Foot metatarsal injury?

[Chongalulu]

twisted my ankle descending stairs yesterday and now almost impossible to put weight on the foot . It wasn't too bad for a while after the incident but I went swimming with fins (flippers) later which may have aggravated it. Not much swelled or pain until I put weight on it then a sharp pain on the top and outside of the foot. I'm suspecting metatarsal injury and think I'd better get an X-ray as is no better this morning. I'm on holiday in kanhom (live in korat) just now where there is a government hospital I think. I self insure so wonder if kanhom is my best bet or any better private hospitals you can recommend in Donsak or next stop is Surhattani.

Grateful for early advice as on my way to Kanhom in a short while to check out hospital there.n

[Kalbo]

My suggestion would be to go have it x-rayed to get a definitive diagnosis. You may have the dreaded 'Jones Fracture'

[Chongalulu]

My suggestion would be to go have it x-rayed to get a definitive diagnosis. You may have the dreaded 'Jones Fracture'

In Kanhom hospital now awaiting doctor. "Jones fracture? " what's that?

[Sheryl]

In small upcountry places government hospitals are always the best bet.

A Jones fracture is a specific type of metarsal fracture occurring in a precise small area of the fifth metarasal. Do not worry about that at this stage, just ghet your xray and see if there is a fracture and if so where.

[Chongalulu]

In small upcountry places government hospitals are always the best bet.

A Jones fracture is a specific type of metarsal fracture occurring in a precise small area of the fifth metarasal. Do not worry about that at this stage, just ghet your xray and see if there is a fracture and if so where.

Just had the X-ray,at first doctor said it wasn't clear but after rechecking he said there was a fracture on fifth metatarsal so I'm about to have a half cast, on table now! I have noticed slight numbness on couple of toes so presumably he's made correct diagnosis? I had seen on Internet plastic casts but they don't have them here. I'm presuming I should have the cast done to immobilise it but is it possible anywhere to get hold of plastic cast to fit at later date. Any other suggestions very welcome

[Sheryl]

I have not seen plastic casts in use in Thailand.

Fifth metatarsal fractures can sometimes be treated with just a special shoe or cast boot, but it does depend on where exactly the fracture is and the alignment of the bones, as well as whether any torn ligaments.

If you have the Xray report, please put here what it says re the location of the fracture (I know 5th metatarsal, but it should say something more like "avulsion" or "diaphysis". )

[Chongalulu]

I have not seen plastic casts in use in Thailand.

Fifth metatarsal fractures can sometimes be treated with just a special shoe or cast boot, but it does depend on where exactly the fracture is and the alignment of the bones, as well as whether any torn ligaments.

If you have the Xray report, please put here what it says re the location of the fracture (I know 5th metatarsal, but it should say something more like "avulsion" or "diaphysis". )

Can't see specific reference other than non displacement and his writing is quite bad but attached photo of his letter. My cast is open at the front with strapping holding the rigid bit which runs from under the foot and up the back of the calf. The bit of the X-ray he was focusing on and where the pain is towards the back of the foot approaching the ankle. There is no pain at all unless I put weight on it which clearly I'm not doing now. I've got old style wooden crutches which are terribly uncomfortable and may cause more injury to my arms than the original! Where can I find better ones? I meant rigid plastic boot not cast in original post. Grateful for your help

[Chongalulu]

I have not seen plastic casts in use in Thailand.

Fifth metatarsal fractures can sometimes be treated with just a special shoe or cast boot, but it does depend on where exactly the fracture is and the alignment of the bones, as well as whether any torn ligaments.

If you have the Xray report, please put here what it says re the location of the fracture (I know 5th metatarsal, but it should say something more like "avulsion" or "diaphysis". )

Can't see specific reference other than non displacement and his writing is quite bad but attached photo of his letter. My cast is open at the front with strapping holding the rigid bit which runs from under the foot and up the back of the calf. The bit of the X-ray he was focusing on and where the pain is towards the back of the foot approaching the ankle. There is no pain at all unless I put weight on it which clearly I'm not doing now. I've got old style wooden crutches which are terribly uncomfortable and may cause more injury to my arms than the original! Where can I find better ones? I meant rigid plastic boot not cast in original post. Grateful for your help

[Chongalulu]

Just redoing copy of his letter in case I messed up original attachment

[nzexpat]

That says

"Closed fracture base of 5th metatarsal -non displaced."

Treatment .

Consult orthopedic (?) - short leg slab - non weight bearing for two weeks.

[Sheryl]

From this, the fracture is at the base of the metarasal, otherwise known as an avulsion. It is the most common type of 5th metarsal fx and not the "Jones" type which is hard to heal. This type usually heals well.

The device he has put on you is not really a cast, it is just a short leg slab and it has been ordered to wear only for 1 week, with no weight bearing for 2 weeks. After week in the slab, wrap the foot in elastic bandages (being guided by what feels most comfortable). After the 2 weeks of no weight bearing, be guided by how you feel - you may need a longer period of non-weight bearing. Elastic wrapping and/or a stiff walking boot may help. DO NOT walk on it if it hurts. Be guided by what you feel.

