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
801-756-0765
http://www.utahfootdoc.com/
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Well I have this non displaced 5th metatarsal fracture. Wore a boot for 4 days and then a stiff athletic shoe. Did not run for 3 weeks until it felt up to it. I am now in discomfort again and have stopped any running. Will have xray next week.
ReplyDeleteWhen can I start running again? How long does this take to mend?
I am a former collegiate and still very competitive runner. I was diagnosed with a 5th metatarsal fracture almost 11 weeks ago. My doctor said that I could start running this week, but he did not advise me how to recommence my training. Should I consult a physical therapist?
ReplyDeleteStress fractures are tricky, because you often will have pain, but it wont completely stop you from walking or running. Due to this fact, many people return to running too fast. Bone takes on average 6 - 8 weeks to heal, although pain may subside closer to 4 weeks. Restressing the area prior to healing can cause reinjury or prolong the healing time.
ReplyDeleteReturning to running should also be done carefully. Ensure any adjustments are made to your running (shoes, orthotics, etc) to limit reinjury, and then progress slowly. Physical therapy can assist, but if you progress back slowly, you can return to full form without recreating the stress fracture.
I have a zone 2 non displaced 5th metatarsal fracture. My Dad is an Orthopaedic Surgeon but I feel like he babies me a bit and is telling me what I want to hear rather than the truth. I am 3 weeks into my injury and am getting another x ray in a week. I know that I won't be able to run again for at least 8 weeks but when will I be able to bear weight on it? I'm in a boot and using crutches. I am also using a bone healing ultrasound system that I'm hoping will speed up the process so that I can walk at my college graduation in 7 weeks (which will be 10 weeks after the injury)
ReplyDeleteDr. Gibson,
ReplyDeleteThis is a great website. I am an avid runner and recently broke my 5th metatarsal while trail running – It’s an acute Jones Fracture so I understand that this is an area of low blood flow which prolongs the healing process. I was immediately put into a cast and was non-weight bearing for the first two weeks and am now bearing weight with a walking boot. I’m using a bone stimulate to hopefully speed up my recovery. One of my concerns is that I was diagnosed with two blood clots in my calf a week after the break and am now taking Coumadin. I’ve heard that Coumadin can slow down the healing process so I am fearful that I may be in the cast for a long time to come. I realize you cannot give medical advice without a proper examination but was wondering if there is any advice (or hope) you can offer on how Coumadin can affect my healing time with this type of fracture.
Thanks,
Sean
Coumadin can be a problem for bone healing, but in the studies has only interfered after prolonged use (> 1 year). It should therefore not interfere significantly with your healing potential. My recommendations are to consider increased use of Vitamin D (15 minutes a day in the sun can provide all you need), calcium, and potassium. These are the principle substances that assist in healing. Best of luck in your recovery.
ReplyDeleteI have an avulsion fracture of the 5th metatarsal and ankle sprain from landing on broken asphalt. I am in a walking boot for approximately 4 weeks. I am 2 1/2 weeks into treatment. My ortho told me I would be up and running in 4-6 weeks from the day of the injury. I find that hard to believe as I am now having a little more pain where the fracture is. Also my ankle swells at the end of the day. My question is, am I hindering my healing? Should I be doing more to help the healing process? I failed to mention that I cannot sleep in the boot, I just prop my foot up. I really don't move in my sleep, I wake up to move.
ReplyDeleteWithout seeing the fracture or the progression thereof, I am unable to say how you will recover. With that understanding, here is some key information:
ReplyDelete1. Bone takes 6-8 weeks to completely heal, although the bone does sufficient healing to be "sticky" at 4 weeks. At that time, pain is often completely resolved. Therefore, 4-6 weeks may be accurate, assuming you heal correctly.
2. Pain is never normal. The boot should limit your motion enough to allow walking without pain. Pain often indicates that too much motion is occurring in the boot. It may be necessary to evaluate whether the boot fits properly. I would also ensure that no motion occurs at night, as continued injury can occur with simple motion while sleeping.
Other options that can be considered:
- Walking on crutches to fully reduce stress to area. Usually not necessary but can be done if necessary.
- Utilizing a bone sitmulator to increase the speed of healing. Often your insurance will pay for this modality if you need it.
I hope these options help. Best of luck in returning to your running quickly.
I am exactly six weeks from 5th metatarsel break, the break was not all the way through. I am an avid crossfitter and cant not wait to be back at it. I can walk fine now, but after a 5 mile walk today I have a very slight pain in the side of the foot, shoudl I go back to wearing the boot? My Dr is out till next week?
