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Old 01-17-2010, 08:03 AM   #1
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severely broken 1st Metatarsal bone and surgical recovery

On the 6th of January my husband shattered my first Metatarsal bone by dropping a very heavy piece of pottery on my foot. The bone broke in several areas and there was a problematic overlapping at the point of the worst break. After some interesting surgical consults with a couple of surgeons that left me uneasy at best I managed to find one that I am very pleased with and confident in. My surgeon has tons of experience with correcting foot fractures and another surgeon told me of how he had even gone to Russia to operate on the less fortunate in less than ideal medical surroundings. At first he had hoped manipulation under anesthesia would do the trick but insteadended up cementing the smaller breaks while grafting the larger break together. I have four pins and two external fixation blocks. After I awoke from surgery I was in severe pain and my Dr explained that indeed the pins and external fixation would be very uncomfortable but that I should see a full and excellent recovery in 8 to 10 weeks time. To give you an example of my high pain threshhold I recovered from three different C Sections with regular tylenol after the initial meds from surgery wore off. So this extreme pain I am currently experiecing at two days post surgery is a concern - do these pins typically continue to cause such pain throughout the whole six weeks of recovery? I will see the Dr at 5 days post op for a check up and am hoping that the bone may show signs of union soon after so that he might remove the soft splint and keep things in line with a hard cast. The Dr said the pins are easily removed and I think the vice grips are removable without another surgery so now I am simply concentrating on controlling the pain with Percocet. Has anyone had a similar surgery in that cement was used for repair along with a bone graft and external fixation device? When is the earliest I might expect the pins to be removed? Also, how important is icing and elevation because honestly I find elevation very uncomfortable and icing through the wrapped foot doesn't seem to make a huge difference. The Dr spoke to me post op but I have since forgotten all the details as the pain was brutal and my focus was simply on getting that under control. Any feedback will be greatly appreciated as I am quite the Type A personality and being stuck on the sofa is driving me mad!! Thanks, T

Last edited by Trixie1966; 01-17-2010 at 08:05 AM.

 
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Old 01-17-2010, 08:59 AM   #2
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Re: severely broken 1st Metatarsal bone and surgical recovery

Sorry you are in so much pain. I've learned through this board that the second or third day is usually the worse, it was for me. It sounds like you had a complicated break and surgery, so my experience with foot surgery will not exactly match yours. That being said, elevation is very, very important. Swelling causes pain and I would guess disrupts circulation. Ice and elevation make a big difference in healing and comfort. Many of us had planned surgeries, so we had time to mentally prepare for a life of impaired mobility, so I can imagine this is a hard adjustment for you. I had two temporary pins (external). They were removed four weeks after surgery. They did cause me a lot of discomfort, but I know I caused myself unneeded pain because I tried to walk too much, too soon before they were removed. I caused so much irritation that the pain was excruciating and I was totally non-weight baring for a week (when I was partial-weight baring immediately after surgery). So rest, elevate, ice and follow doctor's orders. Also call the doctor if something concerns you. Good luck and speedy healing.

 
Old 01-17-2010, 09:29 AM   #3
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Re: severely broken 1st Metatarsal bone and surgical recovery

Thanks for taking the time to reply - info from someone with experience is huge at this point of recovery. The extreme pain seems to be at the site of the fixation devices rather than over the point of worst break which sits about an inch or so above my first toe joint. I have four children from the age of 12 down to a very active 3 and I hate being stuck on the sofa but am definitely following the Drs orders to do so. I will elevate but honestly through the ace bandage I feel very little when icing my foot. Given that my Dr used cement to secure most of the fractures do you think there is a chance the pins will be removed at 5 days post surgery - I would think by then a cast could take care of setting the bone the rest of the way. The Dr did not say what I am coming in for at the 5 day post op appt. and I am just wondering if given that I will be 2 weeks post break just perhaps the removable pins could come out and a cast could be used? Also, I am very opposed to using prescription pain killers as I think they really tax even the healthiest of livers and so would love to know how early anyone here has ceased to use their pain meds after a break like mine. The pain is so bad that I have taken 2 Percocet every four hours since Friday evening - this is way out of my comfort zone but I can't as of yet back off the meds. Thanks oce again for the support and advice - T

 
Old 01-17-2010, 09:53 AM   #4
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Re: severely broken 1st Metatarsal bone and surgical recovery

Hi Trixie, I just want to pop in an encourage you. I had foot surgery with a plate and no external hardware, so I can't comment on that. I think Janesfoot made a good point about how we who had surgery had time to get mentally prepared for being out of commission. You had it thrust on you, plus with three kids, you have more challenges than I did, that is for sure.

I took prescription pain meds for the first four days or so. After that, my foot was okay as long as it was elevated. I too have some ambivalence towards medications, but they are very helpful and have a place in the early recovery stages, so don't be afraid of them.

Do take care. I hope your healing goes well.
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Old 01-17-2010, 10:14 AM   #5
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Re: severely broken 1st Metatarsal bone and surgical recovery

Thanks for the info regarding the pain meds and yeah I figured I would be taking the pills atleast until Monday. I actually have four kids but thank God two are 12 year old twins who have been nothing but kind and thoughtful since the accident. My three year old daughter is lovely but not impressed with my down time - we would walk to Barnes and Noble a few times a week and she clearly misses this time with her Mom. However, no whining from me as my pain is nothing compared to what the poor Haitians are enduring - this being off the feet thing leaves you with tons of reflection time and I am very blessed with good health and decent healthcare. I wanted to ask any of you who are further into recovery - do surgeons annouce confidently that you will have an excellent and complete recovery just after completing surgery if there is any doubt to the matter. My Dr seemed so pleased with how the surgery went even though he said normally he would have prepared the patient better in advance - he really had expected a straightforward problem going into the procedure only to find more complex breakage after exploring. I want to remain very optimistic as my Dr said he feels a 100% recovery is expected. What do you guys think about his optimism so early in the game?

