Should I have surgery or let fracture heal on its own?
September 30, 2015 1:36 PM   Subscribe

I fell down and broke my foot. Oops. My doctor said it can heal fine without surgery. She said she could also do surgery and it might heal a little faster or prevent problems later, but only maybe. I'm not sure what I should choose.

The diagnosis was a "mildly displaced oblique fracture of my fifth metatarsal." My doctor said without surgery, it should heal fine in six weeks, but could take longer. My doctor said she could also do surgery by screwing it in place with a metal plate and it will heal in six weeks, but could be quicker. I want to be able to walk as quickly as I can (who wouldn't) but I'm most concerned with having it heal properly so I don't have any lingering issues. Should I do the surgery, or is it unnecessary or creates other problems? (Sometimes I think doctors offer surgery because they make money from each procedure.) Are you a doctor, or have you had a similar fracture? For any podiatrists out there, this is my foot.
posted by AspirinPill to Health & Fitness (19 answers total)
 
I would leave it alone. Of all the breaks I've had (arm, toes, ribs, knee), those with the least amount of interference healed faster, as in one day you're surprised to remember that you're no longer in discomfort.

Given the hardware I had installed for my knee break and the surgery that came with it, I really can't see it speeding up the process one bit. The exact opposite, really. The surgery introduced a whole new set of problems (not that it was an option in my case).
posted by Capt. Renault at 1:50 PM on September 30, 2015


Should I do the surgery, or is it unnecessary or creates other problems?

In your shoes (heh!), I would get another opinion from another actual doctor.

I have no experience with that sort of fracture. I have had surgery to repair a fracture, and then surgery to remove what they put in (pin and screws). On balance, I would opt to avoid surgery if it is possible to. All surgeries carry a non-zero risk of complications, and add an injury to an injury.

I think you're right to question surgery. I'd also talk to another doctor and see what they say.
posted by Pogo_Fuzzybutt at 1:57 PM on September 30, 2015 [3 favorites]


...I am not a doctor, I am not your doctor, this is not official medical advice. But it IS anecdotal advice from someone who had a break on her own fifth metatarsal as well, albeit a different kind.

I think it depends strongly on how you would take care of yourself if you opt to not get the surgery. I had a modified Jones fracture, which can get really bad and can also sometimes require surgery - if people walk around on it for a while and mess the bones up before finally seeing a doctor. However, I spent the two days after my injury resting with my feet up and binding my foot with an ace bandage (I thought it was just a really bad sprain). So my doctor said that since the bones were all right where they were supposed to be, I wouldn't need surgery, provided I wore my boot cast and followed doctors' orders when it came to how often and how long to wear it. And I did, and it sucked - two solid months of hobbling with a robo-cop boot and having to sit on a stool in the shower - but within two months I could ditch the boot, and after another month and a half with a cane and some physical therapy, I was back to normal.

My point being - if you really and honestly keep your foot immobilized and wear whatever kind of doo-hickey the doctor may have given you (cast, boot cast, brace, whatever) and do what he says, then yes, it's very possible to heal in six weeks without having surgery. You may still need physical therapy, but that should go fine. But if you "cheat" and put weight on your foot after only a couple weeks, that could aggravate the bones trying to knit back together and re-separate them again, and the more you "cheat" the more likely it is to do that, and that's when you'd probably need surgery.

I tried looking online to see how bad your fracture was compared to mine - I think mine was worse. So don't let my two-month time frame alarm you. But yeah, if you really and sincerely treat yourself as "i am injured and I need to take it easy" and stay off your foot, your bones can knit just fine without surgery. Just give them a chance to, is all.

Good luck.
posted by EmpressCallipygos at 2:08 PM on September 30, 2015 [6 favorites]


I had a similar fracture of the 5th metatarsal in July 2014. Slightly more separated, but it was also what the doctors considered a borderline case (one said no, the other said yes, see below). I did have the surgery. The plate causes me no problems (no aches, no weather-sensing, no airport security nonsense) and my foot is fully recovered a year later.
However. The morning after surgery was the most painful hours of my life. My intrepid husband had to go get me stronger pain meds than the surgeon originally prescribed (whereas I hadn't really wanted anything stronger than ibuprofen with the break itself). Also the surface-healing from the surgery - both the incision and a surgery-related loss of hte callusing on the ball of the foot - meant that the foot was fairly tender even when the bones/muscles were healed, such that I feel I had to baby it longer than if I'd just let the break heal on its own.

That said, my choice to have surgery was driven by my desire to have the strongest least-arthritic foot in the long run, to be able to dance and exercise on that foot as if nothing had ever happened, and I feel I do have that one year later.
Also, the first doctor I saw was horrendously rushed, prescribed the "do nothing, it'll heal" treatment before looking at my x-rays, and clearly wanted me out of his office as soon as possible. So when my second opinion doctor was careful, concerned, taking the injury seriously, and paying attention to actual distance of separation of the fragments on the xrays, I took his advice for surgery without much deliberation.
Given my personal outcome, I could see that not doing surgery may have resulted in a similar 1-year outcome, and probably a better 4-month-after status. I am happy enough with my choice to do surgery, though when I have to write it out like this, it seems like maybe it was unnecessary, so I mentally justify it by pretending that the 10-year and 20-year results will be better with a plate in my foot.
posted by aimedwander at 2:08 PM on September 30, 2015


I'm most concerned with having it heal properly so I don't have any lingering issues.

If the surgery has high likelihood to correct lingering issues from a self-heal, do the surgery.

If the surgery has high likelihood to create lingering issues, do not do the surgery.

A doctor competent at doing this particular surgical procedure — not necessarily the doctor you have now, maybe — should be able to discuss the risks and likelihoods of outcomes with you.
posted by a lungful of dragon at 2:20 PM on September 30, 2015 [1 favorite]


As a followup, this was my foot and this is the early part of my story. (And you should totally get a knee scooter if the doc says no weightbearing.)
posted by aimedwander at 2:21 PM on September 30, 2015


Response by poster: The doctor did discuss it with me (the doctor is a podiatrist - I assume there isn't a different doctor I need to see?) but I just feel unsure. She claimed surgery could help it heal faster and could result in less longer-term problems, but she didn't say it was likely it would do that, there was just a possibility. I've had unnecessary surgeries in my life on doctor's advice, I feel. I just want to avoid doing that if this is something where she would rather do the surgery for income.

It is also not a Jones fracture. She said it's a straight forward "oblique" fracture.

If I wanted to get a second opinion, what kind of doctor would that be with? Another podatrist? An orthopedic doctor?
posted by AspirinPill at 2:25 PM on September 30, 2015


Second opinion from an orthopedic surgeon, one who specializes in foot and ankle.

I've broken many bones and have some hardware. For many people the hardware isn't a problem, but for some it is (and then it's a long saga of a second surgery and recovery to remove it). For most people, surgery is straightforward, but for a very small set, it adds problems. In your case I'd see an ortho surgeon but would strongly prefer to avoid surgery and hardware.

2nding everything the great Empress said about really, truly protecting and healing it.
posted by Dashy at 2:44 PM on September 30, 2015 [4 favorites]


[I am not your doctor, you are not my patient, this is educational information and not medical advice/recommendations.]

It depends on a lot on your values and goals. As many have said, surgery is not without complications (bleeding, infection, always are risks -- but then sometimes people have chronic issues with the hardware that gets installed, and then opt/want/need a second surgery to remove it. Two people can have the exact same break, exact same surgery (or opt not to have surgery), and have very different outcomes. Some depends on genetics, but other factors like age, smoking, overall health will also play a role too.

Typically we worry more about arthritis issues when the joint itself is involved as part of the break, which yours does not appear to be.

Any doctor who has confidence in their recommendation or plan will not see a second opinion as an insult or a challenge to their doctorly authority. I usually take them as a sign of an informed, thoughtful patient. You could go back to the first doctor with more questions, you could see another podiatrist, or an orthopedic surgeon, or even a physiatrist or sports medicine doctor. As we say in medicine, "If all you have is a hammer, everything you see is a nail," meaning that if you go see a surgeon (podiatrist, orthopedist), most will recommend surgery, because that's what they're trained to do: operate.
posted by gramcracker at 2:44 PM on September 30, 2015


Response by poster: Does anyone have thoughts on podiatrist vs. orthopedist? I am going to see an orthopedist tomorrow because the podiatrist I saw today will be in another office really far away -- close enough that I could drive, but not close enough that I'd want to take a cab both directions.

I'm going to have to get a knee scooter -- crutches are too difficult. Any other tips for keeping the foot rested and healing without being totally helpless would be cool, if anyone has any ideas? I live alone and I am new in town where I live so I don't know many people (certainly no one I feel comfortable asking to drive me to the doctor), so this has already been horrible.

I'm really bummed out. I had a lot of plans in the next six weeks, including a vacation. Now I'm just sitting inside for the next six weeks, basically. :(
posted by AspirinPill at 7:15 PM on September 30, 2015


Throw money at the problem. Take taxis, order in, hire cleaners, etc. This is precisely why you save money for a rainy day - it's raining.

You might choose to practice with the crutches some more - wheeled devices cannot do stairs. If you can have both devices, do that. Get a shower chair and a long shower head so you can take long showers safely.

When I did in my hip my orthopedic surgeon hemmed and hawed and ultimately declined to operate. That was an unusual decision for that type of fracture, most are operated upon. I was a bit taken aback my this - it didn't help that the doctor wasn't 100% convinced that would give the best outcome. However, it was nice to skip surgery and the fracture healed fine. A week or two extra in healing means nothing a year from now. I might skip it in your shoes.
posted by crazycanuck at 8:17 PM on September 30, 2015


I had an oblique fracture in the fourth metatarsal. I was speed-skating in a dorm hallway. For a brief and shining moment I was Eric Heiden. Then I wasn't. Anyway, I kept it in a walking boot for six weeks, and it was fine. I was good about not waking on it (in the shower I would hop).

Glad I didn't get surgery.
posted by persona au gratin at 12:40 AM on October 1, 2015


My story: I had a broken foot as a teen-ager. I only got to a doctor like three days later (parents out of town, Friday track meet, oldest brother in charge), and my doctor said to wear a good shoe and use crutches.

A couple of weeks later I slipped and caught myself on the broken foot. (The break was in the second toe's metatarsals, about halfway up my foot -- right at the front of the arch.) I could feel it suddenly give way -- presumably re-breaking -- and eventually it healed like that. I now have a sort of ball of bone in that foot and I haven't been able to run pain-free since.

So I would vote for getting the surgery to stabilize things for certain.
posted by wenestvedt at 6:36 AM on October 1, 2015


I've fractured one metatarsal or other five times now and never had surgery. They all healed fine and I'm a regular runner and hiker nowadays. I used a stick/ crutch a couple of those times but the main things was not walking on it too much and wearing a sensible, supportive shoe.
posted by dowcrag at 9:57 AM on October 1, 2015


Any other tips for keeping the foot rested and healing without being totally helpless would be cool, if anyone has any ideas? I live alone and I am new in town where I live so I don't know many people (certainly no one I feel comfortable asking to drive me to the doctor), so this has already been horrible.

I ain't gonna front, this is a pain in the absolute ass. I did at least have friends who occasionally came by on the weekends to keep me from feeling like a total shut-in. But I did a lot of taxis, a lot of paying for delivery for groceries and laundry collection and drop-off...and other than that, the robo-cop moon-boot cast thing helped a lot with keeping the foot immobile during the day, and I was told that taking it off at night was okay. (Check with your own doctor about your own case, of course.) My orthopedist told me that if I moved in a way that caused any twinges of pain, that was a sign that the bones were being pulled out of whack, so I even went without painkillers so I'd know as soon as possible if "hey I need to stop doing that and keep my foot still".

but....After a couple weeks it got pretty dealable. I even live on a 4th floor walkup, and actually got used to hobbling my way up and down the four flights every day for work, and I could maneuver well enough with my boot and my cane.

I'm really bummed out. I had a lot of plans in the next six weeks, including a vacation. Now I'm just sitting inside for the next six weeks, basically. :(

Yeah, it does suck rocks. Another thing I did for moral support, that may help - my doctor gave me a similar six-week recovery period, and I made a deal with myself that at the end of each week, I would go have a glass of wine at the happy hour at a bar just up the street from me. Six glasses of wine, I told myself, and I would be done. It cheered me up, if nothing else. I also wrote a couple things on the inside of my boot cast for moral support - U2's song Get On Your Boots was out at the time, and I played that when I was booting up in the morning and wrote an inspirational lyric from the song ("You don't know how beautiful you are") inside the boot, where I saw it each morning.

And other than that, I just sort of muddled through. And I found that slowing down some was a nice thing too - after going to that bar each week, I'd walk (slowly) down the hill to my house, and I was going slow enough that a neighbor's cat started following me about halfway down the block, rubbing against my legs when I stopped and generally serving as a sort of weird little escort. Before I was always walking too fast for him to keep up, but now I was walking at just his pace and he was keeping me company. Slowing down sometimes can help you notice things you would otherwise miss.
posted by EmpressCallipygos at 2:18 PM on October 1, 2015 [1 favorite]


Response by poster: Well, I went to the ortho and he said surgery for my fracture is totally unnecessary. He said he has seen these injuries plenty and they always just heal fine on their own, particularly in young, healthy people like me. He also said I don't need a splint (which the podiatrist wanted to give me) or a cast. He said the Aircast boot I was given is sufficient, and it's fine to take it off for sleep and it will be able to come off in the shower, unlike splints and casts. He made it sound less drastic of an injury, which made me feel better, and he said it was a really straight-forward fracture. The bottom line from him is that I don't put weight on it and do things that hurt. But he said if I am able to drive (non-booted) without it hurting me, it's fine. He also said I need to keep the foot elevated above my heart when laying down or propped up level when sitting to get the swelling to go down. He recommended calcium too. In three weeks we're doing an x-ray to check on its progress.

I rented both a wheelchair and a knee scooter. My life is 100% easier already. I'm able-bodied enough for crutches, but holy shit do they use muscles I never use. Quite exhausting and such a slow way to move. I'm sure insurance would cover these items, but I didn't want to wait around to get a prescription or go to a certain supplier -- I just needed them right away for my sanity.

Thanks everyone for the input, stories and encouraging words. Big shout-out to EmpressCallipygos for making me feel better. This has been hard and I've cried a few times -- I feel helpless and have needed random strangers to help me do things, which I find embarrassing, and I'm missing out some stuff I had circled on my calendar for months. But I know I just have to tell myself there will be other vacations and other special days. I will get to walk again in a few weeks and some people aren't so lucky. So here's hoping I find my groove in dealing with this and I don't let myself stay bummed out. The past couple days have been rough. Thanks again all.
posted by AspirinPill at 3:02 PM on October 1, 2015 [1 favorite]


Good! Great news. That sounds a lot like what I had treatment-wise I became a maven on crutches. I was on a giant state u campus, and I could get across it about as fast as a bike could (with more stops by the bike for traffic). It was fun at times!

Good luck! The time passes quickly.
posted by persona au gratin at 12:28 AM on October 2, 2015


Response by poster: Thanks again everyone for their input. This is slow-going stuff. I was very depressed the first few days, bounced back and became pretty okay with the situation once I got set up to deal with it, and now more than a month in, it's beginning to wear on me mentally again.

In case it might help anyone who finds this thread, I've been blogging about my broken fifth metatarsal adventures here. I'm going to try to offer some insight and tips I'm picking up along the way, in addition to some venting, of course. :)
posted by AspirinPill at 1:10 PM on November 3, 2015


Check out the web site Broken Beauties for some recovery coping tips. It's like a one-stop resource for dealing with broken bones, with an eye towards comfort AND morale. You'll find everything from practical stuff like cast covers if you take a shower, to seriously cool canes (I was THISCLOSE to buying an 8-ball cane just because). There are also some advice posts about logistics.
posted by EmpressCallipygos at 5:26 PM on November 3, 2015


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