Broken 2nd Metatarsal, any experience with this injury during ski season?

Well last weekend at a party, my somewhat belligerent friend (I wasn't in the best state of mind either) lost his balance and fell on me. He's a big guy and his knee happened to fall square on the top of my left foot.

Immediately I thought I sprained my ankle and limped home (friend lives across the street). Did the RICE sprained ankle treatment and then went to bed.

I woke up the next morning and it seemed ok. Some pain when limping on it, but not too bad. I noticed later in the day that it wasn't my ankle. I had full range of motion on the ankle. Instead, it was a pinpoint pain on my foot just below the second toe. After reading online, I decided to see a podiatrist first thing on Monday.

Well I'll skip the lolli-gagging and show you the damage (this is my left foot, the xray was was just put on the light backwards):


This happened this past weekend (Saturday night), and that Xray is from Monday morning. I'm supposed to be skiing tomorrow in Tahoe, but that has been canceled (now just hanging with the family). However, I have an epic skiing trip to Austria and Switzerland starting on Feb. 1st. The trip has been planned for about a year now and I don't think I can NOT ski.

The doctor can't make any promises and says, "It'll be a game time decision." After my reading online, I've seen people say 4-6 weeks for a metatarsal bone heal for athletes. I'd have to imagine skiing isn't as abusive on metatarsals as football or soccer, but I could be wrong.

Anyways, I've gone the aggressive method and have it in a full, non-weight bearing cast. I'm doing everything I can (improved diet, no alcohol, extra calcium) to improve my heal time.

Has anyone had experience with coming back to skiing from a metatarsal injury? I feel confident that I can ski, but I will probably need to lower my skiing level to more cruising which sucks, but it's better than nothing.

Wish me luck guys, and experienced comments are appreciated.

Other facts:
- I'm 27 so still semi-young.
- The doctor is doing another xray on Monday and said he may decide to do surgery next week and put two screws in it, but he says then I'll have to worry about only 5 weeks from recovering from that.

Thanks for the tips. We happen to have a bazillion 1000mg calcium pills anyways so I figure it can't hurt. I'm only taking 2 per day as I've read the bad things about overdoing it.

I believe my podiatrists plan was to remove the hard cast in 2 weeks and then go with a soft cast for another two weeks and then go from there.

The swelling of the injury and the ankle has been minimal altogether. I had my cast valved today (one day after install) because I thought there was considerably too much pressure around the ankle; it feels much better now, but we'll see what the range of motion and strength is when the time comes. I may need to resort to some ankle strengthening exercises when the time comes.

Thanks much,
Brian

Sorry, I wanted to ask a question to you based on your response after re-reading it. So your concern is more about the side-effects of immobilization than the actual injury to the bone itself. Of course I hadn't thought too much of the side-effects, but I'm really glad you brought it up. What's your armchair MD analysis of the actual injury in 6 month's time. I fear if the bone isn't nearly fully healed than it's a no-go regardless of the other conditions.

Thanks to all. It is slightly displaced downwards, but my doctor says it's not much and should heal naturally without surgery. He's taking another xray next week to see if it's displaced any further, if so he'll schedule an OR to put two screws in it, but he doesn't think that's necessary especially if I keep my weight off of it.

I will keep you all posted and greatly appreciate the second opinion. I took that pic of the xray with my iphone and unfortunately I didn't take the lateral view.

Thanks again, have a wonderful XMAS.

Do you have any recommendations for exercises I can do for my left leg that do not require putting any weight on the foot? I'd love to start training, but everything I know how to do requires weight bearing.

Thanks!!

To the experts out there, I'm now in week2 with my hard cast. I've kept weight off of it and unfortunately I can't tell if there's any progress. My toes are still a little black and blue, but there's no pain anywhere.

I went for a follow-up visit with my podiatrist, but he didn't re-xray (saying a week isn't long enough to see anything significant). He did give me this Orthofix Phsyio Stim thing which promotes bone healing (at least that's what the company says). He says he hasn't had much experience with these as they're very expensive and most insurance won't pay the $5,000 for it (but mine did). He said it couldn't hurt.

