Metatarsal Fractures: Surgery vs. Non-Surgical Recovery

Second metatarsal fracture

I sustained a metatarsal fracture on June 5th when a heavy object fell on my foot and was sent to the emergency room.
I would like to know if this is considered a displaced fracture.
The doctor removed the cast after three days and suggested whether I should undergo surgery or use a brace for stabilization.
I am currently not planning to have surgery; I can walk a little, but bending my foot causes pain.
Is surgery necessary? If I do not have surgery, how long will the recovery period be until I return to normal? Will there be any long-term complications if I do not have surgery? After recovery, will I be able to walk normally and go up and down hills without pain?

Xiao Di, 20~29 year old female. Ask Date: 2023/06/16

Dr. Chen Yongxue reply Orthopedics

1.
It is important to consider whether to undergo surgical intervention or to use a brace for stabilizing the fracture.
This decision can facilitate the healing process.
Surgical intervention involves internal fixation, which allows for realignment of the fracture, while using a brace is a simpler method of stabilization but does not allow for realignment, potentially prolonging the healing time.
2.
You may be able to move around slightly, but if you experience pain when bending your foot, please use crutches and avoid putting weight on the affected limb.
3.
After recovery, you should be able to walk at a normal pace up and down hills without pain.
However, approximately 40% of individuals may experience lingering soreness after a fracture, which is not determined by whether surgery was performed.
The recovery time typically requires about three months, and it is essential to avoid weight-bearing activities to ensure proper healing.

Reply Date: 2023/06/16

More Info

Metatarsal fractures are common injuries, especially in individuals who experience trauma to the foot, such as being crushed by a heavy object. Your situation, where you sustained a metatarsal fracture on June 5th, raises several important considerations regarding treatment options and recovery.

Understanding Metatarsal Fractures
Metatarsal fractures can be classified as either displaced (with misalignment) or non-displaced (where the bone remains in alignment). The decision to pursue surgical intervention often depends on the type of fracture, the degree of displacement, and the specific metatarsal involved. If your fracture is non-displaced, conservative treatment methods, such as immobilization with a cast or a walking boot, are typically sufficient. However, if the fracture is displaced, surgery may be necessary to realign the bones and ensure proper healing.

Surgical vs. Non-Surgical Treatment
1. Non-Surgical Treatment:
- If your doctor has recommended conservative treatment, it usually involves immobilization with a cast or a boot for several weeks. This allows the bone to heal naturally. Non-surgical treatment is often preferred for non-displaced fractures, as it minimizes the risks associated with surgery, such as infection and complications from anesthesia.

- The recovery period for non-surgical treatment can vary but typically ranges from 6 to 8 weeks, depending on the fracture's severity and your overall health. During this time, you may be advised to avoid putting weight on the affected foot, gradually increasing activity as pain decreases.

2. Surgical Treatment:
- If surgery is indicated, it usually involves the use of screws, plates, or pins to stabilize the fracture. This option is often considered for displaced fractures or those that do not heal properly with conservative treatment.

- Surgical recovery may take longer, and rehabilitation will be necessary to regain strength and mobility.

Recovery and Potential Complications
- Recovery Timeline: If you opt for non-surgical treatment, you can expect to start walking with a supportive device within a few weeks, but full recovery may take several months. Pain during movement, especially when bending the foot, is common initially and should gradually decrease as healing progresses.

- Long-Term Outcomes: Most individuals who undergo appropriate treatment for metatarsal fractures can return to normal activities, including walking and running, without pain. However, some may experience lingering discomfort or stiffness, particularly if the fracture was severe or if there were complications during healing.

- Potential Complications: Non-surgical treatment can lead to complications such as malunion (healing in an incorrect position) or delayed union (slow healing). These issues can result in chronic pain or instability in the foot, which may necessitate surgical intervention later.

Recommendations
Given your current situation, it is essential to follow your doctor's advice closely. If you are experiencing significant pain while attempting to walk or if the fracture appears to be misaligned, it may be worth discussing the possibility of surgery with your orthopedic specialist. Regular follow-up appointments are crucial to monitor the healing process and adjust your treatment plan as necessary.

In summary, whether to proceed with surgery or continue with conservative treatment depends on the specifics of your fracture. If you choose non-surgical treatment, be patient and adhere to your rehabilitation plan to maximize your chances of a full recovery. Always consult with your healthcare provider for personalized advice tailored to your specific injury and circumstances.

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