You should be able to get better crutches - metal ones of adjustable height - at any medical supply store or large pharmacy selling wheelchairs and the like. Where do you live? You may only need them for 2 weeks and I have a pair you could borrow though I'd want them back after.

[Chongalulu]

Thank you so much for thatSheryl. That was extremely helpful and reassuring,and to you Nzexpat for your "calligraphy "? Skills. I had by chance just out of curiosity read your post on HRT in case the wife ever needs it. You clearly are very knowledgable to all our benefits.

I'm touring around on holiday at the moment and currently in Samui so it would be an incredible coincidence if that's where you loved to borrow the crutches! I did find a pharmacy selling better designed ones but he only had 1.... TIT?? 900 baht each but no point in buying one.

My hobby is swimming so really crestfallen that just as I had found the perfect place around Kanhom to do my snorkelling it was cruelly snuffed out,but at least my mood has been lifted by a 2 weeks incapacitation rather than 6-8 !

Will heed your advice to the letter and use this as an excuse to return to Kanhom a sap

Thanks once again

[Chongalulu]

From this, the fracture is at the base of the metarasal, otherwise known as an avulsion. It is the most common type of 5th metarsal fx and not the "Jones" type which is hard to heal. This type usually heals well.

The device he has put on you is not really a cast, it is just a short leg slab and it has been ordered to wear only for 1 week, with no weight bearing for 2 weeks. After week in the slab, wrap the foot in elastic bandages (being guided by what feels most comfortable). After the 2 weeks of no weight bearing, be guided by how you feel - you may need a longer period of non-weight bearing. Elastic wrapping and/or a stiff walking boot may help. DO NOT walk on it if it hurts. Be guided by what you feel.

You should be able to get better crutches - metal ones of adjustable height - at any medical supply store or large pharmacy selling wheelchairs and the like. Where do you live? You may only need them for 2 weeks and I have a pair you could borrow though I'd want them back after.

It's been eleven days since the leg slab went on which I've kept on to be on the safe side. As I can put weight on it without any pain I'm about to remove it and replace it with an elasticated support or the elasticated bandages that already hold the slab on(or both?) . I'm back in Phimai now and as the Kanhom Doctor said to see him again in 2weeks was planning on going to my local hospital. The wife advises not to use the government hospital here due to the large queue and use the small private one which apparently isn't expensive. What is your view,and in light of your comments about being guided by how it feels do I really need to go at all? Are they likely to re X-ray it (I have the original) which the doctor said was hard to tell from which alone whether there was a fracture . Just want to ensure I don't compromise the healing. Grateful for your comments

[Sheryl]

Healing isn't going to be visible on Xray after only 11 days. As long as you have no pain there is no indication for a repeat Xray and all a doctor is going to do at 2 week follow up is check to see if there is any pain and if not, tell you to cautiously and gradually resume weight bearing.

So I think you are OK to do this on your own if weight bearing so far is not painful and if when you palpate the foot it is not painful either.

Any pain, immediately stop weight bearing, apply ice and see a doctor-- an ortho specialist, which Phimai Hospital is very unlikely to have (forget the private clinic). You'd need to go into Korat, to either the Provincial Hospital or Army Hospital there. No pain - carry on.

[Chongalulu]

Healing isn't going to be visible on Xray after only 11 days. As long as you have no pain there is no indication for a repeat Xray and all a doctor is going to do at 2 week follow up is check to see if there is any pain and if not, tell you to cautiously and gradually resume weight bearing.

So I think you are OK to do this on your own if weight bearing so far is not painful and if when you palpate the foot it is not painful either.

Any pain, immediately stop weight bearing, apply ice and see a doctor-- an ortho specialist, which Phimai Hospital is very unlikely to have (forget the private clinic). You'd need to go into Korat, to either the Provincial Hospital or Army Hospital there. No pain - carry on.

I've attached photo of my foot having replaced cast with elasticated bandages from which you'll see it looks quite swollen all over the top. This is both with or without bandages on. I can walk on it gently without pain with the bandages although I tried yesterday without and although not painful at time it did become so after the event. I'm keeping it to a minimum. It's still a bit tender when palpating but not so much with the bandages on. It almost feels like there is some numbness and stiffness around the toes which may be normal? Would like to avoid trip to hospital if unnecessary but clearly will if needed. Should I leave it a while? Grateful for your comments

[Sheryl]

These bandages are not properly wrapped. Start by wrapping correctly so that there is some immobilization effect.

See the above for instructions and how to do it and how it should look. The bandage should be firm enough to have a compression effect but not so tight as to diminish circulation.

Since you had pain after walking, stay off the foot for another full week. Then see what happens. If still pain, or if the swelling worsens before then, go into Korat and see an ortho specialist.

[NancyL]

Would some intermittent icing help?

[NancyL]

Would some intermittent icing help? For the swelling?

[Sheryl]

It might, wouldn't hurt, but elevation alone should also do the trick.