Gupta

Orthopaedic Surgeon, Joint Replacement

Practicing since :2004

Answered : 5930 Questions

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Suggest treatment for soft tissue damage and associated muscle spasm

Brief Answer: It could be due to soft tissue damage. Detailed Answer: Hi, Thanks for your query. It could be due to soft tissue damage. More pain in morning could be due to associated muscle spasm. Some time screw removal might be helpful in these cases. There is no any harm in removing the screws after fracture healing. Steroid shots are given locally to reduce pain and inflammation in the area. Sometime it take more time to work. I do hope that you have found something helpful and I will be glad to answer any further query. Take care