- X ray evaluation to decide on surgery vs conservative care.
- If surgery, protocol to be set by surgeon and not purpose of this writing.
- If conservative care chosen, some form of immobilization for 8-12 weeks is typically done based on injury (Immobilization Phase).
- During the Immobilization Phase, lower limb strengthening with some cardio should be orchestrated by a physical therapist. Even one legged stationary bike is very beneficial.
- Bone health is analyzed with dietary calcium and Vit D3, consideration of a bone density screen, and typically healthy diet.
- Transition period from cast to no cast, with or without surgery, can be very difficult. Custom orthotics with full lateral arch support very helpful. At times, extra big shoes as a transition can be purchased so added padding/accommodation can be used.
- When not using a permanent cast, 24/7 compression bandages, ice pack 15 minutes twice daily, contrast bathing each evening, as much as possible elevation, 3 times daily 10 minute self massage for desensitization and swelling reduction, and hourly pain free ankle circles are initiated.
- Weight bearing for bone mineralization, even in casts or boots, is done as early as safe (Good Pain vs Bad Pain)
- All fifth metatarsal fractures, except a few styloid process avulsion fractures, should have a Exogen Bone Stimulator for 6 months (when insurance allows).
- Follow up xrays need only be done when symptoms plateau or worsen. As long as the patient makes steady, gradual, progress, it is better to base improvement on function, not x ray or palpable tenderness.
Saturday, January 3, 2015
5th Metatarsal Fractures: General Treatment Thoughts
The top 10 initial treatments for 5th metatarsal fractures are: