If your physician cannot put your fifth metatarsal
back into position after a fracture, you may need
to undergo surgery to reconstruct the bone. Surgery
typically is prescribed for severe fractures that
have displaced the bone. Surgery also may be needed
to treat a Jones' fracture, which effects
the area of your fifth metatarsal, an area that
has a poor blood supply and may not heal without
surgery. Through an open incision, surgeons can
return your fractured bone into the normal position
and fix your fifth metatarsal bone with what is
called an intramedullary screw. This screw is run
through the marrow cavity in the center of your
fifth metatarsal. Most patients can go home the
same day after surgery. v=PAT&doc_id=29"
target="_new">William G. Hamilton,
M.D., team physician for the New York Knicks and
New Jersey Nets.
The actions you take before surgery can be every
bit as important as the procedure itself in ensuring
a healthy recovery.
Prior
to your return home from the hospital, make sure
that you have received any equipment you will need
when you get home. This may include crutches or
household items to make movement around the house
easier. You should receive prescriptions for any
of these from your doctor before you go home from
the hospital.
Any
physical problems or changes in your overall health,
such as a fever or infection, should be reported
to your surgeon, and you should notify your surgeon
of any new medications you are taking.
Learn
the potential risks and benefits of the surgery
by asking your surgeon any questions that will help
you better understand the procedure. It can also
help to talk to someone else who has undergone the
same surgery.
Discontinue
the use of any anti-inflammatory medicine, especially
aspirin, a week prior to surgery, to prevent excessive
bleeding during the procedure.
To
reduce the risk of infection, improve healing, and
decrease complications, try to quit smoking or decrease
the amount you smoke. In general, smokers have a
higher infection and complication rate overall.
If
possible, practice walking with your walker or crutches,
as you need to use them after surgery.
Getting
a second opinion from another qualified surgeon
is often advisable, particularly in rare or unique
cases.
To
check if the orthopedist performing the surgery
is board-certified or eligible, call the American
Board of Orthopaedic Surgery at 919-929-7103.
v=PAT&doc_id=29" target="_new">William
G. Hamilton, M.D., team physician for the New York
Knicks and New Jersey Nets.
At most medical centers, you will go to "patient
admissions" to check in for your operation.
There may be separate check-in areas for ambulatory
outpatient (patients go home the same day after
surgery) and for overnight inpatient surgery, so
be sure to ask your doctor or an assistant about
this. After you have checked in to the hospital,
you will go to a holding area where the final preparations
are made. The mandatory paperwork is completed,
and your foot may be shaved, though this is not
always necessary. You will be asked to change into
a hospital gown and, if applicable, remove your
watch, glasses, dentures, and jewelry. You will
have the opportunity to speak with your orthopedic
surgeon or an assistant and meet the anesthesiologist
or nurse anesthetist (a nurse who has done graduate
training to provide anesthesia under the supervision
of an anesthesiologist). Then, you will walk or
ride on a stretcher to the operating room. Most
patients are not sedated until they go into the
operating room. Here are some important steps to
remember for the day of your surgery:
You
will probably be told not to eat or drink anything
after midnight on the night before your surgery.
This will reduce the risk of vomiting while you
are under anesthesia.
Arrange
for someone to drive you home when you are released.
Wear
a loose pair of shorts, sweatpants, or other clothing
that will fit comfortably over your short leg
cast or splint when you leave the hospital.
Take
it easy. Keeping a good frame of mind can help
ease any nerves or anxiety about undergoing surgery.
Distractions such as reading, watching television,
chatting with visitors, or talking on the telephone
can also help.
v=PAT&doc_id=29" target="_new">William
G. Hamilton, M.D., team physician for the New
York Knicks and New Jersey Nets.
Surgery
Procedure
Open reduction and internal fixation of your fractured
fifth metatarsal can take about an hour to perform.
An ankle block anesthetic is injected into your
ankle to numb your foot. You usually are sedated
so you sleep through the procedure.
A
small, three-centimeter incision is typically made
along the outside of your foot, close to the base
of your fifth metatarsal.
A
hole is drilled straight through the shaft of your
fifth metatarsal with a special device called a
reamer. Reaming the bone shaft creates a bone graft,
which encourages blood flow and healing.
Your
surgeon puts a screw into the tunnel drilled through
your fifth metatarsal. The screw passes through
the shaft of your fifth metatarsal into the base
of the bone. It protects and compresses the fractured
bone.
