Should I get a CT scan or should I test walking to see if my fracture is healed? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s episode actually comes from a discussion I just had yesterday with an athlete. He had a metatarsal fracture non-union. That is where a fracture of the bone actually keeps moving a little bit too much and doesn’t completely heal.
This can actually happen if you get a stress fracture and you keep running on it and you’re tough and you’re strong and it doesn’t really hurt that bad. So, you keep running, the bone cracks and then because there’s too much motion at the fracture site, it just doesn’t heal. If that happens, you might have to have surgery to fix the non-union to actually get it to heal.
Well, here’s the situation when you have surgery to repair a non-union or if you had a stress fracture that got a crack in the bone, then you go back to the doctor and you get an x ray and it’s time to determine whether or not it’s really healed or not. A couple of things can happen, and you might find yourself in the same situation he was in yesterday.
So, he went into the office took an x ray, they looked at the foot and he said, “You know I think it’s probably healed, but I’m not 100% sure.” So, they took his cast off. They took the X rays, they said it was probably healed and that he could probably walk on it. He said, “You’re young, healthy, all that kind of stuff.” But I’m not 100% convinced based on the X ray that it is really healed. So you have two options.
One option is that you can get a CT scan to actually look closer to see if there’s any actual bridging across the bone that’s just not actually showing up definitively on the X ray. That’s option number one. Option number two is to assume that it looks pretty good on the X ray. You’re young and healthy and it’s probably healed, and it’s probably been enough time so you can start gently testing it by walking on it, applying pressure to it, starting to move it and see if it hurts. And if it hurts, well then maybe it’s not completely healed, and you need some more time off before you actually start walking and certainly before you resume running.
Well, these are both completely reasonable approaches, by the way and the first option that this doctor offered is kind of really and truly going above and beyond the call of duty because most doctors wouldn’t even offer that. They would say either just wait or just try it out. Now here’s the problem is that in this is where I see most people go wrong and this is why we’re doing this episode, is that in his case he decided okay, I’m going to get a CT scan.
A CT scan is relatively easy to get. You can get it at any outpatient imaging facility. In fact, if you’re in California, Texas or Florida and you want me to order one for you, I can even order it for you and review it with you over a webcam visit. It’s not difficult to do and even if you don’t have insurance, it’s not that expensive.
In here in San Francisco, it’s usually somewhere around $500 to get a CT scan of the foot to look and see and confirm is it really healed enough for you to start running on it or not. But here’s the mistake people make, and I’ve seen this over and over where somebody like him decides “Okay, I’m going to get a CT scan. I’m going to make some calls. I’m going to see when I can get one. I’m going to go in and get one and then go back and see the doctor and see if it’s really healed or not.”
In during that time between when you’ve seen the doctor and decided that you’re going to get a CT scan to really confirm whether or not it’s healed. And then a couple of weeks later, maybe when you actually go back to the doctor and get an appointment to review the CT scan, you make a huge mistake and that is that you’ve been told and it’s not that you’re crazy for doing this. It’s just sort of basic psychology. You’ve been told it’s probably okay for you to test it out. It’s probably okay for you to try it out or we can get a CT. But what that does is in your mind, you’re at home and you made some calls. You’ve scheduled a CT scan for a couple of days and you’re sitting on the couch and you’re moving your foot doing your range of motion exercises and stuff and you think “Well what’s the big deal? I’m just going to walk to the refrigerator. I mean he said I could test it out. It’s not really that big of a deal. I’m just going to test it out a little bit. It’s going to walk to the bathroom and walk to the refrigerator. I’m going to walk to the mailbox.”
Next thing you know, you’ve actually without really deciding to do it. You’ve taken a bunch of steps that you decided when you got the CT scan you weren’t going to take. That is a problem because if it’s not actually healed, you can move it and if you only have a teeny amount of healing that’s happened, and you actually move it. You’ve wasted weeks of actual return to running time because you’ve disrupted the fracture healing when it’s almost healed. So don’t do that.
If you decide to get a CT, stay off the foot, do not walk on it, use your crutches, use your boots, use whatever the last thing was your doctor told you to do, so that you don’t disrupt that healing right before you hit the finish line. That’s the crucially important piece.
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