ReplyDeleteI stepped on a rock in the forest and rolled my foot latterally. I heard a snap and new I broke the 5th metatarcel. I had to be driven out of the woods as I could barely walk. The fracture is displaced and I had two srews put in the bone to ensure union of the bone. I am a 2:19:00 marathoner, will I run again without pain?
ReplyDeleteKeith, any fracture healing will take 6 - 8 weeks to get back to normal. Walking without pain is usually a good sign, but as you get back to normal activities, some discomfort is quite common. Without visualizing the healing process on an X-ray, it is hard to determine the amount of healing, but usually you shouldn't need to return to the boot after healing has been documented.
ReplyDeleteRhyrne, although the 5th metatarsal is notorious for slow healing when displaced, surgical correction gets great results. As with any fracture, you should be able to return to running without limitations after proper healing and after transitioning back to your running speed should be able to run without pain for additional marathons. As all runners know, however, the time until you run again will seem like ages (even if if is only 6 weeks).
ReplyDeleteHi there about 5 weeks ago I broke my 5th and 4th metalarsil playing soccer, this is what the dr report said: 60% medially displaced distal fragment+15degree angulation+undisplaced 4th metatarsil shaft. 90% of the swelling has gone down now and im weight baring on the heel and going back to work this week. 2 weeks ago I had another check up and xray and it did'nt look like the fracture had changed but the orth dr said that was normal and it would be a long time before i could run on it again but didnt realy give me any idea when I could play again, it lloked like a pretty bad break but any idea on when i can run on it would be appreciated!!
ReplyDeleteRecently (I am almost at 8 weeks) I broke my fifth metatarsal also and have been monitoring it to get the healing back to running levels. My hope is to be released at 8 weeks to run. Typically bone will take 6-8 weeks to heal, and once sufficient healing is determined, you can return to running. Your x-ray findings can be normal. To learn more about my fracture and the healing that is occuring (and my progression back to running) visit my log of the fracture at: http://www.utahfootdoc.com/library/when-your-doctor-hurts-his-foot-fracture-pain-injury.cfm
ReplyDeleteDr Brandt, sorry to know that u have a broken 5th metatarsals. I had fractured my fifth metatarsals too, and am now going into 9 weeks. I'm off the splint 3 days ago and started to walk barefooted with the aid of 2 crutches. I wonder how some people could walk and run at 8 weeks after fracture, cos when i tried to walk without the crutches, i felt discomfort immediately. Recovery seems so long,and what more, the recent x-ray states that i have disused osteoporosis on the other areas besides the fracture. The orthopaedic said that, with some weight bearing activities, ie walking, this will go off.
ReplyDeleteThank you for your very informative and helpful site, Dr Gibson!
ReplyDeleteJust this morning I noticed a bulge on the side of my right foot. It looks for all the world like a bunion, except it's halfway between my bunionette (on the side of my foot at the base of my little toe) and the start of my heel. It seems to be at the position of the styloid process. But there is no pain -- zero -- no matter how much I press or palpate it. No tenderness, redness, or itching either. I can walk, run, and jump just fine.
I can't remember any injury or unusual activity recently that would have caused an injury. The left foot is normal.
Is this anything to worry about, or am I fine since I have no pain?
I am not a runner but I do walk briskly 1-2 hours per day and dance once a week. I am a 48-year-old female in good health. (Also, I am living in a South American country where medical care is not cutting-edge, so I'd like to avoid intervention if it's not likely to be anything serious.)
Any comments you can offer? I am especially interested in knowing whether pain is a key symptom (and therefore the lack of pain means it's nothing to worry about). Thank you for any insights you can offer.
Ann
First of all, it is always a good sign (if you have normal feeling in your feet) to not have pain. In fact, I usually recommend that nothing be done if the area is not painful. With that understanding, however, I will comment a little more for you.
ReplyDelete1. In the area of the styloid process, a prominence can be seen. It is rarely a problem when not associated with pain and I probably wouldn't worry about it.
What is in that area?
- Styloid process (back part of the 5th metatarsal).
- Peroneal tendon attachment to that area.
Injury to either would be painful. My recommendation is that you watch it and get help if necessary (when or if it hurts). Best of luck in all you are doing.
