What are the three ways you could tell whether or not a metatarsal fracture non-union is stable without getting an imaging study? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
This episode actually comes from a discussion I called with a runner who called me for a second opinion. She had a stress fracture non-union and somebody had remained recommended that she have surgery.
I was looking at her CT scan and she asked me an interesting question. She said, “Does it look stable?” And I said, “Can’t tell.” It looks like a non-union. It looks like it’s broken and never healed. But a CT scan is where you’re sitting still in a scanner, we’re not pushing on it, pulling on it or trying to move it. So, I can’t actually tell even based on a CT scan if it’s really stable or not.
If you have an ultrasound unit and we actually put it up against your foot and look at the images and then move the bone and see if it moves, I could tell with that imaging study but that’s the only one. An X-ray, an MRI, a CT scan, they don’t actually show you if it’s truly stable or not.
How can you tell? Well, the first thing is to try to move it by hand to literally feel if you can move the bone, if part of it is holding still, a part of it wiggles when you push on it, pull on it or move it, well then you know it’s unstable. Don’t do any of this stuff unless you talk to your doctor. So, don’t try it, make yourself worse and say that some guy on YouTube told me to do it. I’m telling you, this is how I would tell.
The other way is if you stand up and you see it visibly move. So, when you stand up on your foot, and if you see the metatarsal head actually the one that’s has the non-union is actually moving under the skin, well then clearly, it’s not stable.
The other way isn’t quite as direct and quite as dramatic. But if you have a non-union and you’re running and you’re getting lots of swelling with activity, then to me it insinuates that it must be unstable because it’s moving enough to cause inflammation in and around the non-union and that applies instability in itself if you’re getting lots of swelling.
So, if you have one of these things, and it’s been calming down, it’s been getting better, but you’ve been sitting around doing nothing forever, you’ve got to get the Running Injury Roadmap. It’s the thing I wrote, it’s really simple. It’s basically if you call me for a consultation, the first thing I would do is get you to shift your thinking from being somebody with an injured foot to somebody that wants to run and wants to maintain their fitness in spite of an injured foot, and it walks you through that whole process. So, if you want to get it, you can get it for free at www.docontherun.com/roadmap. Go check it out, and I’ll see you there.