Joe A Shaw PA-C - 8/8/2009

Question
Dr. Shaw,

I really need help.  I am a 48 yo female who has been a runner for 30 years.  I injured my Achilles Tendon approx 2 months ago.. (grade 1), they put me in a black book cast for 3 weeks during which time, I twisted my ankle (in the boot) and apparently opened up an old fracture injury on the top of my foot.  I cannot bear weight on it at all now.. it is SEVERELY painful.  The CT Scan done next is showing two small bone fragments from the old injurt.  The doctor is saying they are small round and calcified and shouldn't be causing any pain.  Is it possible that the new twisting moved them to a location that is now causing pain when I bear weight.  I'm totally confused as 8 weeks post tendon injury and 3 weeks post ankle twisting and I still cannot walk without crutches.. with or without the black boot cast.  I am scheduled for another opinion next week.. but would appreciate any advice/input you could give me as well.

Thank you


Answer
Ruby,
Sounds like a non-union fracture which can be painful and unstable. Unusual to get a fracture in a walking boot..Could be a pathological fracture so get your calcium level checked, bone density etc checked. You may eventually need open reduction plate/screws/bone graft and/or bone stimulator to get this bone to try and heal properly. Nonunion in foot bones are not uncommon. I would see an orthopedic Dr who specializes in feet. DPM's are fine for a lot of foot problems but not for this IMO.