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The response to the question below was authored by Marc Mitnick DPM

Pain between the 4th and 5th metarsals

by Deborah Godfrey
(Enterprise,AL 36330)

I am a walker. I usually walk 3 miles /day. 1 year ago, I developed a stress fracture in one of the small bones on top of my foot. I was in a cast for 3 months and non-weight bearing. The foot has been re-xrayed twice since then. I am now having excruciating pain between the 4th and 5th metarsals. The pain isn't in the same area that it was with the fracture. The doctor is stumped. He had me see a podiatrist who fitted me with an orthotic device for my shoe thinking that the extra support will ease the pain. The pain has gotten worse since I've been wearing the device. It puts more pressure on the top of my foot and causes much more pain. It even hurts to just touch a specific spot. I don't know where to turn from here. They seem to be stumped by my pain. I'm finding it very difficult to wear any shoe that puts any amount of pressure on the top of my foot. Any suggestions? There has never been any swelling or redness in the area at all. It is in an area about the size of a pea. Deborah Godfrey


Hi Deborah,
A couple of thoughts come to mind. The possibility that the stress fracture is not healed and an x-ray is not showing this. Secondly, the pain is between the fourth and fifth metatarsal bones so there is always the possibility of a neuroma, even though that is not the most common place for one, they can occur there. However, generally neuroma pain will be on the bottom of the foot and you state the pain appears to be on the top.
I would think the prudent move would be to have an MRI for two reasons. If the bone is still fractured, the MRI should reveal this and if not, the MRI should be able to reveal any soft tissue pathology that may be the source of your pain.
There is always the possibility that the MRI will show nothing and if that is the case I would recommend considering physical therapy as a way to reduce your pain.
Marc Mitnick DPM

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