Fifth Metatarsal Fractures: Recovery and Rehabilitation Tips

Q: Fifth Metatarsal Fractures: Recovery and Rehabilitation Tips

Hello： It is fine to remove the protective gear while sleeping since there is no weight-bearing involved. <br>If there is only one pin securing the radiated area, the risk is minimal as long as you avoid weight-bearing activities. <br>The stitches should be removed after two week

Fracture of the fifth metatarsal with comminution?

Hello Doctor: On March 17, 2018, I had a misstep and underwent an X-ray examination at the outpatient clinic, which confirmed a comminuted fracture of the fifth metatarsal in my right foot.
On March 21, I had surgery at the hospital where they inserted a health insurance-approved steel pin.
I am currently using a removable brace.
May I remove the brace while sleeping? Is there a higher risk of rotational displacement with the steel pin? How long will it take to remove the stitches? Currently, I have one stitch on the sole of my foot and over ten stitches on the dorsum.
What rehabilitation exercises can I do one week post-surgery? I am very concerned that the muscles in my healthy right foot will atrophy or that improper weight-bearing on my left foot may injure my knee.
I am currently using a brace and walking with my right heel and a crutch.
Will this affect the recovery of the fracture? How long until the pin can be removed? Thank you for your patience in reading this!

Xiao Ting, 30~39 year old female. Ask Date: 2018/03/23

Dr. Wang Shouji reply Orthopedics

Hello: It is fine to remove the protective gear while sleeping since there is no weight-bearing involved.
If there is only one pin securing the radiated area, the risk is minimal as long as you avoid weight-bearing activities.
The stitches should be removed after two weeks, and as long as you use crutches for walking and perform leg lifting exercises, it should not lead to muscle atrophy, and most of the function will likely return to normal.

Reply Date: 2018/03/23

More Info

Fifth metatarsal fractures are common injuries, particularly among athletes and individuals who engage in high-impact activities. Your situation, involving a comminuted fracture of the fifth metatarsal that required surgical intervention with the placement of a screw, is significant and requires careful management for optimal recovery.

Recovery and Rehabilitation Tips
1. Post-Surgical Care: After surgery, it is crucial to follow your orthopedic surgeon's instructions regarding the use of protective devices. Generally, it is advisable to wear the protective boot or brace at all times, including during sleep, especially in the early stages of recovery. This helps to immobilize the foot and prevent any unintended movements that could disrupt the healing process. However, if your doctor has specifically advised you that it is safe to remove the boot while sleeping, you may do so, but ensure that you are in a safe environment where you won't accidentally put weight on the injured foot.

2. Concerns about Screw Migration: The concern about the screw causing rotational displacement is valid, but modern surgical techniques and materials are designed to minimize such risks. The screw should remain stable as long as you adhere to weight-bearing restrictions and follow your rehabilitation protocol.

3. Suture Removal: The timeline for suture removal typically ranges from 10 to 14 days post-surgery, depending on the surgeon's assessment of the wound healing. Your doctor will provide specific guidance based on your individual healing progress.

4. Rehabilitation Timeline: After one week post-surgery, you can begin gentle rehabilitation exercises, focusing on maintaining mobility in the ankle and toes. These may include:
- Range of Motion Exercises: Gently moving your toes and ankle within a pain-free range to prevent stiffness.

- Isometric Exercises: Engaging the muscles of the foot and leg without moving the joint to maintain muscle tone.

- Non-weight-bearing Activities: If cleared by your physician, you can perform exercises that do not put weight on the foot, such as seated leg lifts.

5. Preventing Muscle Atrophy: To prevent muscle atrophy in the right leg, you can perform upper body exercises and engage the left leg in non-weight-bearing activities. Consider consulting a physical therapist who can provide a tailored rehabilitation program that addresses your concerns about muscle loss and knee stability.

6. Weight-Bearing Activities: As for using crutches, it is essential to follow your doctor's advice regarding weight-bearing status. Initially, you should avoid putting weight on the injured foot. Gradually, as healing progresses, your doctor will guide you on when you can start partial weight-bearing and eventually full weight-bearing activities.

7. Timeline for Screw Removal: The screw is typically left in place unless it causes discomfort or complications. Many patients retain the screw indefinitely without issues, but your surgeon will assess the need for removal based on your recovery progress.

Additional Considerations
- Pain Management: Ensure you manage pain effectively, as this can influence your ability to engage in rehabilitation exercises. If you have allergies to NSAIDs, discuss alternative pain management strategies with your healthcare provider.

- Monitoring for Complications: Watch for signs of complications such as increased swelling, redness, warmth, or discharge from the surgical site, as these may indicate infection or other issues requiring prompt medical attention.

- Follow-Up Appointments: Regular follow-up appointments with your orthopedic surgeon are crucial to monitor the healing process and adjust your rehabilitation plan as necessary.

In conclusion, while the recovery from a fifth metatarsal fracture can be challenging, adhering to your rehabilitation protocol and maintaining communication with your healthcare team will significantly enhance your chances of a successful recovery. Always consult your surgeon or physical therapist before making any changes to your rehabilitation plan.

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