MRI shows broken foot for ds--advice??

[Harriet Vane]

Update below

 

Hi folks,

 

I posted about ds' foot injury a week ago.

 

New information today:

 

I insisted on an MRI. Ds also has an appt tomorrow morning really early with a pediatric orthopedic dr.

 

Here is the MRI summary:

 

Edema and linear areas of low signal within the navicular bone, medial cuneiform and anterior aspect of the cuboid suspicious for nondisplaced fractures and bone contusion. Contusions in some of the other bones including the talus, calcaneus and middle cuneiform.

My questions:

 

This sounds like hairline fractures and bruising to me. Is my perception accurate?

 

The dr's office has already warned me that the type of wrapping is based on the nature of the injury. Okay, understood. They have also warned me that they do not normally do waterproof casts on the lower extremities. HOWEVER, we are going to family camp on Saturday. Not only is this a remote location many miles from meaningful medical care, but it is also a large campus and rain is forecast for the week. I am prepared to beg for a waterproof option for ds as I cannot fathom how on earth we will manage to keep him dry. In addition, if we can at least kayak with him it will salvage the week for him--he is totally brokenhearted about the state of his foot and lack of sports mobility.

 

--Help me understand why a waterproof cast would not be appropriate for lower extremities?

 

--How forcefully should I attempt to persuade them to work with us on the waterproofing? (Forcefully but in a syrupy sweet, totally respectful way of course. ;))

 

--What questions should I ask the doctor? Advice in general for foot injury?

Thanks.

 

UPDATE:

 

The ortho was wonderful. Just wonderful.

 

My kids thought her assistant was wonderful because he looks like Commander Riker from Star Trek (Next Gen).

 

Ds is in a boot and was given a waterproof cover to go with it. He has permission to take off the boot to swim or even kayak in calm water. I am truly so thankful--this will be much easier to deal with than a cast.

__________________

Edited June 23, 2010 by strider

[Perry]

Hi folks,

 

I posted about ds' foot injury a week ago.

 

New information today:

 

I insisted on an MRI. Ds also has an appt tomorrow morning really early with a pediatric orthopedic dr.

 

Here is the MRI summary:

 

Edema and linear areas of low signal within the navicular bone, medial cuneiform and anterior aspect of the cuboid suspicious for nondisplaced fractures and bone contusion. Contusions in some of the other bones including the talus, calcaneus and middle cuneiform.

My questions:

 

This sounds like hairline fractures and bruising to me. Is my perception accurate?

 

The dr's office has already warned me that the type of wrapping is based on the nature of the injury. Okay, understood. They have also warned me that they do not normally do waterproof casts on the lower extremities. HOWEVER, we are going to family camp on Saturday. Not only is this a remote location many miles from meaningful medical care, but it is also a large campus and rain is forecast for the week. I am prepared to beg for a waterproof option for ds as I cannot fathom how on earth we will manage to keep him dry. In addition, if we can at least kayak with him it will salvage the week for him--he is totally brokenhearted about the state of his foot and lack of sports mobility.

 

--Help me understand why a waterproof cast would not be appropriate for lower extremities?

 

--How forcefully should I attempt to persuade them to work with us on the waterproofing? (Forcefully but in a syrupy sweet, totally respectful way of course. ;))

 

--What questions should I ask the doctor? Advice in general for foot injury?

Thanks.

I have to leave in a few minutes but will try to quickly answer a few things:

 

I wouldn't call it a hairline fracture- those are typically caused by repetitive stress (like running, causing shin splints). He had a traumatic injury, so if there is a fracture, I'd think it would be more significant than just a hairline fracture.

 

You are right about the contusions being bruises.

 

I would be concerned about kayaking with a cast. What if it capsizes? Could he get out? Could he swim with a cast on? It sounds risky to me, but I am not a kayaker. I would definitely ask the doctor about it tomorrow.

 

:grouphug: to your son. This stinks.

[Harriet Vane]

I have to leave in a few minutes but will try to quickly answer a few things:

 

I wouldn't call it a hairline fracture- those are typically caused by repetitive stress (like running, causing shin splints). He had a traumatic injury, so if there is a fracture, I'd think it would be more significant than just a hairline fracture.

 

You are right about the contusions being bruises.

 

I would be concerned about kayaking with a cast. What if it capsizes? Could he get out? Could he swim with a cast on? It sounds risky to me, but I am not a kayaker. I would definitely ask the doctor about it tomorrow.

