Q: I had a partial fracture at base of 4th Metatarsal bone of the Rt foot, about 11 days back. The bone is in alignment and undislocated. I have very little pain and no significant swelling. I have been using a crepe bandage. On consultation with Orthopaedician, he said I can have a choice between crepe bandage and plaster. Against crepe bandage he said that swelling will come and go and the healing may be slightly delayed. What do you say? Please advise.

A:What you have asked is often asked by patients who have fractures on their feet. They are very uncomfortable with the thought that they will have to be in plaster for any length of time. Therefore, they try to give all kinds of excuses to avoid a plaster. Let me explain to you the actual process of healing in fracture then perhaps, you can make your own decision. When a bone fractures chemical substances are released along with other changes, which initiate the formation of bone. Bone formation, in normal circumstance takes anywhere from 3 weeks to 4 months. However, radiological (X-ray) evidence of healing usually comes by about six weeks. The degree of healing that is seen varies depending on the site and the type of bone involved. There is no mechanism by which healing process can be hastened. Healing is a natural process and it cannot be created by intervention by the surgeon or physician. There are several conditions which delay healing. Inadequate immobilization is one such reason for delayed union. When plaster is applied all that it does is to reduce movement occurring at the fracture site. This is like sapling taking roots; only if it is allowed to be in place without movement. Failure to apply a plaster leads to movement at the fracture site which then contributes to delay in the union. Eventually, particularly in the small bones of the hands and feet, it may go in to union despite some movement. A crepe bandage only helps provide some compression to prevent the swelling which is normally present in such cases because of the injury or because decreased activity of the limb. A crepe bandage can never provide immobilization. To come to your case, ideally you should be in plaster for about 4 weeks by which time the fracture is sticky enough to allow movement. If you are not putting weight on the foot and you are walking on your heels without putting on the forefoot, you may get away by not using a plaster. However, since the rest provided is never adequate (even a blanket on your foot causes some movement of small bones of foot) there will be some delay in healing and persistence of pain and swelling.