Foot Fracture Often Overlooked

Main Category: Bones / Orthopaedics
Article Date: 18 May 2007 - 0:00 PDT

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Raymond Rapier wasn't like a lot of people. He knew his foot was broken.

Raymond was working on his computer one Saturday morning when his wife opened a door to step outside their North Carolina home. But she forgot their burglar alarm was activated. The siren blared, and Raymond jumped up to turn it off. His left foot slipped on the floor and shot forward under the desk. It slammed into the corner. The pain was immediate and intense.

"Darn right it hurt," the 70-year-old retiree said, ranking the pain an 11 on a scale of one to 10, comparing it to smacking your thumb with a hammer.

Raymond survived the weekend taking pain relief pills and hopping around on an old pair of crutches. Monday morning, he phoned the foot and ankle surgeon he sees for diabetes care and made an appointment. Several hours later, Raymond found himself in the Suffolk, Va. examining room of Matthew Dairman, DPM, FACFAS. Dairman diagnosed a fifth metatarsal fracture, which is a break in the long bone on the outside of the foot that connects to the little toe.

Many people break the same foot bone as Raymond but don't realize they're injured. Not all fifth metatarsal fractures are as sudden and painful as his experience. The American College of Foot and Ankle Surgeons (ACFAS) says people who feel pain on the outside of their foot should seek prompt treatment. Walking on or failing to treat a fractured fifth metatarsal can lead to complications including bone deformities, failure to heal, arthritis and chronic pain.

According to the ACFAS consumer Web site http://www.FootPhysicans.com, symptoms of a fractured fifth metatarsal include pain, swelling and tenderness, difficulty walking, and occasional bruising. Most people walk on the outside of their feet, making this metatarsal particularly vulnerable. Avulsion fractures and Jones fractures are the most common injuries to this bone.

Raymond suffered an avulsion fracture. This happens when the ankle rolls inward, as during an ankle sprain. There's a major tendon attached to the base of the metatarsal. When it's yanked hard, it doesn't tear but instead can pull a chunk of bone loose. Avulsion fractures are often overlooked when they occur with an ankle sprain.

Three days after he was diagnosed, Raymond went to a local hospital where Dairman made a small incision and inserted a screw to keep the broken section of bone stable while it heals. The procedure took 20 minutes and Raymond was in and out within two hours.

Readers of sports news often hear of an athlete having a Jones fracture, which can be caused by trauma, overuse or repetitive stress. These breaks happen in a small area of the fifth metatarsal that receives less blood supply, making it more prone to injury and slower to heal. Even something as simple as walking can cause tiny hairline breaks to gradually develop in the fifth metatarsal, along with dull or lingering pain. Eventually the small breaks in the bone grow and snap.

Pain on the outside of the foot is not normal. Anyone who has symptoms of a fifth metatarsal fracture should see a foot and ankle surgeon as soon as possible for proper diagnosis and treatment. If you cannot see a physician immediately, use rest, ice, compression and elevation to control the pain.

Raymond suffers from diabetes so his fracture will take a little longer to heal. Dairman has him wear a cast boot -- Raymond calls it his "space boot" -- and recommends he avoid walking. But he can still drive.

"Fortunately it was my left foot and not my right foot," Raymond says, "And my vehicle's an automatic."

The American College of Foot and Ankle Surgeons (ACFAS) is a professional society of more than 6,000 foot and ankle surgeons. Founded in 1942, the College's mission is to promote research and provide continuing education for the foot and ankle surgical specialty, and to educate the general public on foot health and conditions of the foot and ankle through its consumer website, http://www.footphysicians.com.

American College of Foot and Ankle Surgeons
http://www.footphysicians.com