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Jones Fracture in Peru with poor medical care, a weird med history & no Spanish, advice needed!

Discussion in 'Ask your questions here' started by lehua, Jul 15, 2016.

  1. lehua

    lehua New Member

    I twisted my ankle two days before my flight to Peru, and I thought it was only a sprain. I went with some borrowed crutches and a $15 CVS foot brace.

    A week later, when it didn't feel any better, I got my first x-ray. That doctor said it was a partially torn ligament and gave me a cast. I did my research and found that sprains are better treated with some mobility so I took the cast off. In the course of my research I found the Ottowa guidelines for testing for breaks and I thought my foot seemed broken.

    Two weeks later, NWB but not immobilized the whole time, I got to a town with a hospital and got new x-rays
    This doctor knew more but I couldn't communicate at all because of the language barrier. The only thing I could understand from him was "6 weeks" in the cast. More internet research and I decided I wanted to ask about getting a pin in my foot for various reasons:
    • My other foot has a history of reflex sympathetic dystrophy when immobilized, which is SO PAINFUL and hard to get rid of and has been known to jump limbs
    • I wasn't immobilized & PWB for the first 3 weeks of healing, which probably puts me at higher risk for non-union
    • I'm backpacking so I resting isn't an option when I need to get from city to city, which I feel like puts me in the same category as athletes who can't be off their foot for extended periods. It can be a matter of safety to be able to move more quickly
    • Because of my RSD I've been on crutches with this (broken) foot as my only foot for 9 month out of the last 3 years, I'm at high risk for reinjury and then I wont have ANY feet!
    Now, 5 weeks since I was injured, 2 weeks since I've had a cast (and 4 weeks NWB since I figured out on my own I had a break), I found clinic that people on the internet recommended, supposedly they spoke English there. Went to the clinic and told him it was a "fractura de Jones," but he said (without looking at my first x-ray at all or giving me a new round of xrays) that the cast was ready to come off. Come to find out that this is a children's clinic so I wonder how many adults with Jones fractures he's ever seen. Anyway, I can't communicate that this is a bad idea, he takes off the cast and tells me to walk on it. Later I get x-rays and the radiologist says I need 3 more weeks in a cast, probably. So I bring it back to the traumatological doctor and he says nah, I can walk on it fine. "5 weeks es sufficiente." No boot or cam walker or anything (apparently it is impossible to get those in southern Peru, believe me, I've tried!)

    Now I'm young and I've been very careful about NWB since finding the break, even though it wasn't immobilized most of that time, and there do seem to be signs of healing. Maybe the doctor isn't crazy but I'm about to go get a second opinion. But seeing as how I can't communicate the details (eg. my RSD, the strange history of this break, ect), and seeing as how the protocol is different here (none of the Spanish language journal articles I found mentioned pins, it was only conservative treatment) I'd love more opinions.
    • Do my second and third x-rays actually look good enough to walk on now, at 5 weeks?
    • Should I order a walking boot/surgery shoe from the US (though it may take weeks to arrive)?
    • Is it past the point of getting surgery?
    • Should I got to a different hospital and demand a new plaster cast (and if so, short or tall?)
    • Can I just stick a piece of hard wood or plastic under the insole of my hiking book, glue some rubber underneath to give it a rounded sole and wear my cheapo ankle splint underneath and use that for a cam-boot replacement?
    Here are my recent xrays:

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