Anyways, he seemed to be saying my chances of skiing aren't that high, yet the nurse said, "Don't worry, you're young and you're keeping weight off it. He's just saying that so you don't blame him if it doesn't heal."

I've also been reading online and have seen articles saying anywhere from 4 weeks to 6 months to heal an acute fracture. I'm in a really down mood now thinking my chances of skiing are really nill.

I don't know how much skiing specifically stresses the metatarsals, but I guess I'm looking for anything encouraging. We've been trying to reschedule our trip and the best we can do is to push it back 1 week, but I'm not so sure that'll really make a big difference.

Also, I'm out of town next week, so I now have to wait until Jan 13th for my next visit which will have new xrays. If no progress is made by then, it leaves basically no chance of maybe even walking on this vacation.

What do you guys think? I know the picture above doesn't show the lateral view, but I guess it's down ever-so-slightly, the doctor said it should union just with immobilization.

Thanks!

Thanks, I guess I'm confused with when I read 4-6 or 6-8 weeks for similar type injuries. Does that mean fully healed, or cast off, or what?

Thanks and I always overthink things

Update

So new xrays today and well I can't say I'm happy with how things are going. The side xrays appear to look better, but the topical xray like the on above looks basically the same. I expected to see some improvement and if there was any improvement it was minor. There were three xrays, one top, one side, and another top that looked the same as the other one. One of the tops (I think he called it the LP) looked really good, I couldn't see anything, but then the main top one looked similar. I dont' really know what the difference between the two xrays were as both were of the top of my foot.

The doctor said it's normal since it's been only three weeks, but I think he expected to see something as well. He commented about usually seeing some sort of build-up on the sides which was apparently absent in my pictures. He also commented that there are variances from one x-ray to another, but that my side x-rays looked good and it appears there has been only less than 1mm total movement which doesn't worry him too much.

So now I'm in an AirCast cam-walker but have been instructed to not weight bear for another three weeks. I was able to move the trip back a week, but that is all I could do due to the way our travel was planned.

Now I go back in three more weeks, or 1 week before our trip for new xrays. I don't know what to make of that.

If there's any good news it's that there is no swelling and really no pain anywhere in the foot which the doctor says is very good.

On a final note, they told me to never take this walker off except for showering, and that I'm even supposed to sleep in it. I found that odd, but this thing is much more comfortable than the fiberglass cast I had so I can't complain too much.

I'm not sure where this leaves me now. I had already come to the realization that I'd be skiing at a very non-aggressive pace for this trip, but now I'm feeling worse about that. There is something bigger than just skiing on this trip that is supposed to take place on the hill so this is why I'm so concerned. There's a plan that's been in effect for years so I will do just about anything to try and get on the hill in some form or fashion. My doctor said to remain optimistic and "we'll try our best" so he hasn't ruled out the possibility, and I will begin working out my quad and hamstring muscles regularly now.

I guess I'm looking for second opinions from you guys. Is it normal to see little to no change in x-rays after 3 weeks? Does the sign that there's no swelling or pain mean anything good?

Also, I'll add that although I haven't really weight-bear'd, we put some weight on it at the Dr's office and I felt no pain. It felt funny just because my ankle felt funky from being in the case, but as far as pain, swelling, standing, getting it into a boot, etc. I don't think that'll be a problem; it's the re-injuring it, causing more damage, etc. that I worry about the most.

Thanks, this is very comforting. In all honesty, I feel like it's strong enough to walk on. I've put limited weight on it during a few situations and it feels completely fine (besides the weak ankle, calf thing). Yesterday I was concerned about being able to even walk, deal with trains, etc. let alone casual skiing.

I was reading about bone healing and apparently you're supposed to walk on it long before it's fully healed and that aids in the complete healing/restoration phase.

I was just really bummed that I'll have to wait another 3 weeks, or ~4 days before our trip to get any new news (and be able to put any weight on it).

Yes, I wish the timing was better, but I need to make an honest women of her, it's been 7 years and this has been planned now for nearly 2 years. It'll be on the border of Austria and Switzerland and Ischgl. I'll accept no less at this point, and that requires at least getting to the top of the mountain and being able to ski intermediates down to the bottom.

