As a runner, I understand how hard it is to not participate in your sport. But sometimes it is necessary to change your routine to allow healing. I will discuss one such situation, a 5th metatarsal fracture. This diagnosis was recently seen in a gymnast in my office and I thought of all the runners that suffer a similar injury.
The fifth metatarsal has a bony process (the styloid process) back towards the heel area. In this area a tendon, the peroneus brevis, attaches and manipulates the foot with walking and running. When a foot or ankle is twisted or an ankle is sprained, this tendon can cause abnormal pull on the styloid process and cause breaking of the bone. This can be a simple stress fracture with incomplete seperation of the bone, a complete fracture with both cortexes (edges of bone) broken, or an avulsion where the piece of bone is pulled from the area and has significant seperation from the remainder of the bone. Any of these can be a problem, but the greater the seperation the more difficult the treatment for an athlete.
If you have pain to the side of the foot that hurts with twisting of the foot or ankle, I recommend evaluation by a foot or ankle specialist. If you sprained your ankle severely and now have pain on the side of the foot, again get the foot evaluated. Although the treatment may preclude you from running for a period of time, the longer you wait the less treatment options that are available.
Possible treatments may include bracing (even a simple ankle brace) if very mild, a boot or cast if more complex (this will stop your running) or surgical correction if it is severe or fails to heal. This area is notorious for not healing and may require surgery in some cases. Severe ankle sprains should be treated early and surgery for this condition may be unnecessary.
Although I hope no runner sees this condition in their running, early treatment will keep you running and allow you to perform at your top level. As I continue to run, I think of these type of injuries as I step over holes on the side of the road, or get mild twists from stepping off the side of the asphalt into dirt. Let's stay injury free and keep running...
Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003