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Dr.Sawhney, Orthopedic Surgeon
Category: Orthopedics
Satisfied Customers: 7221
Experience:  More than a decade of post qualification experience
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Diagnosed with 3metatarsal avascular necrosis early stages.

Customer Question

Diagnosed with 3metatarsal avascular necrosis early stages. I had a previous dislocated joint which was pinned last year. The doc thinks with constant stubbing of toe has caused it to necrose and it putting me in boot for 2 weeks. How long will I continue to wear the boot and is this the best treatment?
Submitted: 1 year ago.
Category: Orthopedics
Expert:  DocPhilMD replied 1 year ago.

Thanks for this question

I agree with this plan for now

There is a chance it might heal on its own

I would give it about 2 weeks and see what happens

Expert:  Dr.Sawhney replied 1 year ago.


I am an orthopedic surgeon and I would be happy to help you today.

I would like to tell you that the most important measure to help heal the avascular necrosis is avoiding weight bearing on the affected toe.

Two weeks is too short a time for this to heal.It would take at least 6 weeks of rest.

If you keep bearing weight on it the avascular necrosis can progress.

Feel free to ask any follow-up questions.

Customer: replied 1 year ago.
The podiatrist has put me in walker boot but I have noticed after working 2 shifts my foot is more swollen than wearing shoes. Is this normal?
Expert:  Dr.Sawhney replied 1 year ago.

This can be due to straps of the boot being tied tight.

Otherwise you shouldn't get increased swelling with the boot on compared to wearing shoes.

Customer: replied 1 year ago.
I've loosed the straps up and still no direrence in pain and swelling. Also I my foot crunches when I'm trying to massage the foot. It makes this noise in 3/4 interspace I've also send last set of X-rays taken at office.
Expert:  Dr.Sawhney replied 1 year ago.
Thanks for your reply.
X-rays show that the disease is advanced. It is not early stage.
There has been resorption of bone and that is why you feel the crunch in the 3rd 4th interspace.
That also is a reason behind foot swelling.
Still the treatment remains the same that is preventing any loading of the involved bone.
Customer: replied 1 year ago.
This should be cured and pain free if foot is in boot for another 5-6 weeks?
Expert:  Dr.Sawhney replied 1 year ago.
Most early cases of avascular necrosis of metatarsal head would recover just with nonweightbearing but in your case the disease seems to be advanced and may not completely cure just with nonweightbearing.Only time can tell.
Customer: replied 1 year ago.
If does what would be the next step? The doctor has not even touched on this option.
Expert:  DocPhilMD replied 1 year ago.

That would be surgical intervention to replace the necrosed bone

Customer: replied 1 year ago.
Which I understand but what are the approaches? There several different ones.
Expert:  DocPhilMD replied 1 year ago.

This depends a lot on the the exact nature of the problem, where it is affected, skill of the surgeon, etc.

A lot of variables there

Expert:  Dr.Sawhney replied 1 year ago.
Surgery is treatment of last resort here.
It is considered only if severe pain persists.
In most cases debridement and removal of lose body is considered as the first surgical option.
Expert:  Dr.Sawhney replied 1 year ago.
Hope you have found my answer useful.
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