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Severe foot pain in fifth metatarsal

by Jennifer
(Visalia, Ca )

History: I successfully had a tailors bunion removed about 13 years ago. Several years later I started developing pain accompanied with callus to the bottom of my foot at what feels to be the 5th metatarsal head. I went to another podiatrist through Kaiser at this time and the callus was removed. The Podiatrist told me that I have no pad in my foot and since I've already had surgery there was nothing that could be done. My age at the time was around 24. Eventually the pain subsided and I thought that was that.

About a year ago I started having pain to the same area and the deep callus returned. The pain was gradual off and on for about 6 months.
About 6 months in I started getting a deep burning pain to again what feels like the 5th metatarsal head bone. The pain was intense and sort of like a burn or shooting stabbing feeling. It also would come and go. I thought it was because I am on my feel all day with constant movement so I would rest and elevate on days off. The pain would subside after a few days resting my foot. Now here I am almost a year later and the area is now in a constant state of pain with the feeling of ache at the bone. The burning shooting stabbing pain happens all day and sometimes night on and off.
I have tried callus or corn pads but they make it hurt worse from the pressure. I wear the right shoes and since the first surgery I only wore high heels once or twice a year due to the pain they would cause up until the new pain about a year go. Since then I have not worn high heels at all. I am stumped on what is causing all of this pain??

RESPONSE

Hi Jennifer,

Well, a few things come to mind. If you are getting pain on the bottom of the fifth metatarsal head AND there is no callus, then you have to entertain the possibility of a sub metatarsal bursitis.

A bursitis is a sac filled with fluid that the body produces to "cushion" an area. If there is too much pressure then the cushion becomes inflamed and it begins to hurt. A bursitis under the fifth metatarsal head is a very common finding.

If you do not have much of a plantar fat pad, as you have been told, then there is not much cushioning between the ground and the bone, so you will be prone to forming a callus.

Now, I do not know what kind of surgery you had, but if the procedure was one where the bone was broken and re-set then there is always the possibility that the head of the bone, when moved, was slightly "plantarflexed" meaning it was bent slightly downward which would then end up causing more pressure against the bone and the ground.

Although not likely, there is also the possibility of scar tissue on the bottom of the bone as well.

So, what are your options?

If it is determined that you have a bursitis, you should consider having a cortisone injection. This could give you a lot of relief but probably not life long relief. I find them to be quite helpful with bursitis of this nature.

Another option would be an orthotic. An orthotic is a device that fits into your shoe and in this instance would be built in such a way to keep pressure off the fifth metatarsal head. It is what is known as an orthotic with a fifth metatarsal accommodative pad. Essentially, if there is reduced pressure on the fifth metatarsal then there should be less pain, particularly if you are developing a callus underneath.

Lastly, as much as the thought may not appeal to you, a second surgical procedure might be indicated. Again, if you had the procedure where the fifth metatarsal was broken and re-set, then you could consider a lesser procedure where the bottom of the fifth metatarsal head is shaved, so there is less pressure on the head of the bone when you walk.

I would suggest you find a foot specialist in your area, someone other than the last one you saw, and discuss your options with the doctor.

Marc Mitnick DPM
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