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5th Metatarsal Base pain...

by Chris
(Severna Park, Maryland)

About 3 months ago I started having pains in my left foot around the base of my 5th metatarsal. I knew i should have seen a doctor but just decided to push it off until it got to the point where i could barely bear any weight on the foot without pain. So after a visit to a foot and ankle specialist we thought we had come to the conclusion that i had an avulsion fracture of the 5th. So the foot has been placed in a walking cast. Well a few days after having the cast put on my right foot started giving me the exact same problems/pain except worse. I then learned that my growth plates in the base of the 5th never fused as a child. My left foot has been casted for about 3 weeks now and my right foot for about 2. I am still am having extreme pain in both feet with out any sign of relief. I have been on short term disability for about 3 weeks now and all i have been doing is laying on the couch trying to rest but they don't seem to be getting better... Which leads me to the question i really want to ask. What are my surgical options and how long would the recovery period take. I am a 21 y/o healthy male and i really need to return to work and would like the fastest fix possible. I cant keep missing work .


Hi Chris,

If the growth plates of the fifth metatarsal base never fused then casting you is not the long term answer. Casting may solve the short term problem of alleviating the pain, but an "unfused" growth plate will at some time probably fracture again. Simply put, there is an inherent weakness in the bone at that level and you will always be prone to fracturing the fifth metatarsal in the same area. This can occur without any history of trauma. It could occur from nothing more than stepping off the curb the wrong way, or climbing a ladder or any number of innocuous ways.
The problem with fractures in this particular part of the fifth metatarsal is that the bone is poorly vascularized meaning the blood supply to the bone is derived mainly from surrounding soft tissue. Without great circulation, fractures in this area have a tendency to be difficult to heal in the first place.
Because you are young and because you have finished growing and assuming you are in good health I would suggest you give some real thought to having both fifth metatarsals surgically fused.
Depending on how bad the non-fusion is, it may require a bone graft and then fixation with a screw. It is not a very complicated surgery and depending on the degree of fusion and the advice of your surgeon each foot would be "tied up" for around six weeks barring any complications.
Having said that, assuming a successful outcome, you should no longer be bothered by this problem.
When people come into my office with fifth metatarsal fractures in most cases we try casting first, but in your case, with an inherent weakness in the bone, I do not see how casting alone, even if the present fracture heals, will not become an issue once again down the road.

Marc Mitnick DPM

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