metatarsal fractures still causing pain

by Lori
(Hardin IL 62047)

My 11 year old son fractured his foot (2-5 metatarsals) a year ago. His foot has never been 100% since but the pain has progressively gotten worse over the last few weeks. He is now to where he can not run, jump or kick. Over the last few days it hurts even at rest. We returned to our Dr last week and they performed x-rays which were negative and the radiologist even said that had he not known he had old fractures he would not have known based on these current films. They have now ordered a MRI. I'm just curious as to what this could possibly be. He doesnt recall any type of injury or anything. He is not a complainer and hates attention drawn to him so I know he has to be hurting to ask the teacher for an ibuprofen at school. There is no swelling or bruising. The pain is over the top of the foot and on the bottom directly under those metatarsals. He says that he cant hardly stand to step down and he absolutely can not run on it. What could possibly be causing this?

Thank you.

RESPONSE

Hi Lori,

Well, hopefully the MRI will give a little bit more insight into your son's foot pain. Keep in mind that sometimes x-rays do not show small fractures and the bones can look normal even to a seasoned radiologist, but still be fractured. An MRI is more sensitive to the possibility of a bone fracture(s) than the x-ray.

Since your son is only eleven years of age, I would also be concerned about the growth plates of his metatarsal bones. As the name implies, this is the spot on the metatarsal bones that allow the bone to grow. There very well may have been trauma to the growth plates when he originally fractured his foot a year ago and this would be hard to show up on x-ray because in many instances the growth plates themselves appear as if they are fractured even though they are not.

However, if the doctor can palpate where the actual pain is coming from and then correlate that with the growth plate on each metatarsal bone, then that could be helpful in making the connection. Another option would be to x-ray the other foot and compare the appearance of the growth plates on that foot with the growth plates on the injured foot.

For obvious reasons, you are focused on his history of fracture to the foot as the cause of his ongoing pain, but you also need to think about other possibilities.

It sounds as if your son is fairly active and so there is always the possibility that he actually injured his foot and it is just coincidental to the fact that he fractured the same foot a year ago.

More than likely depending on where the pain is on top of his foot, it may not even be his metatarsal bones that are affected. There is a fair chance that he has a soft tissue injury of some sort and if it is severe enough, it may show up on the MRI.

I would have liked to know how he fractured his metatarsals last year, but will assume it was some kind of severe trauma. I am assuming it did just not happen from running or playing some kind of sport.

The reason I bring that up is that on the outside chance the fractures occurred while playing a sport, then you need to look at how he runs and the types of shoes that he wears. If there is an abnormality in his gait or he is wearing athletic shoes that are not "good" for his feet, then there is always the possibility that he sustained a second injury, albeit not nearly as bad as last year, as a result of his gait or possibly his athletic shoes.

So, again, he may have a soft tissue injury in his foot that is being blamed on his fracture of last year, where in reality he may have had two injuries to his foot with the only connection being that they coincidentally occurred on the same foot.

Marc Mitnick DPM
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