A recent essay in the New England Journal of Medicine was titled “Heart and Sole – Of Metatarsals, Meaning and Medicine.” I had to read it.
It is not often you come across a reflection on metatarsal fractures, even though they are common. I had just recovered from breaking my fifth metatarsal, the slender leg on the outside of the foot, so I was curious.
The author, Dr. Lisa Rosenbaum, a cardiologist at Brigham and Women’s Hospital, broke a fifth metatarsal while walking in Central Park. “My ankle rolled out of my shoe,” she wrote.
We both felt an intense stabbing pain. But there, Dr. Rosenbaum’s road and mine.
No, she was told, “You have a notoriously slow healing fracture.”
When I injured my foot I called an orthopedist Dr. Justin Greisberg at Columbia University Medical Center, who suggested an x-ray. He called afterwards to tell what I had broken.
The fifth metatarsal hall is a very common fracture, he said and my was not very serious. I should use crutches as needed but could do pretty much what I wanted to do.
exercise? Yes. The elliptical machine? Yes.
I knew that some things, like running, would be too scary to think about. But within a week I had gone from using crutches sometimes to not using them at all. I trained on a bow training in the gym. A week later I was back on the elliptical.
I had another X-ray one month later. Dr. Greisberg told me that I could start running again, as much as it was comfortable. So I did it. And soon I completely forgot the damage.
How did Dr. Rosenbaum? She hobbled around crutches and used a scooter, and cut her leg in one place. After a while, she broke the fifth metatarsal hall in her undamaged foot, because she continually put her weight on it.
I asked my doctor about the differences in our treatments. There are a variety of metatarsal fractures, he told me.
Most are simple, like mine, who do not require anything but patience. Some rare, like the Rosenbaum type, needed what he called “more careful care”.
And she said in an email, it needed care. “Mine was a real Jones,” she wrote. It took three months, but now it is cured.
Thing is, some doctors treat [all] these fractures conservatively.
“One of the most common other views I get in New York City is the fifth metatarsal fracture,” Dr. Greisberg said. “Patients sometimes cannot believe that many of them will heal whatever they do.”
The key is to correctly diagnose the fracture, says dr. Bruce J. Sangeorzan, an orthopedist at the University of Washington in Seattle and former president of the American Orthopedic Foot and Ankle Community.
For the unfortunate people who have the rare, difficult to heal the fracture, treatment means eight weeks not to lie down on the foot. Even with that, they can’t get better without surgery because the break is in an area that doesn’t get much blood.
But a careful diagnosis can be difficult, says Dr. J. Turner Vosseller, an orthopedist at Columbia University. The difference between a hard-to-heal fracture of the fifth metatarsal, the so-called Jones fracture and the most common fracture that mine is less than one centimeter.
“There may be some confusion as to which one, Dr. Vosseller says.
Further complicating problem is that some fractures” line up the line “between difficult and easy-to-heal, Dr. Vosseller said.
centimeter: It is the difference between going about your business and letting the fracture heal – and winding up on crutches, perhaps in a casting.
As is usually true in medicine, a second opinion never hurts.