 

:grouphug: to your son. This stinks.

 

Thanks. I was hoping you would be out there and able to offer your thoughts. We'll have to think this through carefully.

Edited June 22, 2010 by strider

[keptwoman]

Strider, a few years ago DD broke her leg the day before we flew to the US for a family holiday in the height of summer. She couldn't have a full cast due to the air travel, so her cast was a plaster one at the back and bandages at the front. We purchased a waterproof cast cover for her, think giant condom. It enabled her to swim and kayak etc. The only thing was that it couldnt be worn for long periods, so it would not have worked as rain cover :(

I would think kayaking in a cast was fine, as long as he could still bend at the knee, I'd be checking his exit procedure from the kayak before he gets in one in the water, most lifejackets would be ample to hold up a child with a cast unless the child is very near the top of the weight range for the jacket.

I would have thought a waterproof cast was fine myself, I'm sure I've seen kids sporting them, but I'm no medico. Good luck!

[Harriet Vane]

Strider, a few years ago DD broke her leg the day before we flew to the US for a family holiday in the height of summer. She couldn't have a full cast due to the air travel, so her cast was a plaster one at the back and bandages at the front. We purchased a waterproof cast cover for her, think giant condom. It enabled her to swim and kayak etc. The only thing was that it couldnt be worn for long periods, so it would not have worked as rain cover :(

I would think kayaking in a cast was fine, as long as he could still bend at the knee, I'd be checking his exit procedure from the kayak before he gets in one in the water, most lifejackets would be ample to hold up a child with a cast unless the child is very near the top of the weight range for the jacket.

I would have thought a waterproof cast was fine myself, I'm sure I've seen kids sporting them, but I'm no medico. Good luck!

 

Thanks for your perspective. I hope the dr tomorrow agrees with you--I'd really like to see ds able to do at least some things.

 

Dh is quite experienced with both kayaking and canoeing, and the water in the area is not challenging. The idea would be that while ds' group is hiking, dh would kayak ds to a rendezvous point so that ds could participate in some of the activities. Most of this would be on small, quiet creeks or hugging the coast within a bay.

[amyinva]

We have always basically insisted on waterproof casts. They always grumble, for some reason, then put them on anyway. We've never had a problem.

 

Edited to add that ours were not lower extremeties, so that might make a difference.

Edited June 23, 2010 by Amy in VA

[Carrie12345]

I just had a "nondisplaced fracture" of the cuboid w/ankle sprain. After more than 2 months, I'm still not *fully* recovered (but close). There's no way I would recommend kayaking or any sort of activity that carries a risk of putting extra strain on his body (like in the event of capsizing).

 

JMO based on my experience.

[kalanamak]

Thanks.

 

My kiddo is nearly 8 and he had a twist and a fall and wouldn't weight bear. When it continued into the next day with point tenderness, I did take him to the ortho (we don't go to the doc for everything). Because I'm a doc and friends with the clinic manager, the ortho felt comfortable telling me what "he'd do for his kid", rather than the standard spiel to avoid a lawsuit (orthopods get sued quite a bit).

 

There was a possible little shadow on the Xray right where it was tender. He said he wouldn't bother with an MRI. Kids that age are so cartilagy MRI doesn't usually give any new info that changes treatment. He said he could cast it, but that most kids end up stamping around on it, getting itchy underneath and sticking a pencil down and scratching it and getting a skin infection (I have seen this), etc.

 

Alternatively, we could just put him in a supportive shoe/boot and keep him off it. I asked kiddo what he would do. Kiddo voted for shoe. He was much better in a few days, and he, too, was bummed out over missing some days of action. He was able to start swimming in about 5 days, and learned quickly to not do hard stuff even 3 weeks later. I gave him the "all clear" at 6 weeks. He'd been a good boy about it all.

 

Having been FOAF (friend of a friend) of 2 people who lost children in kayaking incidents, I, too, would not put a cast in a kayak. My boy kayaks, too, and, if someone had done all the carrying, he could have done that with his "spot on the X ray".

 

Hope kiddo heals well, and gets over the inconvenience of having to baby his body a bit.

[Harriet Vane]

My kiddo is nearly 8 and he had a twist and a fall and wouldn't weight bear. When it continued into the next day with point tenderness, I did take him to the ortho (we don't go to the doc for everything). Because I'm a doc and friends with the clinic manager, the ortho felt comfortable telling me what "he'd do for his kid", rather than the standard spiel to avoid a lawsuit (orthopods get sued quite a bit).

