Fracture of 5th metatarsal with continued pain

by Jean
(Chester, NJ, USA)

About 9 months ago I rolled my ankle on a weight bar both ways. I heard something crack and the pain was intense and my whole foot was swollen and black and blue. I went to my regular doctor they did an xray and told me it was sprained. I walked around on it for 3 weeks. I then finally went to an ortho cause I could barely walk. He said I had fractured my 5 metatarsal and to wear a boot for three weeks and then take it off. After a few weeks it was still bothering me so I went to another ortho he said it was still fractured and was healing and just to continue as I was doing without a boot. It was slowly getting better but sore on and off. About a month ago it really started acting up again with pain in the side of my foot and a tingling sensation at night. When I sleep i can put my foot down on that side. I went to a podiatrist and he did an mri but did not see anything. He said the pain might just be chronic and wanted to start cortisone shots. I convinced him to reboot and therapy for a while. Could the fracture not be healed and would it show up in the mri or should I get an xray.

RESPONSE

Hi Jean,

In general, an MRI is a better mechanism to diagnose the possibility of a small fracture which has failed to heal. You do not mention which portion of the metatarsal bone actually fractured.

That is important because if it was the base of the fifth metatarsal which would be the portion of the bone furthest away from your fifth toe, where the bone actually flares outward, this could present a problem.

I will make the assumption that it was probably not the base because any orthopedist or podiatrist worth his salt would know of the hazards of fifth metatarsal base fractures and their propensity to not heal in many cases. Three weeks in a boot would not have been enough time for a fifth metatarsal base fracture to heal.

The other good thing about the MRI is that it would have revealed any soft tissue damage to the surrounding structures that may have occurred at the time of trauma, or since then. You do not mention any other problems revealed by the MRI.

There is certainly nothing wrong with further immobilization and some physical therapy, particularly if the MRI was normal. I think it is worth mentioning, that sometimes the boot you are wearing may be more harmful than helpful.

There are many boots on the market and I have found some of them are too narrow for those with a wide foot, so what happens is the side of the boot actually presses into the side of the fifth metatarsal bone and can actually aggravate the bone more than it is helping the bone. Check you boot to make sure it is not to narrow and if that happens to be the case, get a different brand.

You certainly could try a months worth of physical therapy two or three times per week, while wearing the boot in between. I would then have your podiatrist re-evaluate you to see if further therapy might be of benefit. Therapy could last as long as three months, assuming you were making progress. Since I know nothing about you including your age, it is hard for me to predict actually how long it will take to improve.

I would not have a cortisone injection unless your doctor can give you a specific diagnosis as to what is causing your pain and certainly no injection if there is still the possibility that there is a fracture. Of course, the injection would be after you have had your physical therapy.

Marc Mitnick DPM
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