 
Old 01-17-2010, 10:24 AM   #6
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Re: severely broken 1st Metatarsal bone and surgical recovery

My surgeon told me about the risks to the surgery of course, and one of those risks is non-union. (I had the big toe joint fused). I asked what would happen then and he basically said we would deal with it, and that he had not had any problems with that. He was quite confident. When I went for my follow-up visit, he said it was solid and gave me permission to walk on the entire foot instead of just heel weight bear.

I have recently seen my x-ray report from that visit, and the radiologist said there was no evidence of boney fusion. I got another x-ray last week, and will be getting a bone scan to make sure there is no bone infection.

So, I guess I am not quite at the point of having the docs say it is all better now.

Foot surgery takes a long time to fully heal from what I understand. A colleague of mine had the same procedure I had, from the same surgeon. She is happy now and did say it was a year before she felt it was totally healed.
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Old 01-17-2010, 10:42 AM   #7
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Re: severely broken 1st Metatarsal bone and surgical recovery

Northwind,
I do hope that your recovery continues in a positive direction. Perhaps I can help you with something - I was told by the earlier flaky surgeon that a person without a radiology background could not decifer the beginning of a union. Perhaps you are healing more than you think but actually misread the x ray? I hope that is the case for you - as for me we did not consult appropriately given that he had explained manipulation and the possibility of an open reduction involving screws and plates to be left behind permanently. After waking from surgery the first thing he said was that usually he would have better prepared his patient on what to expect but no worries as the cementing and external fixation seemed to be the appropriate route to take. I see how patient you guys all seem and perhaps I better begin to develop some patience of my own. The drag is I had just started a month ago with a wellness plan - tons of green smooties and lots of walking and weight training. I am a little disheartened at having the exercise end of the deal being put on hold but I hear green smoothies should only help in the healing process. I will keep you posted on if my surgeon seems as optimistic as he was that first day. In the meantime I wish you well in your recovery and here is hoping that you misread your x ray! T

 
Old 01-17-2010, 10:56 AM   #8
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Re: severely broken 1st Metatarsal bone and surgical recovery

Thanks Trixie. You make a good point too. A friend of mine had his hips replaced. The radiologist at this hospital said the joint was slipping. So he went back to the surgeon (same one as mine) and the surgeon said that people without orthopaedic backgrounds sometimes misread the x-rays. Let's hope this is the case here.

It does suck to not be able to do the activity part of the wellness plan. You can though, keep up the eating part, and slide into some physical stuff that does not involve putting weight on your foot.

I had a friend who smashed both feet when he fell out of a tree many years ago. (he was helping to trim it and something went wrong). I saw him in the summer after several years. Apparently his feet healed well, though he does have to wear orthotics and proper shoes or he will pay for it. Now, he did break several metatarsals, and his heels, so his feet were really messed up. It was awesome to hear he had done so well. I would not have known by looking at him that he'd had that injury. No limp, and walks properly.
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Old 01-17-2010, 12:04 PM   #9
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Re: severely broken 1st Metatarsal bone and surgical recovery

That is great that your friend recovered so incredibly well. I think if your overall health is good and your attitude is decent then recovery happens a lot quicker overall. My father is 89 years old and is very healthy despite his condition of Celiac. At the age of 87 he was swiftly making his way through a busy section of Manhattan and tripped over a disgarded Christmas tree. My Father broke his arm and it healed in a six week window with no issues. The most amazing thing is that the break happened before he was diagnosed with Celiac Disease and therefore he had poor absorbtion of Vitam C, B 12 and Calcium and yet it still healed beautifully and my thought is that it did because my Father has a great attitude and is always looking/planning for his next adventure. The man is 6'1 and only weighed 145 at the time of his fracture and while the ortho was saying slow down and heal my Dad snuck off to go play the horses in Europe and yet his body healed beautifully - no physical therapy or follow up needed. I don't always look ahead and tend to obsess and worry more than I should but this time I am going to keep things as positive as is realistically possible. No one would ever accuse me of being perky but with a bum foot at stake I have suddenly realised the importance of positive thinking. Out of curiousity is the friend that healed so well a more open and outgoing person instead of say the quieter more introverted type?

 
Old 07-01-2010, 11:43 AM   #10
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Re: severely broken 1st Metatarsal bone and surgical recovery

Hi Northwind,
I saw your reply to Trixie and it seems I am in a treatment similar to yours. I had my first metatarsal broken by a moving cart last Thursday. This was basically a giant flat frame on wheels, must have been more than 5ft high. It was propped up unsafely on the street and fell on me as was passing. The ER gave me a splinter and crutches but in my follow up visit , the Xray showed that the two parts of the bone are displaced. So, I am going to have a plate and i think grafting. I am still figuring the terminilogy and the process out, but the doc said he also has to cut my bone a little, it seems this is what is called reduction.Am I understanding this correctly? What kind of procedures did u have done? My doc is saying they usually leave the plates inside but can remove after a year. Did you remove yours?

 
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