Question
QUESTION: Have been told that I broke a 5th metatorsal bone and doctor didn't tell me anything about the Rice method. He just said for me to wear the boot for next three months. How do I treat it until than?

ANSWER: 3.  Debbie, the RICE method is commonly used to treat symptoms of an acute injury.  Rest, Ice, Compression and Elevation help to calm down some of the inflammatory components of an initial injury.  Usually it抯 important during the initial 48-72 hours post injury; however, if swelling or pain persists, icing and compression can continue to improve these symptoms.  Anti-inflammatories such as Advil, Motrin, or Ibuprofen also help reduce pain and inflammation to an injured area and should be incorporated into your treatment plan.  5th metatarsal fractures can be difficult to heal at times depending on the site of the fracture.  The boot is definitely required for these fractures.  It takes approximately 6-8 weeks for bone to heal from an injury such as a fracture regardless of the location.  Minimal ambulation and absolutely no activity other than daily walking should be performed.  I have a patient right now that has re-fractured his 5th metatarsal because he was not compliant about wearing a boot and refraining from exercise and excessive walking when the fracture was healing.  So do it right the first time by wearing the boot, restricting your activity, and continuing compression and use of anti-inflammatories.  If you have any other questions, please feel free to respond!

Dr. Leslie Johnston, DPM
Tampa, FL
Advanced Podiatry

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

QUESTION: I thank you for your answer. I rate it a 10.
I only walk about less than a half mile from the VIA bus to my office to and from work. Its not long at all.  I haven't token the Moltrin 800. Am I soppier to? I did feel throbbing like a pulse feeling on my right foot on Thursday but since than not enough pain that I can't stand. Even though i dont feel but little pain, should i still be having to take the pills?  I've noticed that I have a higher bone or raise in my foot, kind of on the midfoot you could say. The bump is just alittle higher on the 2-4 metatarsal shaft of the area. I know that looking at my other foot its higher but on the injured one the area seems to be higher raised. I am really concerned about that? I also see a rounded little bump on the lower shaft of the metatarsal bone not too close to the base of the 5th metatarsal bone. Should I go back to the doctor cause of the appearance looks strange? I have been applying ice to the foot and once in a while I will place my foot in a bucket of warm water. Should I even be placing it in warm water? I have had to ask the nurse questions of what should I do to treat it on Sept. 14th cause the doctor just told me that the boot will heal the bone. The report says "Proximal shaft of the metatarsal. trasversital (crack is across the bone)

ANSWER: Debbie, if the pain has resolved and you are not experiencing significant swelling, then skipping the Motrin is fine.  A new finding such as the one you are describing could be 2 things: (1)the fracture is healing and bone callous is surrounding the fracture site which can cause a bump to occur; (2)the fracture could be displaced, meaning the fragments are not in correct alignment anymore.  If you haven't been to the doctor within the last 2-3 weeks and this is a new finding, I would suggest going back to your doctor for repeat xrays just to be safe.  As far as using ice vs heat, at this point I don't think either will do any harm.  Usually you use these methods 48-72 hours after the injury to reduce swelling and inflammation.  I hope this helps, please let me know if I can be of any further assistance.

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

QUESTION: I thank you for your answer. I now have some pain under my foot when I walk Is that the process of the healing? I didn't get a chance to get stays from September 5th where the doctor didn't see any broken bones and than I see a Podiatrist September 13th (tried to get one earlier than this date but wasn't possible) Why is that the first x rays did not show any breaks (did three angls) and I go to the doctor 13th and it shows a broken bone?

Answer
Debbie, pain is normal after breaking a bone.  Healing can take anywhere between 6-12 weeks, especially if you were placed in a walking boot or shoe.  If the fracture was not displaced initially (meaning the break in the bone was pulled apart), then it can be difficult to see it on early xrays.  Sometimes it can take 2 weeks before you see any sign of a healing fracture on xray as well.  Since you went to the other doctor one week later, they may have noted some healing on the xray or that the fracture was slightly displaced.

Dr. Leslie Johnston, DPM
Tampa, FL
Advanced Podiatry

http://www.thetampapodiatrist.com
http://tampafootandanklepain.blogspot.com/
http://www.tampacryosurgery.com
http://katzpodiatristtampa.blogspot.com
http://twitter.com/TampaPodiatrist
http://www.notoenailfungus.com
http://www.vibranttampatoenails.com  
Advanced Podiatry Facebook Page
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