Your
incision is closed with stitches. A splint is applied
to immobilize your foot and ankle, and you are taken
to the recovery room.
v=PAT&doc_id=29" target="_new">William
G. Hamilton, M.D., team physician for the New York
Knicks and New Jersey Nets.
After surgery on your fifth metatarsal, you will
be transported to the recovery room where you
will be closely observed for one to two hours
while the immediate effects of anesthesia wear
off. Your foot will be elevated and immobilized
in a plaster splint when you wake up. There usually
is minimal bleeding after surgery. You typically
cannot see the incision in your foot because it
is wrapped in the splint. After surgery, you usually
experience some pain. Adequate pain medications
will be prescribed for you. You will be given
intravenous (IV), oral, or intramuscular pain
medications as needed. Your surgeon will prescribe
crutches and you are usually instructed to keep
weight off your foot for the four to six weeks.
Your temperature, blood pressure, and heartbeat
will be monitored by a nurse who, with the help
of the doctor, will determine when you can prepare
to go home. Make sure to have someone available
to drive you home, as you will be unable to drive
a car. v=PAT&doc_id=29" target="_new">William
G. Hamilton, M.D., team physician for the New
York Knicks and New Jersey Nets.
Home
Recovery
For four to five days after open reduction and internal
fixation of your fifth metatarsal fracture, you
should keep off your feet, elevate your foot above
heart level, and move around the house as little
as possible. You should try to rest and avoid too
much movement for at least a week. Crutches usually
are prescribed for about four weeks so you can keep
your body weight off your foot. Rest as much as
possible with your ankle elevated. This helps blood
drain away from your ankle and can control swelling.
Putting weight on your ankle increases the chance
of disrupting the healing process in your foot.
Household tasks that require you to be on your feet
may be difficult for about four weeks. Try to have
someone around the house to help with any physical
chores. The dressing covering your wound inside
your post-surgery foot splint usually does not need
to be changed until the splint is removed. A typical
follow-up schedule after you leave the hospital
may go as follows:
Ten
to 14 days after surgery – Stitches are removed
and your foot and ankle are put into a short leg
cast. Most casts need to be kept dry when bathing.
Four
weeks after surgery – Return for a check-up.
Receive X-rays and, if necessary, a new cast. You
may need to continue using crutches for up to six
weeks after surgery, depending on how quickly your
fifth metatarsal bone heals. If you show signs of
healing, you typically are put into a cam walker
or weight-bearing cast, and you can put some weight
on your foot.
For
the next four to six weeks - Your physician may
ask you to return at regular intervals for X-rays
to check your progress. Gradually increase your
weight bearing over this time span until you can
comfortably walk without crutches. You progress
out of the cast, into a removable brace, and possibly
into a cast shoe with a hard, plastic bottom as
your bone heals. You can begin stretching and strengthening
exercises for your foot as pain allows.
Eight
to 10 weeks after surgery – You may be able
to bear your full body weight and return to normal
shoe wear.
v=PAT&doc_id=29" target="_new">William
G. Hamilton, M.D., team physician for the New York
Knicks and New Jersey Nets.
Before you return to normal shoe wear after surgery
for a fractured fifth metatarsal, your physician
usually instructs you to steadily increase your
weight bearing exercises. As pain permits, begin
with short walks in your weight-bearing cast or
cam walker about four weeks after surgery. The key
is to avoid pain - do not do what hurts. If pain
flares up, use your crutches when walking around
so you can modify the amount of weight you put on
your foot. When you are put into a cast shoe, your
walking exercises typically become more comfortable.
You also can ride a stationary bicycle and swim
to help improve your fitness. 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 eight
to ten weeks to heal before you can return to normal
shoe wear. Most patients can return to sports and
activities about twelve to fourteen 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 physical therapy or medical treatment. v=PAT&doc_id=29"
target="_new">William G. Hamilton,
M.D., team physician for the New York Knicks and
New Jersey Nets.
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 difficult 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.
v=PAT&doc_id=29" target="_new">William
G. Hamilton, M.D., team physician for the New York
Knicks and New Jersey Nets.
Prior
to your return home from the hospital, make sure
that you have received any equipment you will need
when you get home. This may include crutches or
household items to make movement around the house
easier. You should receive prescriptions for any
of these from your doctor before you go home from
the hospital.
