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Walking boot provided faster recovery for avulsion fractures of the fifth metatarsal
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BIRMINGHAM, England — Patients treated with a walking boot for avulsion fractures of the base of the fifth metatarsal returned to preinjury levels of pain and function three weeks earlier than did patients treated with a below-knee cast, according to recent study.
“The walking boot is more expensive, but it provides earlier recovery and return to work,” Mohammad Kamran Shahid, MBChB, MRCS, MSC (ORTH ENGIN), of the Department of Orthopaedics and Traumatology at Yeovil District Hospital, Birmingham, U.K., said. “Patients can return to their preinjury level three weeks earlier—at 9 weeks as opposed to 12 weeks with the short-leg cast,” he said.
Shahid and colleagues compared pain, functional outcome and time taken off of work after treatment with a short-leg cast or Aircast walking boot (DJO Global; Vista, Calif., USA).
Thirty-nine patients with acute avulsion fractures of the base of the fifth metatarsal provided consent to participate in the study. Of these patients, 23 patients were treated with a below-knee cast and 16 patients were treated with the walking boot. Treatment was at the discretion of the consultant at the time the patient presented in an outpatient clinic.
Questionnaire to assess function
Researchers assessed functional outcome with a validated VAS Foot and Ankle Questionnaire at 3 weeks, 6 weeks, 9 weeks and 12 weeks post-injury. According to Shahid, the questionnaire consisted of 20 questions, including 11 questions that were based on function, four questions based on pain and five questions based on other complaints.
All fractures were clinically united at 12 weeks, Shahid said at the British Orthopaedic Association Congress.
Patients treated with the walking boot returned to preinjury levels of pain and function at approximately 9 weeks compared with at 12 weeks for patients treated with the short-leg cast. Based on the results, patients with walking boots also reported less pain between 3 months and 12 months than did patients treated with a short-leg cast, and patients reported significantly better function with the walking boots at 3 weeks, 6 weeks and 9 weeks, but not at 12 weeks.
Return to driving results
“Patients returned to their preinjury level of driving at 6 weeks with the walking boot as opposed to 12 weeks with the below-knee cast,” Shahid said.
Overall, patients reported taking time off from work for a mean of 35.8 days, but again, patients treated with a walking boot took off from work for fewer days compared with those treated with a short-leg cast: a mean of 31.5 days vs. 39.2 days, he noted.
According to Shahid, long-term follow-up of these fractures is challenging because of financial and time constraints and because most of these fractures typically heal well.
“Most departments would discharge them for physiotherapy follow-up and to return if they have any concerns,” Shahid told Orthopaedics Today Europe. “We were fortunate in our relatively non-busy district general hospital, where we would follow up such patients for some time, which allowed for this study to look at their outcome using a validated questionnaire.” – by Tina DiMarcantonio
- References:
- Shahid MK. Paper #437. Presented at: British Orthopaedic Association Congress; Oct. 1-4, 2013; Birmingham, England.
- Shahid MK. Foot Ankle Int. 2013. doi:10.1177/1071100712460197.
- For more information:
- Mohammad Kamran Shahid, MBChB, MRCS, MSC (ORTH ENGIN), can be reached at 46 Pereira Rd., Harborne, Birmingham, B17 9JN, UK; email: kamren35@hotmail.com.
Disclosure: Shahid has no relevant financial disclosures.