Need advice on boot for broken foot

Bones, joints and muscles
1

I broke my foot just under a week ago, although I've only been in a cast/boot for two days - first went to the walk-in centre who told me it was a sprain, then went to minor injuries two days ago after no improvement with rest and elevation. They X-rayed me and put me in a temporary plaster cast with crutches, then referred me to orthopedics the next day.

I've fractured the middle three metatarsal bones in my right foot (the doctors at minor injuries called it a Lisfranc, but the orthopedic surgeon didn't, so I'm not sure), but according to the orthopedic surgeon it's a stable break with no displacements or dislocations, so they're not going to operate. I complained about the plaster being uncomfortable (it was too heavy and made my foot freezing cold) so they took it off and gave me one of those big moon boots which I have to wear for the next six or seven weeks at least.

I've never broken a bone or had to wear one of these boots before, so I feel a bit at sea with the whole thing. They didn't give me much advice other than to take the boot off to wash and dress, and to start off non-weight bearing but try to gradually ease into walking in the boot over the coming weeks as pain allows. If anyone else has been in a similar situation I could use some advice:

- Do I have to sleep with the boot on? I tried last night (just with the straps loosened) and it's SO uncomfortable - I already miss being able to sleep on my side and I'm bad at falling asleep as it is let alone with a sore foot! The nurse who fitted me with the boot said I could take it off at night if I wanted, but now that I've had it on my foot feels so naked and unprotected without it and I'm scared I'll do more damage to it through the night. What do you reckon?

- How long would you wait before attempting weight bearing in the boot? I don't want to try too soon and risk damaging my foot even more as it's a new injury, but I also don't want to prolong my recovery after the fracture heals by letting the muscles waste away, not to mention crutches are the devil. From what I've read online most people with metatarsal fractures are non-weight bearing in plaster for a good few weeks before easing into using a boot, so I'm a little confused as to why they want me to try weight bearing so soon.

- How do I know if my foot is being properly supported by the boot? When I first had it put on it felt like it was slipping down slightly as I hopped around on crutches, which concerned me. I've since tightened it up slightly but now I'm worried about compressing my foot too much and either cutting off the circulation or damaging the broken bones, as they're in the top of my foot where the straps press down. My foot has felt more sore and painful since I've had the boot too, which is worrying me (I don't know if it's because I can't put ice on it?). Should I call the hospital and ask for it to be adjusted/re-fitted?

Sorry for the long post - I have hypochondriac tendencies, so with every jolt or twinge of my foot I just feel like it's being damaged instead of healing! I think I've just resigned myself to feeling constantly uncomfortable and worried for the next couple of months until it heals.

2

Hello,  I just had the 2 year anniversary of when I had a Jones fracture, 3 breaks in 5th metatarsal near the rear of my right foot. I was in a non weight bearing cast for 4 weeks.  I kept my foot elevated as much as possible during that time.  The schedule was to go into a weight bearing cast for another 4 weeks but I was allowed to go into a high heavy boot all day and night instead because my xray showed healing was taking place.  I was not to try any walking with out the boot.  I used a walker with the boot and over the next 4 weeks was able to shift from relying on the walker to carry most of my weight to walking with just the boot.  The first night was horrible and I wanted my cast back.  The boot was so painful at night I couldn't sleep.  I learned that I had the straps way to tight covering the hard plastic front shell of the boot.  I didn't have a problem after that because I left that front shell off at night.  I doubt that you would do any damage to your foot if, as your nurse told you, you didn't wear the boot to sleep.  I had to wear it because my doctor thought that I would get up in the middle of the night to go into the bathroom and not take the time to put the boot on to do so.  You could get up without the boot and use your devil crutches to avoid that possibility.  Does your boot have the hard plastic shell that covers the padding that covers the front of your leg from knee to toes that the boot straps wrap over to tighten the boot?  If so I doubt that you could pull the straps tight enough to cut off circulation or damage the break.  Remember your break was not displaced.  It was stable as it is.  However,  you could probably add some additional padding before you cinch up your boot if that would make you less worried.  Try that with a pair of thick socks.  Don't put them on just lay them on top of your foot and leg before everything else.  How tightly are you making your boot?  I was making mine too tight to begin with and that's why I couldn't sleep at first.  It's kind of a learning curve as we go along we find what works best.  Your muscles will not waste away during this time and ice is used early on after an injury.   Regarding your feelings of doing damage if you feel a twinge etc.  A jolt or twinge is not a sign of injury but some feel twinges when healing.  Also, will constant worrying change the outcome or time frame of your healing process?  I can tell you that it takes as long as it takes and all of us want everything to be over ASAP.  No amount of worry will make anything go quickly.  What makes the time go quickly is thinking about other things.   Thank goodness for friends and family.  I hated not being able to drive!  I'm also sorry for the long post but I hope this helps some and that you hear from others too.  Good luck.

3

If they said you could take it off to sleep, probably OK. I was told to leave it on initially. I was only allowed to take mine off after 6 weeks. There is risk that you could displace the bones moving in your sleep. A week is very little time, you'll soon feel better.

4

Thanks for replying! That's reassuring at least - it's good to hear from someone who's been through a similar ordeal (foot fractures are just awful, aren't they?!)

I think the reason my foot has only just started hurting and throbbing is probably because initially I was icing the injury and taking ibuprofen to control the inflammation thinking it was a sprain, but when I went to hospital they told me to take paracetamol instead which isn't as effective for pain relief. The boot doesn't have a front plastic panel (it's one of the ones that's kind of like a big padded sleeve strapped to a splint with a rocker sole), but I've used the extra padding I was given down the front of my foot where the fracture is and it seems to have helped slightly with the discomfort. I think the padded part is pressing down on my foot though, since when I took the boot off to shower I could see an outline and a red mark on top of my foot where it's been - hopefully it's not damaging the broken bones any further? I should maybe try and loosen it slightly as it's one of the ones with Velcro fastening down the front, but I'm worried about the boot not giving my foot enough support. I've been loosening the boot to sleep at night but keeping it on so far - I think as my foot starts to heal and get less painful I'll start taking it off at night, but right now it just feels a bit too risky.

The only thing I'm concerned about is the fact that they've put me straight into a boot for six and a half weeks and told me to try and ease into weight-bearing as soon as pain allows, instead of starting off with a fully non-weight bearing cast. Don't get me wrong, I'm glad not to be in plaster for over a month as I loathed having a plaster cast even for just one day (it was so heavy and clammy and uncomfortable, not to mention I was constantly scared of it cracking or getting wet). But it seems odd that they've given me a boot straight away for a multiple metatarsal fracture when, from what I've seen, most people with similar injuries are given non-weight-bearing plaster casts for at least the first few weeks? Although I haven't come across anyone with the exact same injury as me - the orthopedic surgeon did say that it was unusual for me to have only broken the middle three metatarsals (apparently most people usually break either the first or the fifth ones), and that I was lucky it was such a stable break as dislocations or displacements are common in metatarsal fractures. I know they're the experts and I'm just some hypochondriac on the internet, but I think I've just been left with a lot of residual "oh sh*t" because the doctors at minor injuries were so sure it was a Lisfranc injury that might need extra scans and possibly surgery, whereas orthopedics didn't think that was the case. I'm a little concerned that I have no check-ups or follow-ups for another six weeks, either, as I'd want to know sooner rather than later if anything isn't right or if it's not healing how it should rather than getting a nasty shock in April after weeks of thinking I was getting better...