When P was 7 years old she wanted to play soccer and so we signed her up in a rec league. Soccer turn out not to be for her. She spent most of her time standing in her position on the field and wiggling her loose tooth. She rarely chased after the ball. One morning following a game the top of her foot was swollen and it hurt to put weight on her foot. We felt this was odd because she hadn't really done anything during the game to hurt herself.
After many different doctor visits, she was finally diagnosed with a stress fracture on the end of the second metatarsal. It was formally named Freiburg's Infraction, which is common in the second metatarsal and in young girls. She was not placed in a cast and we were told that she would have pain on and off again for about a year until the bone healed itself.
When she was around 9 we noticed that the second toe was shorter than the other toes. After x-rays and a doctor visit we found out that as the second metatarsal healed from the stress fracture, the growth plate solidified. We now realized that the second metatarsal would not grow any longer and would continue to look shorter and shorter as all the other toes grew. Not much could we do at this point, we just needed to keep an eye on it and reevaluate as she continued to grow.
At age 11, we realized that we were going to have problems with this short toe. It didn't want to stay in place, instead it would overlap the third toe and the big toe started to move over to fill the gap. After seeing an Orthopaedist in New Jersey, he highly suggested that we make arrangements to have surgery to have the second metatarsal lengthened. Since she is still growing yet closing in on her final height, the doctor would know how long to lengthen the toe. Due to our impending move to Alabama we could not pursue any further course of action with this doctor and waited until we were settled to start the process again.
P is now 12 years old. Once we moved to Alabama the toe situation got worse. She started having pain in the ball of her foot whenever she skated and then progressed to having pain whenever she was walking. When we started seeing the pediatric orthopaedist we found out that this pain was associated with her short toe. Since the joint between the second metatarsal and the toe no longer lined up with the other joints, it was no longer located under the fatty part of the ball of the foot. That joint was feeling like a rock in her shoe, a constant burden.
The following is the procedure that P underwent in order to lengthen the second metatarsal. Beware, this part might make you feel queasy. The surgery involved putting 4 pins in her second metatarsal, 2 at each end. Then the doctor drilled several small holes in the bone between the pins in order to break the bone. A jagged edge is better than a straight edge for bone growth. He then attached a fixator to the outside of the foot which connects the four pins together by a screw. Finally a pin was inserted down the length of her second toe which extends out past the end of her toe and is bent up and over the toes . This was done because as the bone is lengthened the muscles do not stretch as easily and the doctors have learned that the toe will dislocate if not secured into place.
After almost a week of healing from the surgery, we started the lengthening process. Twice a day, after she has had her pain meds, we place an allen wrench into the end of the screw and turn it 90 degrees. By doing this, we slightly stretch the bone apart at the break and then the amazing body will start filling in the gap with new bone. We are in a sense tricking the body. By going slowly and steadily at the lengthening hopefully a strong and uniform growth of new bone will result. Each day we lengthen the toe by 1/2 mm. Our goal is an increase of 15 mm, so that will take approximately 4 weeks of turning.
After the 4 weeks of turning, the Doc will remove the pin that is down her second toe. She is then allowed to put some weight on her foot. The other 4 pins will stay in another 4 weeks to allow the new bone to get strong. After that, P will go back into surgery to have the pins removed. The Doc promises that this will be easier than the first surgery - all he needs to do is unscrew the pins from the bone. However, she will now have 4 holes in that bone, and will most likely be put in a cast for another 4 weeks until new bone fills in the holes.
Here is a lovely x-ray of P's foot a week after surgery. You can see the four pins in the second metatarsal along with the long screw connecting them. The most unsettling part is the pin sticking out the end of her second toe.
Please keep P in your prayers because this will be a long undertaking for a girl of 12! She has handled everything so far fantastically - she is such a mentally strong person -but constant pain and discomfort can really wear a person down!
1 comment:
Yowsa! Thanks for sharing that, R. We'll keep praying for P and her toe. I'm so glad there's a way to fix it, even if it IS painful.
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