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Foot & Ankle Problems Message Board

Foot & Ankle Problems Board Index

In September, I misstepped and blessed myself with a spiral fracture of my left 5th metatarsal (distal lateral to proximal medial, full length of the bone).

I was put in a walking cast for 4 weeks, and when it came off, there was no evidence of callus formation or primary healing.

First attempt at surgical repair was in December, but again there was no callus formation despite 8 weeks strict non-weight bearing and 12 weeks casted.

Additional surgery was done in June. The surgeon removed all the hardware and reoriented a new plate, screws and wire. In addition, he used a synthetic grafting matrix to try and stimulate bone growth.

Currently, he says based upon the appearance of the x-ray and what he saw during surgery that healing is simply not going to happen. He considered removing the damaged metatarsal entirely (but leaving the toe) during my last surgery, but as it was far beyond the realm of the consent form, he opted against it.

So, now he is recommending this as the next step. Currently, the base of the bones in my toe are not sitting on what is left of the metatarsal, and I don't have any movement of that toe. If I cross my leg so that my foot is parallel to the ground, the toe just hangs down.

So here is my question... The surgeon says if he removes the metatarsal but spares the toe, the space where it was will fill in with scar tissue. However, as I can't move the toe now due to the bone's deterioration and nerve damage from repeated surgeries, would I be unreasonable to consent to him amputating the toe as well?

Without the bone in my foot, the toe won't help with my balance at all, and having it flopping all over the place is just asking for me to injure it again and again (I am a barefoot at home kind of person).

Does anyone have any sort of experience with something like this who can give me some guidance?
My surgeon here did briefly bring up the idea of bone stim prior to my first surgery after 3 months of no evidence of my body's attempt to heal the fracture. I would have loved to try it, but the price tag (over $5000) was way out of my reach, sadly. I live in Canada - it isn't covered under the provincial health care plan, and even if my secondary insurance had covered it, I would have had to pay the total upfront and after partial reimbursement would have had to "foot" (sorry, couldn't resist) the remaining 20% of the cost. Still out of my reach.

I was offered the loan of a used one from a friend, but the surgeon explained about finite battery life and the fact that the DME that dispensed it wouldn't have supported its transfer (as they would have seen it as lost revenue).

The compliance calendar idea is brilliant - it is a very effective way to stand behind a product (oh, the awful puns!).

As of now, I have had the distal 2/3 of the metatarsal removed. Immediately following the second ORIF, the surgeon said he didn't feel positive that we were going to be successful, and after 4 weeks non weight bearing, there wasn't even any evidence of callus formation. He left the decision with me, but I could see that he felt I would be better off with the excision.

While I wouldn't recommend the recreational removal of bones for entertainment purposes, for me, I think it was a good decision. 6 weeks out it isn't pain free - it's tender and I am reminded that it has been through a lot after a long day, but to be back on my feet and working my way back to baseline feels very good indeed.

I am not without challenges, but looking back I think that I made the right decision given the circumstances. I will be honest, though, the toe is annoying. It seems silly because it is so small on the big scheme of things, but between nerve and muscle damage from the first two procedures and the lack of a supporting structure, it does get in the way.

Small price to pay, though.

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