Question
Thirteen weeks ago i fell walking out our front door (eight months pregnant at the time).  I broke my left cuboid (microfracture) and my right first cuneiform (transverse fracture).  The fractures were not diagnosed until three weeks after i fell.  I began to wear air casts on the right foot, and stayed in a wheelchair.  Ten weeks after the fall i had a follow up MRI.  The left foot healed.  The right foot was still showing bone contusions to the 1st metatarsal and big toe joint, as well as a microfracture of the first cuneiform.  Three weeks later i had delivered my child and followed up about my foot.  They hard casted it.

Before the hard cast i had little pain in my foot, usually only if the break was touched with some pressure.  Inside this hard cast i have intense pain on that bone and all the way into my big toe.

Is it normal to have more pain after a hard cast is applied?  Has this hard cast done damage to the healing of that bone?  Should i wait it out or have it taken off asap and go back to the air cast?  

Do i really need a hard cast or will this heal in the same amount of time in an air cast?  This is an important question because with the air cast i can be up on my feet a small amount with a walker.  with the hard cast i can't even stand up.  I need to be up and moving a small amount right now since i am post surgery.


Answer
Hi Heather,

It is difficult to know what type of cast you need since all fractures are not created equal.  Either type of cast may be sufficient, however, if a hard cast is painful then it needs to be removed.  It may be poorly positioned or could be too tight or rubbing on a bony prominence.  So, I would have it removed and your foot evaluated.  Generally, if the fracture is severe or has the potential to be unstable, a hard cast is better if properly applied.

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
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