Jones’ fractures or stress fractures of your
fifth metatarsal, where the shaft of the bone meets
the base, typically are treated in a cast for about
eight weeks. This area of your fifth metatarsal
is more difficult than others to heal, and physicians
generally prescribe crutches so you can keep all
your body weight off your foot while you wear the
cast. A short leg cast wraps around your foot, ankle,
and lower leg. Made of layers of fiberglass, it
starts below your knee and is open around your toes
to allow toe movement. Your physician rolls a thin,
elastic stocking, called a stockinette, over your
skin and then pads your leg with soft-roll bandages.
A dry layer of fiberglass is wrapped around your
leg and foot. Extra fiberglass strips are wrapped
around the sole of your foot. Additional fiberglass
layers are applied wet over the first layer. When
the short leg cast dries, it should immobilize your
foot and ankle but still allow you to move your
toes. It should be snug, but not tight. The cast
may be applied in your physician’s office
the same day as the diagnosis is made. You usually
are sent home with instructions to keep your leg
elevated when resting and to use crutches when you
need to get around.
While wearing your short leg cast for about eight
weeks after your fifth metatarsal fracture, it is
important to retain blood circulation and movement
in your toes. Wiggle your toes and pinch them to
check for numbness. Though swelling is rare, if
your toes become numb you should call your physician
to receive a new cast. It is essential to keep as
much weight as possible off your foot while wearing
your cast. The more weight you put on your foot,
the greater your chances of prolonging your healing
time. If your fifth metatarsal does not heal properly,
you are at risk of suffering complications, such
as arthritis or a chronic limp. Though everyone
heals at a slightly different pace, a typical recovery
schedule after your foot is placed in a cast may
go as follows:
Two
weeks – Return to your physician for X-rays.
If you are having any problems with your cast, such
as discomfort or numb toes, you should consult your
physician.
Four
weeks – Return for more X-rays.
Six
weeks – More X-rays of your foot are taken
and if your physician sees signs of healing, your
cast may be removed.
Eight
weeks – X-rays typically show signs of healing
and your cast is removed. Your foot may be put into
a removable brace, called a cam walker, or into
a weight bearing cast with a shoe on the bottom.
You may need to continue to use crutches as you
begin to bear weight. As pain decreases over the
next four weeks, you will become less reliant on
crutches.
Twelve
weeks – Your physician may take you out of
the brace and return you to normal shoe wear. Your
foot will be weak when it first comes out of the
brace and your physician typically teaches you basic
foot stretching exercises to perform at home.
Sixteen
weeks – With a proper stretching and strengthening
regimen, you may be able to return to sports and
activities without pain.
If your physician does not see signs of healing
in the X-rays of your foot taken at eight weeks,
you will have to decide how to proceed. Some patients
may not show signs of healing for 10 to 14 weeks.
You may opt to continue wearing the cast and using
crutches for another four weeks to see if your fifth
metatarsal heals. The other option is to undergo
surgery, which can fix your fifth metatarsal bone
in position and stimulate blood flow if your fifth
metatarsal will not heal in a cast. If your foot
heals on schedule, you ordinarily spend about four
weeks stretching and strengthening your foot and
ankle after you return to normal shoe wear.
Most people do not need formal physical therapy
to recover from a fifth metatarsal fracture treated
in a cast. As your foot heals, you slowly graduate
from the cast to the cam walker to normal shoe wear.
Before you return to normal shoe wear, your physician
usually instructs you to steadily increase your
weight bearing exercises. As pain permits, begin
with short walks eight weeks after the injury while
wearing your cam walker or walking cast. The key
is to avoid pain. Do not walk distances that cause
discomfort in your foot. As pain decreases, slowly
increase the duration of your walks. A safe way
to increase your workouts is by 10-percent increments.
For example, if you walk one mile on Saturday, continue
walking one mile for about a week, and do not go
further than 1.10 miles on the following Saturday.
If your workout causes pain, decrease its intensity
or duration. Your fracture usually takes about 12
weeks to heal before you can return to normal shoe
wear. Most patients can return to sports and activities
about 16 weeks after the injury. Test your foot
strength before returning to strenuous activities.
You should be able to run, jump, and cut side-to-side
without pain. If your foot continues to hurt, talk
with your physician before returning to activities,
as you may need further treatment.
To prevent complications after a fifth metatarsal
fracture, it is important to make stretching and
strengthening exercises part of your everyday routine.
A strong and flexible foot will be less likely to
suffer reinjury. Though it is hard to avoid accidents
that cause traumatic injuries to your foot, you
can be cautious during your training and activities
to avoid drastic increases in the duration or intensity
or your workouts. Your fifth metatarsal should heal
and return to full strength, but if you feel pain
return, especially after a period of overuse or
high intensity training, you should visit your physician
as soon as possible.
SHOES
Finding a shoe with the proper shape and support
for your foot can help prevent abnormal foot strain.
Your athletic shoes should have good shock absorption
in the heel, good flexibility, and sturdy materials
to prevent side-to-side motion. Try to minimize
the time you spend walking in unpadded dress shoes
or boots. If your physician has prescribed orthotic
inserts, you should continue to wear them in all
your shoes. Based on your activity level, shoe inserts
may wear out within six months and need to be replaced.
Two
weeks – Return to your physician for X-rays.
If you are having any problems with your cast, such
as discomfort or numb toes, you should consult your
physician.