Dr. Brandt, I had 5th metatarsal fixation last November 6. The K-wire was removed only last December 14. I am undergoing therapy for 5 sessions now which uses only TENS and Ultrasound. I can walk but there's still a little pain on the surgery part. I was advised not to put full weight on my foot yet. It still swells a bit at day's end. When will I be able to go back to normal walking and running. I am a basketball player and have been longing to come back to play. What other things do I need to do to speed up my recovery? please help me.
ReplyDeletehi there. I found this site really useful and i just wondered if you could possibly offer me some advice. i had a metatarsal fracture around 3 months ago. I was keen to get running again so I waited until pain had gone (about 4 weeks) and began with some slow running. The pain wasn't really noticed at first but as i gradually built up the running the pain kept flaring up. I had another gap of about 2 weeks but then even now when I try of even doing some some very low intensity running the pain flares up within 10 minutes. I know I rushed the recovery but I found it very frustrating. Do I need to have 6-8 weeks out to let it recover again? Thanks
ReplyDeleteDr. Gibson,
ReplyDeleteThanks for starting this discussion. I was also a collegiate track & field runner and in my senior year I fracture my 5th metatarsal by rolling my ankle. This healed without any serious complications, but for the last four years since the fracture I have been unable to train consistently due to severe shin splints in the same leg (none in the other leg) that develop if I run more than 2-3 days a week. I used to train every day without any shin problems. I believe when my foot healed, it changed the way my foot pronates (arch collapses) which leads to straining on the inside of the shin. Do you have any experience with these issues?
Thanks again.
Hello Doctor! I am exactly in my 12 weeks now after the fixation of my 5th metatarsal of my right foot. The K-wire was removed on December 12. I am able to run now although there is still some swelling and stiffness around the ankle but very minimal. There's very little discomfort but manageable. Overall, it is not as normal yet compared to my other foot. I have undergone 15 sessions of therapy already using TENS and Ultrasound. Should I continue with my exercises and strenthening? I am a basketball player. Should I go back playing now? Please tell me what to do?
ReplyDeleteSome good info, I have an avulsion fraction of the 5th and it has now been 5 weeks. I can now walk but have been told not to run for another 3 weeks. I have however been given the OK to ride my bike and have been clocking up some good mileage. The cycling shoe has a solid carbon sole which provides good support. I am looking forward to running again but a will be a little nervous getting going again.
ReplyDeleteAll the best @lincsquad24
My 17 year old son, a soccer player fractured his 5th Metatarsal. For several weeks we thought he'd just pulled something. He'd rest it for a couple of weeks and the pain would go away, then he'd play again and the pain would come back. Finally we got an x-ray. He walked with a boot for 3 weeks, after about 2 weeks he felt no pain and at the end of the 3 weeks stopped using the boot. He's done some light jogging without pain. His x-ray today shows healing and the doctor says to keep wearing the boot for 4 more weeks, but my son is going crazy not playing soccer and insists on playing. We are saying no and I want to know what to tell him about what may happen if he starts to play again. If he did play and felt no pain would that mean he's healed enough? Or will putting stress on the bone make it heal slower or cause some long term problems? If he started to play and then stopped the moment he felt pain, would that be not such a bad idea? Thanks for any info that may help us know what to do here.
ReplyDeleteHi--
ReplyDeleteThis site is very helpful. I have a non-displaced avulsion fracture at the base of my fifth metatarsal. The problem is, this injury happened five weeks ago, but was initially misdiagnosed as peroneal tendonitis. It actually felt like it was slowly getting better in the orthopedic sandal I was given, but then two weeks in I was given a steroid shot. I had an INSANELY painful reaction to it--it didn't alleviate the pain--and parts of my feet that weren't hurting before started to hurt. I went to a different doctor, they did X-rays and properly diagnosed me with the avulsion fracture and put me in a walking boot. The problem is, I'm still having pain where the steroid shot was given and in other parts of my foot and it's actually worse in the walking boot than in the sandal because it's putting more pressure on my skin. It's been 10 days since I had the steroid shot and I still feel worse than after the initial injury (after the initial injury I could weirdly walk barefoot without pain and now I definitely can't.) How far did the steroid shot send me back? Will it make it impossible for the avulsion fracture to heal? What can I do to speed up healing?
Thank you so much for your time...
Hello Dr. Gibson. Thanks for all this great info. There isn't much out there geared for runners. I am an avid runner (30+ miles per week) and 6 weeks ago had a rough ankle inversion injury playing basketball. The injury completely ruptured my ATFL, partially tore my achilles, and left me with an intra-articular fracture in the 5th metatarsal. I saw an orthopedic surgeon, who had me wear an Aircast boot for 6 weeks. The Dr.'s primary concern was the achilles, and he wanted me to start bearing weight ASAP.
