Metatarsal Fractures: Symptoms, Recovery, and Rehabilitation

Fractures of the second, third, and fourth metatarsals?

Hello Doctor: On June 7, I went canyoning with friends and unfortunately sustained linear fractures in the second, third, and fourth metatarsals of my left foot! The pain was unbearable that day, but the doctor said surgery was not necessary and that I only needed to have it wrapped in a cast! The next day, June 8, I woke up completely pain-free! On June 11, during a follow-up visit, the cast was removed, and my foot was swollen, so now it is wrapped in a fiberglass cast.

Question 1: Starting around June 16, I have been experiencing pain when pressing on the gastrocnemius muscle area of my left calf! I do not feel any pain when my body and foot are parallel or when I lift my leg! However, as soon as I lower my foot to stand, there is a sharp pain that radiates to the sole of my foot! Could this be due to the fracture?
Question 2: Sometimes I jump on my right foot while the injured foot is off the ground.
Will this affect the fracture site?
Question 3: Recently, I have tried to move my toes, and when I point my big toe down, there is a bone that pushes against the cast, causing slight pain.

Question 4: I would like to know how long it will take to heal and if I need to undergo rehabilitation.
Thank you!

Yu, 30~39 year old female. Ask Date: 2020/06/20

Dr. Shi Guozheng reply Orthopedics

1.
It is indeed caused by a fracture.
2.
There will be no impact.
3.
When the toes move, it can affect the tendons, which in turn can influence the area of the fracture.
4.
It will heal in approximately two months.

Reply Date: 2020/06/20

More Info

Metatarsal fractures, particularly linear fractures of the second, third, and fourth metatarsals, can significantly impact mobility and daily activities. Your experience following the injury, including the initial pain, the subsequent relief after immobilization, and the swelling upon removal of the cast, is quite common. Let's address your questions one by one, while also providing a broader understanding of metatarsal fractures, their symptoms, recovery, and rehabilitation.

Understanding Metatarsal Fractures
Metatarsal fractures are often caused by trauma, such as a fall or a direct blow to the foot, and can also occur from repetitive stress. Symptoms typically include pain, swelling, bruising, and difficulty bearing weight on the affected foot. In your case, the initial pain you experienced was likely due to the fracture itself, while the relief you felt after immobilization is a positive sign that the fracture is being stabilized.

Addressing Your Questions
1. Pain in the Gastrocnemius Muscle: The pain you are experiencing in the gastrocnemius (calf) muscle when pressing on it could be due to several factors. After a foot injury, the body often compensates by altering movement patterns, which can lead to muscle strain or discomfort in the calf. Additionally, prolonged immobilization can lead to muscle stiffness and discomfort. If the pain persists or worsens, it would be wise to consult your physician to rule out any complications.

2. Jumping on the Right Foot: Engaging in activities like jumping on your uninjured foot can place additional stress on the injured metatarsals, especially if you are not yet fully healed. While it is important to maintain some level of activity to prevent stiffness, high-impact activities should be avoided until your doctor gives you the green light. This is crucial to ensure that the fracture heals properly without further injury.

3. Pain When Moving Toes: The discomfort you feel when moving your toes, particularly if you notice a bone pushing against the cast, indicates that you may need to adjust the cast or your position. It’s essential to communicate this to your healthcare provider, as they may need to reassess the fit of your cast or consider other interventions to alleviate pressure.

4. Recovery Timeline and Rehabilitation: The recovery time for metatarsal fractures can vary widely based on the severity of the fracture and individual healing rates. Generally, it may take anywhere from 6 to 8 weeks for a metatarsal fracture to heal adequately. During this time, rehabilitation is crucial. Once the cast is removed, physical therapy can help restore strength, flexibility, and range of motion to the foot. Rehabilitation exercises may include gentle range-of-motion activities, strengthening exercises, and gradual weight-bearing activities as tolerated.

Rehabilitation Importance
Rehabilitation is essential for a full recovery after a metatarsal fracture. It helps prevent complications such as stiffness, muscle atrophy, and loss of function. A physical therapist can guide you through a tailored rehabilitation program that focuses on:
- Range of Motion: Gentle movements to regain flexibility in the foot and ankle.

- Strengthening Exercises: Gradually increasing resistance to build strength in the foot and surrounding muscles.

- Balance and Proprioception: Exercises to improve stability and coordination, which are crucial for returning to activities like sports.

Conclusion
In summary, while your initial recovery seems promising, it is vital to monitor any pain or discomfort closely and communicate with your healthcare provider. Engaging in appropriate rehabilitation exercises will be key to ensuring a complete recovery and returning to your normal activities. Always follow your physician's advice regarding activity levels and rehabilitation to avoid setbacks in your healing process.

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