Question
QUESTION: 7 weeks ago I miss stepped a couple of steps and came down on my right foot and fractured it and displaced slightly, at my 1 month x rays it showed no mending started, and the bone had shifted slightly, my Dr has me in a hard shoe brace, I am 50 and would like to know if its common for the first month that no mending had not started? is it true that the soft tissue healing don't show up on x ray? I have a apt in 1 1/2 weeks till my next x rays and hoping to have some healing taken place. I have started taking more calcium magnesium, vit D and boron is there any other I should be doing?
Thank You

ANSWER: Hi, Becky,

Thank you for your question.  I'm sorry to hear about your misfortune and hope you feel better soon.  I'm not sure which bone was fractured, but it can sometimes take a little longer for some fractures to mend.  And because we're on our feet, our bodies have to work a little harder for those areas to heal.

You are correct...soft tissue healing/repair does not show up on xray.  When a fracture heals, it begins with soft connective tissue, then calcium comes and starts to create a bone callus (an area that's slightly white and sort of hazy-looking) across and around the fracture site.  If at 4 weeks there is no sign of any of that, I as a physician might consider ordering a bone stimulator to encourage the bone to form.  I'd also encourage you to stay off your foot as much as possible.  If the bone is moving a lot, it can break apart the bone callus or not even allow it to form.  If the bone has changed position, that tells me that something probably happened to disrupt the healing process, so your body might take longer.

There could be a few other explanations.  Do you take a little longer to heal, in general?  Do you have diabetes, or do you take prednisone for any reason?  Is there any osteoporosis in your family, or any thyroid problems?  It might take longer if any of those things are true.  As women go through menopause, it also has an effect on our bones and can delay healing time.

In a perfect world, when bone is completely immobilized (doesn't move at all), it takes approximately 4-6 weeks to heal.  The images on x-ray can be delayed because it takes a little bit of time to lay down that calcium, and it's the calcium deposits that show up on x-ray.  The calcium also might be present in amounts that are too small to see on x-ray right away.

If there's no change with your next x-ray, I would definitely encourage you to talk to your doctor about using a bone stimulator.  It's a small device that usually has some sort of strap and is placed on your foot, over the fracture site, to encourage healing.  That might speed up the process a little, and it doesn't hurt at all.

In the meantime, you can definitely continue taking the supplements, and I'd encourage you to do what you can to stay off your right foot, when possible.  I know that's much easier said than done, but if it prevents you from needing surgery, it might be worth it.

I hope this helps!

Best of luck to you, and happy healing,
Dr. Bodart

---------- FOLLOW-UP ----------

QUESTION: Thank You so much for this information, the fracture was the 5th metatarsal my Dr said its one of the easier fractures to heal so its is not at the base of the bone but about one inch from the small toe on on an angle.

Answer
You're welcome, Becky.  Thank you for the clarification.  In that case I would definitely recommend taking it easy.  That bone carries a lot of the body's weight when we stand or walk...not as much as the first metatarsal or the big toe, but it also moves more than the 1st when you walk.  Hopefully your doctor will see some bony growth when you get X-rays again.  And if it doesn't hurt when you walk or when you touch that area, that's a good sign that you are healing, regardless of what the X-rays say.

Feel free to contact me again if you have any additional questions.

Take care,
Dr. Bodart