The Healing Process of a Fracture: Why Does My Foot or Ankle Fracture Hurt A Year Later?
Posted by Jenn F. on Monday, November 16th, 2015
Last Christmas Eve, I stepped on my German Shepherd’s Nylabone while walking down the stairs with a load of laundry. It had been sneakily placed right up against the step and caused my foot to roll outward as I stumbled. It didn’t take me long after hearing the tell-tale crunch, observing the bruise, and feeling the warm rush to know that I had cracked my fifth metatarsal.
What’s a person to do in that situation? An x-ray and expert diagnosis is always a good step. From there, it’s basically up to the individual to run through the regular course of rest, ice, compression, and elevation. The first two weeks of off-loading, getting around the house with a walker, and caring for a baby with a bum foot was worse than the pain itself. About three months later, I shed my compression garment and was able to resume brief stroller walks again. If I did too much, my body let me know and I backed off a bit.
It’s been almost a year since my injury, but every once in a while, that deep ache returns and I worry that something is amiss. So I asked the good doctors at The Center for Podiatric Care and Sports Medicine, “What gives? What might cause a person’s fracture to experience residual pain after healing has supposedly taken place?”
The Healing Process of a Fracture
Fracture healing is divided into three stages:
- Inflammatory stage: If you were to look at an x-ray right now, a fractured bone would just look “broken.” Yet, there is plenty of unseen activity going on. As soon as the bone breaks, cellular activity at the fracture site increases, the bleeding forms into clots, and the bone knits together with fibrous tissue over the first few days or week. Inflammatory cells (macrophages, monocytes, lymphocytes, and polymorphonuclear cells) and fibroblasts form granulation and vascular tissue. Nutrients and oxygen flow to the exposed bone. Anti-inflammatory medication can interfere with the process at this point, so we do not recommend it.
- Healing stage: For the next six to sixteen weeks, the body lays down building block tissue that supports vascular ingrowth, followed by soft cartilage and new bone, which can be seen by x-ray several weeks after your injury. The bone can support your weight, but is not entirely healed and remains delicate for the first four to six weeks in particular. Bracing and fixation are important for healing. Nicotine interferes with this part of the process, so we advise patients to do their best not to smoke.
- Remodeling stage: At this point, we can still see where the bone has been broken in our imaging tests. The bone continues to become more compact, blood circulation goes back to normal, and the bone assumes its original shape. Weightbearing and physical therapy become important mechanisms for remodeling, as the body picks up on these signals to lay down bone where it is needed and reabsorb bone where it is not needed. Children show complete healing within a few years, but adults continue the remodeling process indefinitely, even though adequate strength is typically achieved in three to six months. Sometimes inflammation, swelling, and pain follow.
Possible Bone Healing Complications
Full healing from a fracture can take as long as a couple years if there has been nerve damage, ligament and tendon damage, scar tissue development, or arthritis.
Long-term complications are rare, but may include:
- Compartment Bleeding Syndrome: Primarily associated with “crushing” trauma, broken bones or torn muscles cause swelling within the muscle compartment.1http://emedicine.medscape.com/article/825060-followup When pressure becomes too high, circulation is cut off to living muscle, which may then die, causing severe pain.
- Malunion: Bones that heal out of alignment come together in an abnormal shape, appearing rough and irregular and causing limited, painful movement and premature joint wear.
- Post Traumatic Arthritis: When the foot joint wears out due to malunion, patients experience pain and stiffness. This process is similar to osteoarthritis (the wear and tear of old age), but becomes accelerated when the joint is damaged.
- Refracture: Stress fractures may occur if the healing process is rushed or if surgical fixation is not successful.
The Role of Physical Therapy in Foot Fracture Healing
Most residual pain is related to weakened soft tissue support structures. Physical therapy can be particularly helpful at this stage, since the body strengthens or reabsorbs bone depending on the mechanical demands placed upon it. Physical therapists at The Center for Podiatric Care and Sports Medicine may use exercises, ultrasound, electrical stimulation, massage, or injection therapy to help you recover from a fracture. They can also prescribe medication that addresses acute pain, without interfering with the body’s natural healing processes. Contact NYC foot fracture specialists for more information.
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If you have any foot problems or pain, contact The Center for Podiatric Care and Sports Medicine. Dr. Josef J. Geldwert, Dr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.