 

There was a possible little shadow on the Xray right where it was tender. He said he wouldn't bother with an MRI. Kids that age are so cartilagy MRI doesn't usually give any new info that changes treatment. He said he could cast it, but that most kids end up stamping around on it, getting itchy underneath and sticking a pencil down and scratching it and getting a skin infection (I have seen this), etc.

 

Alternatively, we could just put him in a supportive shoe/boot and keep him off it. I asked kiddo what he would do. Kiddo voted for shoe. He was much better in a few days, and he, too, was bummed out over missing some days of action. He was able to start swimming in about 5 days, and learned quickly to not do hard stuff even 3 weeks later. I gave him the "all clear" at 6 weeks. He'd been a good boy about it all.

 

Having been FOAF (friend of a friend) of 2 people who lost children in kayaking incidents, I, too, would not put a cast in a kayak. My boy kayaks, too, and, if someone had done all the carrying, he could have done that with his "spot on the X ray".

 

Hope kiddo heals well, and gets over the inconvenience of having to baby his body a bit.

 

The thing is, it's been more than a few days. The original injury was on June 3. Ds has been totally, completely responsible about not weight-bearing, believe it or not--he's been absolutely great about using his crutches or hopping. Even so, with all the rest care we've given him, he's still in definite pain when he puts his weight on it or when the doctor probes his foot. That leads me to think that the mri findings hold validity???? Or do you think the "cartilagy" nature of a 9yo foot would still obscure things? I ask because if that's a possibility, that's a point I would want to bring out with the ortho tomorrow.

 

I pray they consider a boot for him. It would be ever so much easier than dealing with a cast.

 

Also, when you say you wouldn't put a kid with a cast in a kayak, do you mean a kayak specifically or in any watercraft? I truly don't want to risk further injury for ds (in the last two months he has hurt his foot AND broke his two front teeth, it's been really rough). On the other hand, if we could shlep him in a rowboat safely as opposed to the more tippy and enclosed kayak, we could still help him participate in the activities (like meeting his group at the end of a hike).

 

Thanks for your perspective. It's hard trying to figure out the best course of action. It would be soooo much easier if we didn't have family camp just around the corner.

[kalanamak]

The thing is, it's been more than a few days. The original injury was on June 3. Ds has been totally, completely responsible about not weight-bearing, believe it or not--he's been absolutely great about using his crutches or hopping. Even so, with all the rest care we've given him, he's still in definite pain when he puts his weight on it or when the doctor probes his foot. That leads me to think that the mri findings hold validity???? Or do you think the "cartilagy" nature of a 9yo foot would still obscure things? I ask because if that's a possibility, that's a point I would want to bring out with the ortho tomorrow.

 

I pray they consider a boot for him. It would be ever so much easier than dealing with a cast.

 

Also, when you say you wouldn't put a kid with a cast in a kayak, do you mean a kayak specifically or in any watercraft? I truly don't want to risk further injury for ds (in the last two months he has hurt his foot AND broke his two front teeth, it's been really rough). On the other hand, if we could shlep him in a rowboat safely as opposed to the more tippy and enclosed kayak, we could still help him participate in the activities (like meeting his group at the end of a hike).

 

Thanks for your perspective. It's hard trying to figure out the best course of action. It would be soooo much easier if we didn't have family camp just around the corner.

 

It isn't that the MRI would be obscured, it is that plain Xrays don't show it as well. Since kids little non-displaced fractures heal well, my ortho didn't see the point in confirming whether this little darkish area WAS a fracture or not, that, in the words of medicine "if a test will not alter the treatment, don't get the test".

 

Yes, a boot would be nice.

 

Kayaks are tippier than, say, a rowboat. And my fellows take some risks (rough water) now that kiddo is stronger. The two young teens I knew about were both on rivers, and my boys do the Puget Sound, which is not as rough as rivers. I would judge the water, the lifejacket and the child. My boy hates his jacket, but it would float a 53 inch TV screen, conscious or unconscious.

 

Bummer about family camp. My boy would be very slump-shouldered over it.

[Harriet Vane]

UPDATE:

 

The ortho was wonderful. Just wonderful.

 

My kids thought her assistant was wonderful because he looks like Commander Riker from Star Trek (Next Gen). :lol:

 

Ds is in a boot and was given a waterproof cover to go with it. He has permission to take off the boot to swim or even kayak in calm water. I am truly so thankful--this will be much easier to deal with than a cast.