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How do you know when a stress fracture has healed?
July 24, 2014 9:32 AM   Subscribe

My 11 year old daughter suffered two stress fractures in the top of her foot back in May. It is now late July and she is still in a lot of pain and still on crutches, unable to bear any weight, even in a boot. The orthopedic says it is because she needs physical therapy and that she should be healed by now.

Her pain has not changed at all. She still cannot bear any weight. She has missed girl scout camp and a trip to see her dad due to all of this. She is motivated to feel better. Everything that I have heard about a stress fracture is that you let the pain tell you when it is healed. She is still in pain. I take her swimming as often as I can to try and keep the area loose. She is a kid and could have re-injured. I'm bringing her to our primary care physician this afternoon for more direction. I need to know what to ask for and what to expect.
What is your experience? Should I make her push through the pain, without a follow up MRI, and trust the doctor that she 'should' be healed? Or do I continue to treat her as if it is still fractured, and risk her starting back to school on crutches?
On a side note, she takes a long time to get teeth in. She lost her front four and finally got them all in 2 years later. I mention this in case it is an indicator of slow bone development? Might be a reach?
For those of you who are curious as to how it happened- she was the victim of a hug gone wrong. Yes, that is right, she's been on crutches all summer because of a hug. A friend of hers (who is a foot shorter than she is), picked her up, swung her around, lost balance, and then landed on her at school, bending her foot backward. That's the kind of luck this poor child has.
posted by myselfasme to Health & Fitness (19 answers total) 1 user marked this as a favorite
 
You are asking for medical advice in contradiction to a medical professional in an area where you could seriously injure your daughter with a mistake.

The answer to your question is that you should listen to your doctor, and if you disagree with your doctor, you should find another doctor for a second opinion.
posted by saeculorum at 9:38 AM on July 24 [6 favorites]


That sounds pretty much in line with my metatarsal stress fracture experience. The ongoing pain had to do with soft tissue. (In my case, when I stopped driving stick, my foot healed rapidly, which is to say that it's possible your daughter may be doing something that's exacerbating the pain without directly connecting it.) PT helped a lot. I run again.

Nobody would fault you for getting a second opinion, though a second opinion would also probably require an MRI.
posted by chesty_a_arthur at 9:40 AM on July 24


Yes, I am working on getting a second doctor, thank you. I was wondering what other's experiences have been with stress fractures. I should have been more clear and less emotional.

When a stress fracture is healed, should there still be pain?
posted by myselfasme at 9:40 AM on July 24


I know a lot of people who have had stress fractures (runners), and they are normally healed within 6-8 weeks. If your daughter can't put pressure on the foot, chances are the diagnosis could be wrong. Go back, get an MRI, today.
posted by roomthreeseventeen at 9:48 AM on July 24 [5 favorites]


Definitely take this to another doctor for a second opinion. How has your daughter responded to issues of pain in the past?

But for anecdotal experience, I fractured my 5th metatarsal exactly 4 weeks, 2 days ago. Sometimes I step/move at a weird angle and have a spark of pain, and there's still a tiny bit of swelling (or new, larger, bumpy bone growth) that can cause tinges of pain in certain shoes (or doing certain things with certain shoes).

But for the most part, I'm close to back to normal, and mostly pain-free. Walking normal. Ran 3.5 miles this morning, did Zumba last night, but go a little lighter on jumps with the affected foot. Still have to pace myself and listen for moments where the bone might become a little angry, but I feel maybe 80% healed roughly one month later.
posted by raztaj at 9:51 AM on July 24


I can't speak to stress fractures, but I tripped over a sidewalk and sprained my ankle very badly. I went to the hospital, got x-rays, and was sent home. I had continued pain in the ankle for two and a half years. I just kept being told it was normal and to do stretches until I finally demanded to see an orthopedic specialist. One look at my x-ray and she saw I had torn a ligament and needed surgery. A plate and five screws later I have LESS pain in my foot, but walking on it damaged for 2 and a half years has created problems all on its own. It has been over 5 years since my surgery and I sincerely think my ankle will never be painfree or "normal".


Count this as another vote for "Get another opinion".

Oh, and I was also called a hypochondriac and a drama queen for my foot, made to feel like CLEARLY I was faking or being a wussy for whining about a sprained ankle 2 years later... Not by my doctor, but everyone in my family. If someone had actually listened to me when I said I was in pain instead of making me feel like an asshole faker I never would have let it go so long before demanding to see a specialist. So I give you a huge thanks for actually listening to your daughter.
posted by PuppetMcSockerson at 9:54 AM on July 24 [12 favorites]


I think without imaging you have no idea what the state of her break is. An X-Ray may be enough but she should definitely be evaluated and once imaging shows that she's healed do follow the recommendation for pt. bones don't always heal on schedule but pain could also be soft tissue.
posted by leslies at 9:56 AM on July 24 [2 favorites]


Broken bones (and other serious injuries) can still hurt, say, in cold weather or under other stressors for many years after they heal. But, I think, no, she should not still be in the exact same amount of pain.

I would not accept the "professional" opinion of someone who is saying, basically, "X amount of time has passed, thus the bone should be healed and we are going to assume she is being whiny" without an exam. To me, that just sounds like jerk behavior.
posted by Michele in California at 9:59 AM on July 24 [2 favorites]


I just know from following sports figures that stress fractures take a really long time to heal. Maybe it's different because your daughter is 11 and not a professional athlete, but two months doesn't seem that long. I don't think she should still be in so much pain though. I would see another doctor, for sure.
posted by AppleTurnover at 10:00 AM on July 24 [1 favorite]


IMNAD, but I have been seeing a sports doctor who treats professional athletes and really took care of me.

