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Tuesday, July 12, 2011

Email Regarding Good vs Bad Pain (Weaning off Crutches after Foot Fracture)

Brooke broke her right fifth metarsal on 6/16/11 and was placed on crutches and a removable boot with accommodation. My initial visit was 6/22/11 and followup on 7/6/11 now 4 days ago.On the 7/6 visit, I discussed with Brooke trying to wean off the crutches with the full protection of the removable boot.

Base of 5th Met Fx

Hi Dr. Blake, I was in last Wed. when you got me started walking without my crutches. All has been going really well until today  (7/9/11) when I woke up with soreness at the site of the break.

Yesterday I tried wearing a Superfeet insole that I had on hand in my boot, and I'm wondering if this is what caused the pain. Or maybe I just overdid it and walked too much yesterday. I was on my feet for a couple hours straight in the afternoon.

It's not sharp pain. I would describe it as slight tenderness when I put weight on it. Probably pain level is around 1.5-2 out of 10. So not really bad, but definitely more than I've had in the last week (which has been 0). Do you think I should stay off if it completely and go back to the crutches for a day or two? Is this amount of pain OK? Can I keep walking on it without crutches?
Dr Blake's Note: Her pain level is less than the restrictions she prescribes needs. However, I find patients are very protective since they want do have no setbacks.I am not wearing the insole today.
Thanks so much for your help!


Here is my response to Brooke. 
Brooke, Hope you don't mind I put your question on my blog this week. Of course no names, but I get this question all the time. Hopefully, you have read the post on good and bad pain, but when it comes to yourself, logic and reality sometimes do not match. It is hard to stay objective with your own body. Definitely level 2 is good pain, even if it is in the fracture area (weakest link in the chain right now). I find people over protective, which is okay because we have to feel good with what is going on as we Listen To Our Bodies. It would be fine to slow down the no crutches by at least bringing them with you for the next several days, or go back on them for a few hours after the pain (but not 2 days back on the crutches with only level 2 pain). Not sure of the role of the Superfeet, but if you feel pain again, take it out, and see if the pain dissipates. Experiment. If the pain increases over the next several days, then we know we have to slow down and go back on the crutches. See yesterday's post on Activity and Pain Scale Log and consider doing one yourself and emailing me. Hope this helps. Rich
Here is Brooke's response on 7/12/11
Hi Dr. Blake, this is very helpful. Thank you. I did read your post on Good vs. Bad Pain. It makes sense, although at the time I read it I wasn't totally sure how it applied to me since I'm not an athlete and my pain isn't happening because of working out. I reread it, and I guess just putting weight on it and walking counts as my work out these days. What you say about sharp pain versus soreness makes sense, and I don't have sharp pain. My pain didn't disapate after a day, but I'll keep an eye on it and consider tracking it.

thanks so much for your response. I'm very eager to be done with these crutches!

By all means, use this for your blog!

Base of 5th Met Fracture Side View

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.