Thanks for all your help!

Also, one more question. My doctor told me to leave the Aircast on 100% of the time (including sleeping). He said the only time I should take it off is to shower. However, I think he meant that as don't try to walk on it, keep it immobilized, etc.

Is it ok to take it off when sitting down and work on the range of motion around my ankle? It's still without putting any weight or pressure on the metatarsal?

Thanks,
Brian

Thanks for the luck, and all the advice. I was really in a poor mood after coming out of my last Dr's visit seeing the break nearly the same as before. After reading part of that resource as well as others, I realized that the crack will take a long time to visually heal, but that the actual healing process requires the callous formation and then light use/weight bearing on it to finalize the rebuild period. After three weeks, we didn't see any callous formation on the Xray but my understanding is that that's normal. I'm trying to remain optimistic that my next visit (a total of 6 and 1 days weeks after being originally casted) will show that callous formation and we can move to weight bearing in the aircast. I'll do that for a week or so and see if we're ok to get it into a ski boot and try the slopes.

I do have a small fear that the next xray won't show callous formation and then I'll be really depressed. If I can't weight bear, I can't walk and therefore can't do the trip, and I will lose out thousands of dollars and more importantly completely screw up my other "plans".

I have the aircast now, and there's no swelling or bruising anymore. The doctor pressed on the top of my broken metatarsal and asked if there was any pain, and there wasn't which he said was good. I haven't put any weight on it in the AirCast, but the other day I tripped over a power cord and had to put a decent amount of weight on my aircast in an emergency, split-second natural reaction and it felt completely fine. I'm hoping since this was a good 4.5 weeks after being casted that I didn't do any damage; I'm fairly certain I didn't.

On a final note, in hindsight, I would've preferred having this aircast from day 1. The Doctor originally recommended the aircast, but I asked him which cast would be better, and he said, "You can't beat a fiberglass cast." so I went with that. However, I felt it was cutting some circulation in my ankle (when it came off I had a huge sandpaper like patch where my skin rubbed clean off at the ankle). Plus it was way more slippery and I had more accidents/slips with it. Finally, there wasn't any support over the toes and I have a tendency to curl toes when surprised. With the aircast, there is bottom and top support for the toes so I don't have that problem. This is just my observation, but I feel the AirCast is actually better for this injury.

BTW, I'm not stretching my ankle based on the advice I got from the Dr's office, but my ankle no longer hurts either. It has a bit more freedom, and like I mentioned above, I think the fiberglass cast was too tight around the ankle and had it tweaked at an odd angle since it hurt pretty good the first two days I got it off.

Anyways, thanks again to all, and keep your fingers crossed for me! I am hitting the gym every day to do those leg excersizes and my bad foot'd leg is now back up to about the same strength on those excersizes as my good leg so that's promising.

Thanks, that's good advice. I just checked it out and it's only like $3 per day. Fortunately, my insurance covers medical evacuation, but my g/f's does not so I'll probably get it for her just in case something happens.

I already checked into this as I'm also a scuba diver and was contemplating buying DAN insurance for evac+deco-chamber but I found out my Bluecross PPO is a special variety that covers both of those; our company sends a lot of people overseas frequently.

Well, I had my checkup yesterday, and the xrays showed improvement.  The area between the broken bones is lighter and less defined, but the break is clearly there.

 

The doctor said I can walk on it with a stiffer sole boot, like a hiking boot, but I'm opting to stay in the aircast for the next week.

 

He said I can ski, but should take it easy, and if there's pain that's the signal to take it easy.

 

I'm really excited, and have been enjoying walking again, albeit in this cast.  On another note, I asked my doctor when I could start playing basketball again, and he said I should be able to do ALL activities by March which I felt was really optimisitic.

 

Thanks again for everyone's help, and I'll let you know how it does after the trip.

Well, our trip went well and I was able to ski at about 85% capacity.  At first, it felt a bit weak, but by the end of the trip I was skiing at ~90-95% on piste.

 

The foot now feels stronger after skiing as I can walk longer without any pain, etc.

 

Thanks for all the input, and the main reason for the trip went off without hitch!!!