Question
I am 45 f, I started having right foot pain last week which then worsened over the weekend following running, something I don't typically do.  The pain was so intense I could not sleep, and meds did not seem to touch it. On Tuesday I went to Urgent care, received xrays and was told I have an avulsion fracture, and possibly a fractured sesmoid bone.  I was even shown the area on the xray where the fractures were viewed.  I was told 3 doctors reviewed the xrays and concurred with the dx. The subsequent radiology report however states there is no evidence of fracture.  A splint was applied and I was told I would need a cast for at least a month but that would be applied by an orthopedic MD.  I am not sure who to believe at this point.  What I know for sure is that the pain continues, and I am now struggling to get a referral to a podiatrist or orthopedist, but without a definitive xray results, the insurance company is balking. Is it common for this type of error to occur?  Should I pursue getting a cast applied or give more time and see if my foot feels better.  I work 12 hour shifts on my feet, so this certainly affects my livelihood, but I don't want to cause more damage.

Answer
Hi Julie,

It is fairly common for ED doctors to have a hard time with foot fractures.  Some people have a split sesamoid and this can be misdiagnosed as a fracture.  There can be an extra bone at the base of the fifth metatarsal and this also can be misdiagnosed as an avulsion fracture.

First, I would request that another radiologist review the xray and give an opinion.

It would be best to see a podiatrist for repeat x-rays which is standard practice.  It is time for a follow-up x-ray if you did have a fracture.

You can tell your insurance company if there is a misdiagnosis and your fracture doesn't heal that they will need to pay for a surgery to repair the problem and a bone stimulator.  This usually gets them to pay for another visit and xray.

Good Luck.


Sincerely,

Marc Katz, DPM

Tampa, FL
Advanced Podiatry
http://www.thetampapodiatrist.com
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