Metatarsal Fracture - Jones

Today is exactly eight weeks and a day since I stepped in a pothole, rolled my left foot over, and fractured my fifth metatarsal bone. The fifth metatarsal is the outside bone on the foot, and the type of fracture that I have is the dreaded Jones fracture. Why do I say "dreaded?" Well, this fracture is known to be resistant to healing. For athletes such as soccer players, basketball players, and runners, it can be a career-ending injury. However, I knew none if this when it happened to me.

On September 12, a beautiful warm Saturday, we went to the mountains for our last camping trip of the season. We pulled into the campground late in the afternoon, and I took the dog on a leash and my purse and walked down the road to go and register while Rob and Alex got the campsite set up. It was glorious. The trees were in full colour and the sunshine was sparkling on the lake. The high rocky bluff where we planned to hike the next day was dramatically lit. I was staring about at the beauty of the place and not really watching where I was going. I somehow stepped into a pothole, turned my foot, and fell hard. 

I immediately knew I had injured myself seriously. I thought it was either a sprain or a fracture. I also was bleeding from gravel cuts on both hands and legs. I hobbled back up the road, probably a distance of about two bocks, trying to put minimal weight on my left foot. Back at the camper, I cleaned up the blood and elevated and iced my foot. We decided to stay the night and see how the foot was the next day. 

The next day, the foot was badly bruised and I could not put any weight on it. However, the pain was not very bad, so Rob and Alex went hiking while I hung around the camper. I had not brought my painting equipment along, so I sat outdoors taking closeup photos of the autumn foliage. 

That evening when we returned home, Alex went and got my old crutches (from the days of the medial meniscus tears in both knees) out of the shed. I drove myself to the emergency room at the hospital  and used the crutches. They took an X-ray, and the doctor diagnosed it as a Jones fracture. He said that a fracture of the fifth metatarsal bone was the most common foot fracture. He recommended that I arrange to be fitted for an air cast, a type of walking cast. In the meantime, he put on a fibreglass backslab (splint) and tensor bandage, and told me not to weight bear on the foot. He also said that I probably would be in the air cast for seven to eight weeks. 

My question to him was whether I would be ready for ski season. I didn't think to ask whether it would impact my work, or daily life, or whether there was anything in particular that I should do to aid the healing of the bone. I didn't ask whether I would be able to weight bear in the air cast. I heard "walking cast" and thought I knew the answer. I thought a fracture was not a big deal and that it would be healed up in seven to eight weeks, and in the meantime I would be walking around in a walking cast.

It was the orthotics guy who fitted me for the air cast the next day that alerted me to the fact that although the cast could be used for walking, I shouldn't walk in it unless the doctor had said I was ready to weight bear. So, it wasn't time to ditch the crutches yet. 

Regular readers will know that I have a demanding job with extremely long hours. Having not considered that the injury would impact my work (I work with my head and computer, and through interpersonal relationships and meetings; how would my foot have anything to do with that?), I went off on crutches to my usual hours of work, eleven-hour days. By the end of that first week, I was miserable. My shoulders, wrists, back, and right leg and foot were so sore from trying to get around at work on crutches. My usual parking space suddenly was way too far from my office, and it was impossible to even get to meetings in distant buildings. I did paperwork to get a special parking pass at work and for the city. I was exhausted. 

When I saw my doctor ten days after the injury, she told me that I had to continue to be completely non-weight bearing. She told me to reduce my hours at work to four hours a day (plus four hours a day at home), and to rest and put my foot up. But work was extremely busy, with some difficult issues facing me. I cut back my hours a little to about nine hours a day, and spent my time at home with my foot up, being waited on. 

Two weeks later, at the three and a half week mark, I saw my doctor again and she did an X-ray. She said that she saw very little healing. She shook her head about the hours I was working, and wrote a note restricting me to four hours a day at work. She told me to come back in three weeks for another X-ray. She acknowledged that sometimes the early healing does not show up well in an X-ray, and said I could start putting a little weight on my heel as I felt ready, then begin to wean myself off the crutches. 

I started putting my heel down for balance. At about five weeks post-injury I started weight bearing a bit on the heel. It didn't hurt to put a little weight on it, so by the sixth week I was walking short distances in the house with one crutch. A few times I actually forgot to grab my crutches and walked away across the room. I felt so thrilled to have some mobility back, and some of my independence! It was wonderful to be able to pick something up in one hand instead of having to have people bring me everything little thing. I wrote a post about it called I Cleaned the Toilet. A few times, I slept with a bare foot rather than wearing the backslab or cast. 

At the six and a half week mark, I had another X-ray. The doctor said that the bone was starting to heal, but very slowly. She said the bone was filling in on the inside (medial) side, but the bone separation was still clearly visible on the outside of the bone. I told the doctor about sleeping with a bare foot, and sometimes taking the cast off when I was resting on the couch with my foot up. She said that I must not put any weight on my heel/foot with the cast off, but that I could continue with light weight bearing with the cast on. I made another appointment to come back in three weeks. I was pleased that some healing was happening but disappointed that I would still be in the cast for another three weeks. 

During all of this time, work continued to be extremely busy and difficult, and I was getting little sleep because I kept waking up in the night with insomnia, worrying about work issues. This was exacerbated by not being able to exercise (walk, cycle, hike), participate in social events, cook, garden or paint. These are leisure activities that are great stress relievers, but now I seemed to have nothing to distract me from work thoughts. Also, my time at work was creeping upwards again, and even included one fourteen hour day.

The next day, a Thursday, the doctor's office phoned our house and left a message to call. By the time I returned from work, the office was closed. I returned their call late Friday afternoon. It was bad news. The radiologist had taken a look at Wednesday's X-ray and saw very little healing. I was told to stop weight bearing, and to keep the cast on at all times. I was told that the doctor was referring me to an orthopedic surgeon. When I asked how long it would take to see the surgeon, the staff member said typically five to six months. 

I was devastated. I hadn't anticipated that the fracture would not heal. I had thought that I would be out of the cast after seven or eight weeks, then have a few weeks of physio, and then be ready for the ski season. Going back to no weight bearing after a week and a half of greater mobility was very difficult. The thought of being on crutches for another five months while waiting to see the surgeon, then having to undergo an operation was horrible. And of course there would then be a couple of months of recovery time after the surgery. I became grumpy and depressed (which did not endear me to Rob). 

I decided that I needed to make a greater effort to rest, stop working so much, and to elevate my foot as much as possible. I contacted my supervisor at work and explained the setback that I had experienced regarding my healing. He was very supportive, and he, another colleague, and the members of my leadership team met with me this week to help identify what tasks could be taken on by each of them and what could be deferred. I am now strictly obeying the restriction of four hours a day at work. I have accepted my immediate future as a couch potato. If this is what I need to do to help the bone heal, this is what I will do. 

Although up to this point I had done a little reading on fractures and healing processes (which had led me to start taking calcium and a multivitamin, as well as to avoid ibuprophen and other NSAIDS), I had not researched my condition very thoroughly. have now begun doing more extensive research on Jones fractures and approaches to treatment. These fractures are often slow to heal and sometimes result in non-union of the bone. The section of the metatarsal where a Jones fracture occurs is poorly served by blood flow. I plan to write another post on what I have learned about fractures of the fifth metatarsal bone, and in particular Jones fractures. 

In the meantime, I am trying to rest, rest, rest. I am trying limit my focus at work only to those critical pieces that I must do, and let others do the rest.