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Sunday, August 18, 2019

Blogger Contact Question #3: Rehabilitation from Metatarsal Stress Fracture

Dear Dr. Blake, 
     July 2, 2019 put in walking boot for pinpoint pain/circle of swelling over  

4th metatarsal shaft. Crutches, non weight bearing with boot.

    July 12, 2019  MRI
    July 16, 2019. MRI showed increased T2 and subtle diminished T1 marrow  
signal mid 4th metatarsal. Discrete fracture line not identifiable.

    Was put non-weight bearing for 5 weeks with boot; begin adding weight on  
week 6, 25% and then one crutch for 50% week 7 to start 8/16/2019. 

    Began using Exogen 4000 Ultrasound machine; 2X daily Aug 14, 2019.  Have some  
swelling in ball of foot, goes down over night.  Is this normal to add  
weight progressively?
Dr. Blake's comment: Typically with 4th metatarsal stress fractures you do not need non weight bearing, but I will assume your doctor wanted to protect you very cautiously for some reason. The boot, if you are to bear weight must have some accommodation to protect the metatarsals with either metatarsal padding for off weighting and straight off weight padding to place weight on the 1st through 3rd metatarsals and 5th metatarsal. This takes a lot of work and time, so many facilities just off weight the patients. Yes, you want to go from non weight bearing to full weight bearing in the boot gradually, using the 0-2 pain level as a guide. You can not have more pain as you increase weight bearing. Consider doing contrast bathing each evening for a deep flush for the swelling. 

When might I possible be able to walk for recreation/health?
Dr. Blake's comment: Based on your progress, when you are 2 weeks full weight bearing in the boot, you begin a 2 week gradual weaning out of the boot. When you are 2 weeks out of the boot, and having no setbacks, you start 30 minute walks every other day, then add 10% per week. This way you gradually add more stress to the tissue and see how it responds. 
During non-weight bearing swam (no pain), rode stationary bike 30-30 minutes  
(no pain) and weightlifting on gym machines to maintain some fitness/core.
Dr. Blake's comment: Great, as much pain free cross training you can do for cardio and leg strength is wonderful. As you get out of the boot, begin metatarsal doming and some single leg stance strengthening work. A PT can advise. The bone stimulator in this case is a 3 month commitment. Good luck my friend. Rich


1 comment:

  1. Hello Dr.
    After coming out of the boot and wearing asics 2000 with orthotic shoe for 2 full days, experienced pain in the bottom of ball of my foot near 4th and 5th metarsal. Went back to boot what is occuring? And will I have to have surgery for metatarsal? OR need to progress more slowly with shoe acclimation? I did what my othro suggested but experienced pain. Little to no swelling? OTher than shoe, kept with ice, ultrasound Exogen 4000 the same?


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.