jed@twitch.UUCP ( J.Dail) (02/27/86)
About 5 weeks ago, I fell and injured both feet. They ended up underneath me. I went to a hospital and they Xrayed one foot and decided that I had over-extended a muscle on the top of the foot, pulling away a small chip of bone (<1/4 inch). The emergency room physician was not an orthopedic expert, but told me of the chip and suggested that I see an orthopedic surgeon. One was called and showed up two hours later, after at least one more call by the emergency room personnel. I don't know his problem, but he was not willing to discuss treatment alternatives and ikely outcomes. He suggested that the foot be placed in a cast. Because of his hostile attitude, unwillingness to answer questions, and the delay he caused me sitting with an ice pack for hours, I decided to get a second opinion. I requested and received copies of the X rays and arranged to see an Orthopedic surgeon, who was referred by the Emergency Room. The second doctor reviewed the X-ray and agreed that a small piece of bone had been pulled away by the muscle. His recommendation for treatment was entirely different, suggesting that exercise would be required once the swelling had subsided. He did not agree to placing the foot in a cast. I now had two pieces of conflicting medical advice and two very sore feet. Not wanting to have a cast in the first place, I sided with the second doctor. Needless to say, I am still concerned who was right and both feet still hurt though I am able to walk. The second foot which was also injured is another story, which because of length I will omit here. My questions to any who have knowledge or experience in these problems are: How will this separated muscle/bone chip be able to reattach if it is continually being moved during walking, standing, or just moving my feet? How long should it take to heal? Should I be exercising now to strengthen the injured area or should I try to keep pressure off it? I was using a cane, but the doctor suggested I stop after two weeks. Should I get a third medical opinion, since the two Orthopedists disagree about treatment? Thanks for the information, if anyone can offer help.
john@ur-tut.UUCP (John Gurian) (03/02/86)
> About 5 weeks ago, I fell and injured both feet. They > ended up underneath me. I went to a hospital and they > Xrayed one foot and decided that I had over-extended a > muscle on the top of the foot, pulling away a small chip > of bone (<1/4 inch). The emergency room physician was > not an orthopedic expert, but told me of the chip and > suggested that I see an orthopedic surgeon. > Sounds like you sustained an "avulsion fracture" where the bone is pulled off (avulsed) by the connecting tendon. Usually, it's not that big a deal; the bone chip avulsed is usually just reabsorbed and the tendon will heal on its own. It will probably take a few weeks, depending on how much of the tendon was left attached to the bone - usually only a small portion is avulsed. You should probably take the advice of the second orthopod, as his management seems more prudent - remember, primum non nocere, and as the book "House of God" pointed out, "Do as much nothing as possible" is usually the safest treatment for most medical conditions. Usually, pain is a pretty good indicator of how much you can walk on it. If you look at the X-ray yourself, you can probably see a small white "density", as it's called, sitting in the dark joint space between the two bones. I'd still be demanding answers from the orthopod that's following you on the indications for the two differing management plans. Remember the old adage: "To be an orthopedic surgeon, you have to be as strong as an ox, and at least as smart as one". -- -- John Gurian -- !rochester!ur-tut!john
jin@hropus.UUCP (Jear Bear) (03/04/86)
If you really want to be confused see a Podiatrist :-> . Seriously, a Podiatrist specializing in Sports Medicine (and I'm not sure if there is a formal specialization procedure) may give you, or others, an alternative view to the "Orthopods". Check with your local runner's clubs for recommendations. -- Jerry Natowitz ihnp4!houxm!hropus!jin The Master Baker