Foot Fractures: Healing Progress and Walking Advice

The third metatarsal has noticeable cracks even after a month, but the doctor says it's okay to walk?

Hello Doctor, I consulted you about a month ago regarding my ability to walk.
I was involved in a motorcycle accident where my own motorcycle ran over my foot, resulting in fractures in the second, third, and fourth metatarsals.
The attending physician said that I did not need a cast or surgery.
After a month, I decided to get an X-ray to check the healing progress.
It has now been one month and two days since the incident.
After the X-ray yesterday, I took a quick look at the images.
The previous doctor mentioned three fractures, but this time I noticed that only the middle metatarsal has a clear fracture, while the others are not visible anymore.
When I first got injured and had the X-ray, I didn’t understand much, so I only heard about the fractures from the doctor, and I am not sure how large each fracture was.
The current doctor, who is different from the last one, said that based on the X-ray, only the middle metatarsal has a significant fracture.
I asked him if that meant I still couldn’t walk, and he told me that I could start to put some weight on it.
I would like to ask you, Doctor:
1.
Is it possible that after initially being told there were three fractures, two of them could heal completely in a month, leaving only one with a fracture?
2.
Since I can still see a clear fracture on the X-ray, does that mean the third metatarsal hasn’t healed at all this month? Otherwise, why would the other fractures disappear while this one remains?
3.
If there are still fractures, why did the doctor say I could start putting weight on it? Does this mean I can walk now? Will this not create a burden on the healing process and increase the risk of displacement later?
4.
When can I try to walk normally? I am concerned that repeated X-rays might expose me to excessive radiation.
5.
Currently, when I slightly put my foot down, it immediately turns purple and red, but it returns to normal when elevated.
I am using a compression bandage and crutches to slowly move my foot, but I am afraid to put full weight on it.
Is this approach correct?
6.
Does the doctor recommend heat therapy? How can I improve the swelling and discoloration when I put my foot down?
I apologize for the lengthy message and the numerous questions.
Thank you for your help.

Ting, 20~29 year old female. Ask Date: 2016/07/09

Dr. Shi Guozheng reply Orthopedics

Fractures of the foot, such as metatarsal fractures, typically begin to form primary callus about one month after the injury, providing some stability and reducing the likelihood of displacement at the fracture site.
After one to two months, the callus undergoes calcification, and the fracture line may become less visible.
If the fracture was non-displaced initially, the fracture line may disappear more quickly.
The bone is rich in blood vessels, and the circulation is interrupted following a fracture.
It takes time for the blood vessels to reconnect as the fracture heals, which is why swelling occurs when the foot is placed down; this is a normal response due to impaired circulation.
Elevating the foot or performing foot exercises can improve circulation and help reduce swelling.

Reply Date: 2016/07/09

More Info

Understanding foot fractures, particularly in the context of your situation, requires a nuanced approach. Based on your description, it seems you have sustained fractures in the second, third, and fourth metatarsals of your foot due to a motorcycle accident. The healing process for fractures can vary significantly depending on several factors, including the type of fracture, the location, and individual healing responses.

1. Healing Progress: It is indeed possible for some fractures to heal faster than others. The fact that two of your metatarsal fractures are no longer visible on the X-ray could indicate that they have healed sufficiently, while the middle one remains fractured. This can happen because different bones have different healing capacities, and the stress placed on them can also affect healing rates. The body’s natural healing process can lead to the absorption of the fracture line in some bones while others may take longer to heal.

2. Assessment of Fractures: The presence of a visible fracture line on the X-ray indicates that the bone has not yet healed completely. However, the absence of visible fractures in the other two bones does not necessarily mean they have not healed; it may simply mean that they have healed well enough that the fracture line is no longer discernible. It is essential to rely on your physician's assessment and the X-ray findings to determine the status of your fractures.

3. Weight Bearing and Walking: When your doctor advises that you can "put some weight" on your foot, it typically means that you can begin to gradually increase your activity level. However, this should be done cautiously. The risk of re-injury or delayed healing is present if too much weight is applied too soon. It is crucial to follow your doctor's guidance closely and to communicate any discomfort or unusual symptoms you experience while attempting to walk.

4. Timeline for Normal Walking: The timeline for returning to normal walking varies widely among individuals. Generally, if the fractures are healing well, you may be able to start walking without crutches within a few weeks to a couple of months post-injury. Regular follow-up appointments and X-rays will help monitor your healing progress.

5. Managing Swelling and Discoloration: The swelling and discoloration you experience when placing weight on your foot are common after a fracture. Elevating your foot can help reduce swelling, and using ice packs may also alleviate discomfort. It is essential to avoid prolonged periods of weight-bearing if it causes significant swelling or pain. Your current approach of using crutches and gradually introducing weight is appropriate.

6. Heat Application: Heat therapy can be beneficial for muscle relaxation and pain relief, but it should be used cautiously. If you notice increased swelling or discomfort after applying heat, it may be better to stick with cold therapy. Always consult your doctor before starting any new treatment modalities.

In conclusion, while it is encouraging that you are seeing some healing, it is vital to proceed with caution. Follow your doctor's recommendations, and do not hesitate to reach out for further clarification or assistance if you have concerns about your recovery. Regular monitoring and communication with your healthcare provider will be key to ensuring a safe and effective healing process.

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