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walking again after metatarsal fractures

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Hi there. Six weeks ago, I jumped down onto concrete, my left ankle rolled, and I landed full weight on the top left side of my left foot. My fifth metatarsal was fractured--it wasn't a Jones fracture, and no surgery was needed. My fourth metatarsal also sustained a hairline fracture. I didn't get a cast because I had a pretty bad superficial scrape where my skin met the concrete, and my orthopedist was worried we wouldn't be able to monitor for infection if they did that.

So I was sent home with a walking boot under orders not to walk--NWB for 6 weeks. I checked back in after a week and everything looked good on the xray: there was no further fracturing and there was no displacement. For the last 4 weeks I've been completely off the foot, keeping it elevated, trying to eat well, rest, etc. I don't smoke, never have.

So I had my 6 week check up and xrays--the doctor said everything looks excellent. My scrape is healed, the fourth metatarsal fracture can barely be seen now, and the fifth metatarsal fracture has begun to close up. There is still some fracture towards the outer edge of the bone, but she said she's confident the bone isn't going anywhere and it's okay to start putting full weight on it at this point. So I can walk on it, only in the boot, for the next 2 weeks and then she says we can move to regular shoes. I have full range of motion in my ankle and toes, and she said she wants me to walk on it and put full weight on it now because this will stimulate more bone healing.

I'm actually not really what I'd call "walking" just yet--I'm using the crutches to support me as I go, and I'm putting as much weight on it as I can. Basically, I feel like I need to build up to actual, real walking. She acted like I should just walk out of the office, but I know the muscles in my leg and foot have atrophied, and want to take it slow and easy. I'm fine with working through whatever I need to to rehab them. I go back to work in about 3 weeks, so I want to make sure I'm as physically able bodied as possible. Here's my question (finally):

When I walk (and I've only been back on it for 2 days now), the area at the base of my 4th metatarsal (where the hairline fracture was) really aches. It's not a sharp, shooting pain, but it's really achy. It's not fun to walk on. So I'm worried I'm hurting it further by putting full weight on it. Everything else seems to be starting to work again--the balls of my foot and heel really hurt, but I can tell they're starting to get used to pressure again. It's really just that one area that's scaring me a bit because of the achiness when I walk on it. Is that normal? I've never broken any bones before, so I'm not really sure what to expect as I work to get back to "normal."

Thanks so much for any help or insight.
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replied July 4th, 2013
Especially eHealthy

Yes, it is very common for the area around the fractures to ache when first putting weight on the foot.

And the heel and sole of the foot also will have some burning pain when first pressure it put on them. They have to get used to the pressure again, but it usually only takes a little time.

You have to understand that when a bone is fractured, that is not the only injury. All of the soft tissues around the fracture are also injured. So, the muscles, periosteum, fascia, are all torn and ripped apart. They also have to heal. And many heal with scar tissue. This takes a long time to get used to the weight bearing again. But, it will come around.

The weight bearing will stimulate the bone to fully heal. This is known as Wolff's Law (bone will respond to the stresses applied to it). But, it is okay to use your crutches as you advance your weight bearing. You may want to transition to a cane. Use the cane in the hand opposite the injury. That way you maintain proper gait mechanics and arm swing.

But, it sounds like you are progressing well.

Good luck.
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replied February 10th, 2014
4th metatarsal stress fracture (3x and now surgury)
I had a stress fracture about 9 months ago in my 4th metatarsal, the xray showed some bone still joined so they put me in a cast for 6 weeks then i slowly returned to rugby, after about 5 months it happened again, cracked worse this time. again they put me in an aircast for 6 weeks, then told me it was healed so i went back to slow training but it didnt feel right, i had my comeback game a futher 8 weeks after the doctor told me i could go back playing, in the warm up.... it happened again. i was devastated thinking that my career was over. absolutely gutted. so, back in to the hospital, we went private this time as my father has completely had enough and at 23 years old i shouldnt be having these problems, i take my rugby very seriously and still striving to play at the highest level i can. so all of this was quite depressing. We now have the best orthopedic surgeon in south wales looking at it, my CT scan showed a clean break which would never of healed without surgery. he said he is going to need to take a bone graft from my hip, put it between the break as the bone sealed it self off and basically stopped healing.... and then either pin it or plate it depending on how it looks. he thinks im very unlucky, but hopefully will have the operation on thursday and then can start rehab. But overall it has basically written me out of work (estate agent) and out of any kind of sport for almost 9 months.... hopefully I can get it sorted for good this time. apparently the bone will actually heal stronger ones the operation and recovery is complete.


has anybody had anything similar or can relate? give advice?

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replied February 12th, 2014
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Imperial1000 - Wow, I can’t imagine how torn you are about the re-occurring breaks experienced! I know rugby is a really rough sport. So the doctor was ok with you returning so soon? Being such a combative type sport, seems to me a potential for problems? I’m only going off of my injury! I’ve been trying desperately to return to riding (quad) and I’m simply not able to yet, and this is nothing like the sport you play!

I know how devastating it is when you can’t do something you have such a passion for and love! I have been down for 9 months, and has been killing me. My passion is riding my quad, and my snowmobile, and during the summer wakeboarding. I am just now getting to the point of walking ok (with a limp). I have an intense rehab program I started 3.5 weeks ago, and since then I am finally starting to see the light! Tired of not being able to do anything, so this will hopefully get me back on my feet, and get my leg strengthened in order to get me ready for riding.

Nice how you have a top orthopedic surgeon. From what I’ve heard the whole “public” doctor thing in the UK, leads to further problems, or doesn’t get the imminent problem addressed correctly, because of the public health system??????? Anyway, this is certainly good news for you!

I do have to say, I’m glad I got the care from my orthopedic surgeon that I did. I happened to luck out when I got him. My boyfriend’s son had wrecked two months before me and had him do the surgery on his knee. Well he happened to be the surgeon on call when I came to the emergency room! I absolutely love him, and love his support towards my injuries.

The one thing I can offer for advice is “be patient!” This is extremely difficult for me, and most people! I have moments where I want to throw a tantrum like a two-year old, because I feel trapped; caged-up like a wild animal, and I HATE IT! When I start feeling this way, I have to realize it won’t’ do me, or my leg any good to get stressed out! Body doesn’t like stress at all! I try to live ‘one-day-at-a-time.” It’s really the only way. Physical therapy, is a must as you know, and might I add… Vitamin D Supplement with 1250%, and calcium. I truly believe this has helped my breaks heal so well! Now, If I could only find something to help with all the torn tendons, muscles, tissues, etc. =-)

I wish you the best, and hope for a quick recovery!!! Take Care

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