“Injured foot?”
Female | 35 years old
22 Answers
Pain in the fifth metatarsal in an athletic person should often be evaluated relatively quickly after it is felt. Stress to the fifth metatarsal may weaken the bone, predisposing it to more simple trauma that can break the bone in an area with poor circulation. Initial x-rays may be necessary but if the clinical exam is consistent with an injury, MRIs may be necessary to further evaluate the injury. If MRLs do show that there is bone marrow edema then this injury should be treated with a period of immobilization to allow the area to heal. Failure to address this when it is in a pre-fracture stage may predispose the athlete to further injury.
If the x-ray does show that the bone has fractured in the region with poor circulation, conservative and surgical treatment options are offered. Conservative care includes a non weightbearing cast for eight weeks. A return to sports may be 3-4 months. There is a high risk of refracture to this area in athletes with a high arch foot. In those patients, surgical treatment may be performed initially to allow the fracture to heal more rapidly and return the athlete back to sporting activity. This would require non weightbearing for six weeks in a boot. Athletes can usually return to activity following the use of screw fixation in approximately 10-12 weeks. If the foot has an excessively high arched posture in which the heel bone is turned under, surgery in the rearfoot may also be necessary at the same time to get the heel bone straight and take the stress off of the outside of the foot. A procedure on the heel bone usually recovers more quickly than a procedure on the metatarsal.
Surgery when performed is done on an outpatient basis under a twilight anesthetic. An incision of approximately 1/4" is placed on the side of the foot. Through this incision, a small pin is placed into the bone. A screw is then applied over the pin to compress the fracture and allow it to heal more rapidly. The size of the screw depends on the size of the bone. We usually employ a 4.5 mm titanium screw in females. In athletic males who have much larger bone screws that are 5.5 mm to 7.0 mm may be necessary. In athletes, we prefer solid screws over partially threaded screws. We have had great long-term success in healing patients with these fractures. Patients are typically allowed to bathe 2-4 days after the procedure, as only one stitch is used. Although they are non weightbearing they can get into the gym very quickly and work their upper body. Leg extensions and leg curls can also be performed. We have found a period of non weightbearing for six weeks is typically best. However, x-rays and clinical exams are important to assess how the patients are healing. A return to walking in a boot is usually performed at week 7 or 8. If the fracture is healing as expected sneakers and an orthotic device in their shoes utilized in running can begin between 8 and 12 weeks depending on the clinical exam and x-rays. A return to active sports may take 10 or more weeks. We typically do not allow athletes to return sooner for fear of reinjury to the bone or fracturing the screw.
Jones fractures can often go on to delayed union. This means that the fracture is not healing in the expected time. In those cases, bone stimulators may be used to help accelerate the healing process. In some cases, this fracture may go on to a nonunion. Nonunions of the fifth metatarsal can become very painful and cause a disability in a running athlete. It will most often require surgery to remove the areas of the bone that are devoid of blood supply. A bone graft is then applied to the fracture and a small plate or screw is utilized to stabilize the fractured area. Nonweightbearing for 8-12 weeks would be mandatory. The long-term prognosis is excellent. If there is a foot deformity that predisposes the patient to increased stress to the fifth metatarsal, surgery would be necessary for these other areas to unload the fifth metatarsal more permanently.
The best of luck to you.
Dr. M