5th metatarsal foot fracture

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Hi everyone, hope i can get some answers and info from other peoples opinion. Beginning of june, first week, i had fractured my 5th metatarsal bone in left foot. Doctors put me in a tall boot and i have crutches. He told me at my first appointment i had 2 choices, either i can get sugary and get screws put in my foot or i can wait it out to see if it will heal on its own since it was lined up pretty good. Well i went back a week ago and still nothing and he dont want me to put any weight on foot. Its been 8 weeks probably yesterday, and still not any weight bearing on it. I thought and hope to of heard good news on my last visit because the swelling seem to of start getting better and was actually able to see arch in my foot again, and some of the discoloration was looking a little better. So anyways he said he was going to schedule me back in 3 weeks, so that will be aug. 13th i believe lol and i dont know if i should go ahead and get sugary set up or wait and see what happens at next visit. Im so ready to get this over with, considering i have 3 kids and my hubby out of town working a lot. Im wondering if i should try to put little weight on it, since ive seen other people say its supposed to help heal the bone better, but the doctor also said something about a blood vessel in foot and if i move my left foot toes to the right and may bust it. So i dont know what to really do and im looking for some info and help from others on my decision. I really was hoping not to get sugary and get a screw put into foot (sounds painful) . Any help and advise would be greatly appreciated. TIA, juls

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  • Posted

    Fixing 5th metatarsal fracture varies depending on the nature of the fracture, that is a transverse fracture might be treated with a single retrograde intra-medullary screw. An oblique fracture might warrant screws which cross the fracture or a plate. (Oblique or spiral fractures usually heal spontaneously)

    I treat these fractures conservatively in the patients' own shoe (if swelling permits), since that is the best fit apparatus which exists. This is a more American approach (perhaps because of cost consiousness)

    Below knee casts are to be condemned (as are "moon boots") since they are unnecessarily cumbersome and do little to effectively immobilise the pertinent region. In addition there will always be some adjacent soft tissue damage which seems to do best if allowed to move (otherwise the "moving parts" become relatively adherent).

    Further, DVT is not an inconsequential risk, and therefore the "calf muscle pump" needs to be allowed to function (which is not possible in high casts or boots), ..

    I often encourage stationary cycling in these injuries which also makes immobilisation with a shoe sensible.

    Surgical fixation is only justified if there is symptomatic non union.

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    • Posted

      Hi JP66967,

      I hope you don't mind but if you have time a just have a couple of questions. It is so hard to get some tangible information that makes sense with a 5th metatarsal break and your reply in this post makes good sense to me.

      2,5 weeks ago I broke this bone kite surfing in Bali and was flown to New Zealand by my insurance company as they thought an operation was needed. Once home the general doctor at the local hospital and an orthopaedic surgeon said conservative treatment was best. (I have attached an X-ray).

      I am very active person participating in action sports most days of the year and wish to get back out there as quickly as possible. I am back in Bali again and I am wearing a moon boot when moving around... I take it off when I am sitting down and sleeping. I have no pain or significant swelling and wiggle my toes comfortably along with move my ankle around. 

      The million dollar question is what should I do from here? It will be 3 weeks in a couple of days and do you think I should I perhaps start wearing shoes and weight bearing lightly or stick with moon boot and non weight bearing for a couple more weeks? 

      Any thoughts on what do from this point would be greatly appreciated. :-)

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  • Posted

    Hi Juls217,

    From a patients point of view, i also had the jones fracture(5th metatarsel break) in 2 places. I was also told that because my break was close to the tendon going up into the ankle I should have a screw put in, which I did no argument.

    I was laid up for 6 weeks and started putting weight on the foot after the 7th week. I even tried to ice skate as I play ice hockey.

    It has been 20 weeks now since the operation and I still get a pain on the top of my foot near my toes. I am playing ice hockey at the moment without issue as the boot keeps my foot stable however there is still swelling around the operated area. If your break is near the base of the bone then I would suggest going to get a screw put in as the tendon will keep pulling the fracture apart as is the nature of that perticular tendon.

    Just my opinion.good luck.

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    • Posted

      When you say "laid up" were you off of work that whole time? I have seen varying opinions about this.  I have a very active job, so my doctor said 6-8 weeks off of work.

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  • Posted

    Hello,

       Sorry to hear about your fracture, a 'jones' (zone 2) that nobody seems to be able to keep up with, varying opinions from everyone, medics included.

       I fractured mine (R) in January of this year and also had an avulsion and fractured 4 and 3, I was first put in a moon boot, which immediately caused me burning and swelling (week 2), then a p.cast for 7 weeks, then moon boot and alternating stiff soled shoe for another 3/4 weeks.

       This fracture certainly left it mark on my mental state, with all the research and opinion. I decided to just go along with my consultants instructions and so far so good. I did use a spin bike for light use, increase circulation and general keeping fit, although i did long light sessions, not hard fast. I started walking and cycling in mid April and have gone from strength to strength, thankfully. I do still get the odd ache in my foot, but this is expected and will eventually settle. Even when i was re-scanned after 8 weeks i had minimal callous formation, yet my fracture, with care and no screw has healed well.

       I suppose i can count myself lucky, i did however go through all the mental trauma of: Have i been advised properly? should i take supplements? should i go private and get it screwed? will it ever heal (HELP)? should i get another opinion?...........in short it was hell!!! I did what i was told and in the end it seems to have worked.

    Just another opinion, hope it helps smile

    Good luck to you.

     

     

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    • Posted

      Thanks for the reply, i try to keep boot off when im at home because it seems like when i do wear it, my foot swells back up, mostly around ankle area, which is odd i think but i been able to wiggle some of my toes but sometimes it hurts to. I hope to get some better news next appointment. Thanks again
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  • Posted

    I did mine on the 12th of Feb, also fractured my ankle at the same time, I had a screw put in two weeks later as I was informed the gap was too large to heal on it's own and that whilst it's an avulsion fracture it's in the area where healing is poor due to the lack of blood vessels.

    Now over 5 months later it still hasn't healed.

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  • Posted

    The argument for surgically intruding on Jones' fractures is that one study showed a 25% non union rate.What that says in real language is that 3 out of 4 will heal if left alone. Conservative management seems a good bet to me.
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