Stress Fracture Foot: Followup Visit with Xrays

Patient seen on 3/30/10 with a 10 day history of pain in his metatarsals was highlighted in post entitled: Patient Footlight#1: Possible Foot Stress Fracture. The x-ray taken above was during the follow up visit on 4/7/10. The patient was already feeling a lot better with the removable cast. Contrast bathing was initiated at the 1 hot 1 cold cycle (see the post on the secrets of contrast bathing).

The x ray shows the subtle new bone formation (just above the magnifying glass marker) seen in stress fractures. You actually never see the fracture line unless the stress fracture has turned into a full fracture. The patient was again reminded about Calcium and Vitamin D. The patient will spend 6 weeks in the cast, then begin to gradually wean out of the cast over another 2 week period.

Golden Rule of Foot:The patient must be two weeks totally pain free in the cast before the weaning process begins. No increase in pain is tolerated during the weaning process. The patient is followed every two weeks. With metatarsal stress fractures, plastic orthotic devices for a balancing function (see post on Orthotic Devices: General Principles) are normally ordered 2 weeks prior to the weaning process. This insures that the patient is walking with orthotic devices and with the foot taped with every step when out of the cast.

These orthotic devices are worn for up to 2 years in athletic/strenuous activities to prevent re-injury. This particular patient walks everywhere in San Francisco in our very hard cement jungle. Taping (to be taught in a later post) is also used with strenuous activities.

Since bones first heal, then double heal, symptoms related to increased circulation can last for many monthes after the stress fracture heals. It is important to do the contrast bathing daily, and ice after strenuous activity, until all symptoms have been gone for 2 weeks straight. The contrast bathes continue to flush out unwanted swelling and the icing minimizes the aggravation of symptoms.