I have a stress fracture that is currently healing, although it doesn't sound as bad as your daughter's. He told me the average time for recovery is around 6-8 weeks, although it could take longer since hers sounds pretty severe. Still, it sounds quite possible that she is re-injuring the bone if she's still in so much pain.

Physical therapy is a good idea, so your lower body muscles can carry more weight and take the pressure off the bones. If your insurance covers it, an Exogen bone stimulator might be beneficial as well - it's supposed to speed up the healing process by around 40%. My doc brought it up, so yours might recommend it if prompted. Also, I had a bone scan which is quite a bit cheaper than an MRI, and detects stress fractures just as well (although it's not as location-specific). I was told that X-Rays are pretty worthless.

The doc also told me that the SF is healed when the pain is gone. Definitely stay on the crutches until she can walk without pain. The doc said that you can do any non-impact activity so long so long as you feel NO pain doing it; he was pretty adamant on that point. If you push on the fracture, try to walk, cycle, etc. and you still feel pain, it's not ready yet for that particular activity. I'm sure you're both getting anxious, but you don't want to let it completely fracture!

And, yeah... go see another doctor for a second opinion.
posted by Kamelot123 at 10:24 AM on July 24


Go get a second opinion. Doctors are people too, and as such they get things wrong sometimes.

I broke my right leg skiing almost 15 years ago. Ski Patrol was wrong ("oh, you just bruised it, here put some snow under it in a grocery bag and drive home and by the way here's a free lift ticket!"). They should have sent me to the local hospital, but somehow I managed to drive the three hours home (in increasing pain) and then asking my then-girlfriend to drive me to the ER.

The hospital took X-Rays and referred me to an orthopedist. That doctor was wrong ("You've torn your ACL and need surgery ASAP!"). I sought a second opinion. The second orthopedist I saw actually looked at the X-Rays and said I did not need this scary ACL surgery, that it was just a crack in my leg bone near the knee (which he showed me). I was on crutches and in a knee immobilizer thingy for six weeks and then in physical therapy.

I can't speak to stress fractures, but in my case, by the time I started PT after 6 weeks, most of the pain had subsided.
posted by tckma at 10:46 AM on July 24


A second opinion sounds reasonable to me; If you go that route, try to find a pediatric orthopod, especially if the first one doesn't specialize in kids.
posted by TedW at 11:09 AM on July 24 [5 favorites]


Sometimes fractures just take a long time to heal. I had a friend who had to have holes drilled in her broken foot to stimulate new bone growth after a year of nothing happening. Other times what is required (and I swear to cats this is *not* a euphemism) is a strap-on bone stimulator on the affected area. These are not cheap but they do work.
posted by fifteen schnitzengruben is my limit at 11:59 AM on July 24


I broke my ankle in December and had a cast for 6 weeks. Once I had the cast off and "re-learned" to walk...everything was fine. There's an issue and your daughter needs a 2nd medical opinion. Don't worry what she missed out on and the ridiculousness of the cause (most accidents have ridiculous causes!), just get to a respectable orthopedic doctor as soon as possible.

To me (obvious someone with no clue as to your daughter's situation) I would guess that it wasn't put in a cast or immobilized. She possibly re-injured it. Or was mis-diagnosed in the first place. Pushing through pain (except maybe some aches from PT) is the worst idea possible.

Get her to the best ortho doctor possible as fast as possible. More x-rays and a second opinion is way overdue.
posted by bquarters at 12:47 PM on July 24


When I was in university, I developed stress fractures in both shins due to overuse. It hurt to even stand. I missed an entire 3-month season waiting for the injury to heal. I then started on a rehab program with a physio. It was easily 6 months after my initial diagnosis before I could run again without pain.

In my case, I saw a sports medicine doctor. Stress fractures are a common injury they deal with. The x-rays were inconclusive, so I was sent for a bone scan. Imaging the injured area revealed multiple stress fractures criss-crossing my shins. After making the diagnosis, there was nothing more the doctor could do. It was a matter of rest to allow the fractures to mend.
posted by gox3r at 2:42 PM on July 24


When I broke a foot as a teen it was over a year before I could stand on tip toe or squat without pain. It was two months before I could walk in it but no pain took a full 12 months.
posted by saradarlin at 9:01 PM on July 24


If it were my child, I'd be hauling her in for a second. PT may be all she needs, but it's not worth screwing around with if your first doc is not seeing the whole picture.

And that happens quite a bit.
posted by BlueHorse at 10:03 PM on July 24


I'll nth getting a 2nd opinion, followed possibly by some graded motor imagery from a PT. It's also worth looking into what pain actually is, as sometimes pain goes away once bone and tissue heals, and sometimes it doesn't (and becomes chronic pain).
posted by MillMan at 12:30 AM on July 25


Yeah, doctors are far from infallible. I was sent home from an ER with a broken ulna in just stabilizer and was told I had a sprain. 16 hours later the ER called me at home and informed me that a second person had reviewed my films and had changed the diagnosis from sprain to fracture. I went to an ortho guy to get casted and his eyes bugged out a little when he heard that the first person who viewed the film didn't notice the fracture. He spun his little monitor around to show me the film and even *I* could see the fracture. So. Second opinion, and don't feel bad or weird about it for even one second.
posted by xyzzy at 2:11 PM on July 25


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