Fifth Metatarsal Fractures: Symptoms and Recovery Concerns

Fifth metatarsal bone

Hello, Doctor.
I fractured the metatarsal bone in my left foot 14 days ago and had it casted up to my calf.
Initially, I didn't experience much discomfort and didn't elevate my leg regularly (which I now realize was a big mistake).
The swelling was not significant.
However, in the past few days, whenever my foot touches the ground, my toes immediately turn red and feel prickly, as if blood is rushing down.
When I lie down and elevate my foot, I feel that the blood return is very slow, and my toes still feel numb and prickly (but there is no swelling).
My thigh and calf also hurt, even when lying down.
I have a sensation of warmth in my thigh.
Overall, I feel extremely distressed.
I have a pre-existing issue with varicose veins and usually wear compression stockings, but I can't wear them now, which makes me feel that blood flow is not smooth.
I have been mostly bedridden.
A few days ago, I had a follow-up appointment, and the X-ray showed that the bone is healing, but the issues mentioned above were not as severe at that time.
Since I have to wait another two weeks for my next appointment, I am very worried and uncomfortable, so I am asking here.

1.
Is this a normal phenomenon? If the blood return continues to be poor until the cast is removed, could there be issues with circulation in my foot, potentially leading to venous thrombosis or other serious problems?
2.
How can I determine if the cast is too tight? There is still localized tenderness.
Would re-casting resolve the blood return issue? Thank you.

Anna, 50~59 year old female. Ask Date: 2020/09/06

Dr. Chen Bochen reply Orthopedics

1.
Is this a normal phenomenon? If the circulation is not smooth and persists until the cast is removed, will there be issues with the foot's circulation, potentially leading to venous thrombosis or other serious problems? >> When not walking, perform more "ankle pump exercises" (see attached image below).

2.
How can I determine if the cast is too tight? There is still localized tenderness.
Can reapplying the cast resolve the circulation issue? Thank you.
>> You are the best judge of whether it is too tight; if you feel persistent swelling or even numbness and tingling, it is likely too tight.
If this occurs, consider using an "inflatable protective boot." Wishing you a speedy recovery.

Reply Date: 2020/09/06

More Info

Fifth metatarsal fractures can be quite concerning, especially when accompanied by symptoms like pain, swelling, and circulation issues. Based on your description, it seems you are experiencing a combination of symptoms that may require careful evaluation and management.

1. Normalcy of Symptoms: The symptoms you are experiencing, such as redness and a tingling sensation in your toes when your foot is on the ground, can be indicative of several issues. While some discomfort is expected after a fracture, the fact that you are experiencing significant pain, especially with a sensation of blood pooling or slow return when elevated, raises concerns. Given your history of varicose veins, it is crucial to monitor your symptoms closely. While some degree of swelling and discomfort can be normal, persistent or worsening symptoms could indicate complications such as impaired circulation or even the risk of a deep vein thrombosis (DVT), especially if you are largely immobile.

2. Circulation Concerns: If the blood flow does not improve or if you notice increasing pain, warmth, or swelling in your thigh or calf, it is essential to seek medical attention promptly. These could be signs of a more serious condition, such as a DVT, which can lead to pulmonary embolism if a clot dislodges and travels to the lungs. The fact that you have a history of varicose veins makes you more susceptible to circulatory issues, so it is vital to keep your healthcare provider informed of any changes in your symptoms.

3. Assessing the Cast: To determine if your cast is too tight, look for signs such as increased pain, numbness, tingling, or a change in color (like excessive redness) in the toes. If you experience persistent pain at the site of the fracture or if the area feels excessively tight, it may be necessary to have the cast evaluated. A healthcare professional can assess whether the cast is constricting blood flow or causing undue pressure on the surrounding tissues. If the cast is indeed too tight, a cast change may alleviate some of the symptoms you are experiencing.

4. Managing Symptoms: While waiting for your next appointment, you can take some steps to help manage your symptoms. Keeping your leg elevated as much as possible can help reduce swelling and improve circulation. If you are able, gently moving your toes and foot can also promote blood flow. However, avoid any movements that cause pain or discomfort. If you have access to a healthcare provider, consider discussing the possibility of using a compression wrap or stocking that can accommodate your injury while still providing some support to your veins.

5. Follow-Up Care: It is crucial to maintain regular follow-up appointments to monitor the healing process of your fracture. If your symptoms worsen before your next appointment, do not hesitate to seek immediate medical attention. Your healthcare provider may want to perform imaging studies or other evaluations to ensure that your fracture is healing properly and that there are no complications related to circulation.

In summary, while some discomfort is expected after a fifth metatarsal fracture, the symptoms you describe warrant careful monitoring. It is essential to communicate openly with your healthcare provider about your symptoms and any concerns you have regarding circulation and pain management. Early intervention can prevent complications and ensure a smoother recovery process.

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