I decided to write about this one because I am currently living it in my household. I have three kids (11,8 and 3 years old), and it seems as though at least one of them gets hurt in some way every day.
My 8-year-old is quite honestly tough as nails, but he is very injury prone. Maybe he is unlucky, clumsy, aloof.......I think it is a combination of all three of those. The way he broke his foot will most likely make you chuckle a bit.
About a week and half ago, he was in his room changing out of his wet swim clothes after we got back from a little family swim at the neighborhood pool. As we all know, wet clothes can be hard to take off. He apparently lost his balance because he got stuck in his swim trunks trying to pull them off. He stepped awkwardly but forcefully down on his right foot to catch himself. Unfortunately, he landed on the outside part of his foot causing his foot to roll over. He described a painful crack on the outside part of his foot.
I had my suspicions in the moment that he could have broken his foot because the pain was located directly over the 5th Metatarsal, which is the long skinny bone on the outside of the foot. It connects to your pinky toe. I usually think of worst-case scenarios when it comes to my kids' injuries because I have seen so many bad orthopedic injuries and overlooked injuries in my career, but he said it was feeling better after a short period of time. For this reason, I did not rush off to get x-rays just in case he only sprained his foot.
He continued to limp around the house the rest of that day, but he still insisted it was improving. The next day was a school day. I woke him up and asked him how his foot was doing. He said, "It still hurts, but I think it's getting better." I dropped him off at school and watched him limp on in thinking that he had dodged a bullet and didn't break his foot. This was the parent in me and not the clinician in me because the clinician should have known better.
I was halfway thinking that I would get a call from the school nurse at some point that day to tell me his foot was really bothering him, but that did not happen. Remember.......this kid is tough as nails.
He got home and was still limping around. He still gave me the same line that it hurt but wasn't terrible.
I decided to do a thorough evaluation of the foot as if he was coming in to see me as a patient. He had developed some swelling over the area over the course of the day, and his pain was so focal to one area on the 5th metatarsal that I had to take him in for x-rays.
This is where I believe the Orthopedic gods decided to punish me for not trusting my gut initially and taking him in for evaluation.
As I mentioned in a previous blog post, I am not currently practicing in an Orthopedic Clinic. I am a stay-at-home dad. For this reason, I couldn't just take him in the back door at my clinic to get some quick x-rays. Our city has an Orthopedic Urgent Care Clinic that is nice because you generally do not have to wait long because they are not seeing patients with general medical issues to stack up the waiting room like a traditional Urgent Care or Emergency Room.
That was far from the case on this day though. We walked in, and the waiting room was packed. Long story short......we were walking out of there three hours later with a fancy new walking boot for my son that he will be wearing for the next month or so. I honestly think the pain of the three-hour wait was much worse to him than the actual injury.
Since you most likely didn't come here to hear a day in the life of my family, let's talk a little science before I wrap this one up.
He has what is called a "Buckle Fracture" of his 5th Metatarsal. Buckle Fractures are common in kids. It is where the bone bends and deforms a little bit but does not fully break in two. Bones in kids are much more pliable than adult bones, so many times they bend but don't break. You can usually see a little bit of a bulge on the injured area of the bone. These abnormalities can be subtle, so the provider needs to really scrutinize the images. His x-ray is below with an arrow pointed to the buckle:
We will go back for follow up x-rays at the two-week mark to see how it is healing and to make sure nothing has shifted. These types of fracture are pretty stable, but you can never assume broken bones will not move. If all is well, we will give him a few more weeks to heal, then he can be a normal kid again. Unfortunately, it looks like he will miss his flag football season, but he should be good to go for basketball.
Hunter Greene, MS, ATC, OPA-C
Comments