ReplyDeleteI wasn't able to put weight on the foot at all, even with the boot. A couple of weeks ago, I was able to lose the crutches. I was doing mobility exercises for the ligaments, but avoiding any stress to achilles.
I saw the dr. again after the 6 week mark, and he told me that the fracture hasn't healed, and it probably wouldn't. He said I could keep wearing the boot if I wanted to, but it probably wouldn't help. I want to get back to running, etc. he said I can, even with the fracture. But it hurts - does what he said sound reasonable? Can I expect to run on this fracture? Should I stay off it? What would you suggest?
Dear Doctor,
ReplyDeleteFirst of all, great thing your doing by offering advice. You probably heard this many times before, so my apologies if my story is repetitive to you.
6 weeks ago today I suffered a fracture at the base of the fifth Metatarsal(Right foot). the Initial Xray showed a "crack" and wasn't displaced as the bone was still connected (Pardon the layman's terms)
I was put in a cast and was allowed no weight bearing at all. At 5 weeks the cast was removed to make another Xray and the Doctor treating me said he could see cortex healing and "bridges" forming. Im in a walking boot now. And walking with the boot causes no pain at all. touching the area of the break and its surroundings causes no pain also. I do cheat once in a while and try to walk bare foot or in my uniform shoes. First of all, I'm very scared to put any weight on it so I'm sort of walking in a distorted manner. And if I walk long enough it causes discomfort/pain. Not sure if this is muscle or the bone.
Will weight bearing break these "bridges"? Will all the healing done so far be lost?
Many thanks:-)
Jan
Dear Doctor,
ReplyDeleteFirst of all, great thing your doing by offering advice. You probably heard this many times before, so my apologies if my story is repetitive to you.
6 weeks ago today I suffered a fracture at the base of the fifth Metatarsal(Right foot). the Initial Xray showed a "crack" and wasn't displaced as the bone was still connected (Pardon the layman's terms)
I was put in a cast and was allowed no weight bearing at all. At 5 weeks the cast was removed to make another Xray and the Doctor treating me said he could see cortex healing and "bridges" forming. Im in a walking boot now. And walking with the boot causes no pain at all. touching the area of the break and its surroundings causes no pain also. I do cheat once in a while and try to walk bare foot or in my uniform shoes. First of all, I'm very scared to put any weight on it so I'm sort of walking in a distorted manner. And if I walk long enough it causes discomfort/pain. Not sure if this is muscle or the bone.
Will weight bearing break these "bridges"? Will all the healing done so far be lost?
Many thanks:-)
Jan
Dr. Brandt Gibson,
ReplyDeleteI am a college soccer player and i suffered a jones fracture while changing direction in a game. I have been out for 9 weeks and i have been on an ebi bone growth stimulator for 4 weeks. At my last appointment the doctor told me that the x rays looked good and showed signs of healing. he said the gray color in the space between the bones was a good sign. However, i didn't really notice it all that much. Nonetheless, i was wondering how long it generally takes a jones fracture to heal once bone repair is evident on an x ray? I assume that once the osteoblasts start working to build bone, they will continue to do so and healing will become faster. But i was wondering what your thoughts were?
I realize that it is not easy to answer such a question without the x rays in your possession, but i figure you may have some good advice and information. Additionally, I was wondering if you find it possible i will be back on the field in an additional 9 weeks when my season starts? That will be 18 weeks post injury.
I appreciate the help! thanks
I know this is a very late comment, but I'm hoping you're still around! I've had a fracture of the 5th metatarsal and have been in a brace boot for about 5 weeks.
ReplyDeleteThe fracture wasn't a stress fracture from running, it happened when I tripped and rolled my ankle while walking.
I have an important race in 1 and a half weeks and am going for X-Rays again on Friday, but I was just wondering if it's possible for the bone to be healed but for the area to still be sore and if so, is that ok to run with?
It doesn't hurt to walk anymore (that leg just feels a bit weak from being in that boot 24/7), but when I tried to jog up and down the street tonight I got a bit of a dull pain in the area of that bone. If the X-Rays on Friday come back clean, can I run despite the pain? I have even heard of some people running with a minor stress fracture, so what about if the bone is -almost- fully healed? I know that you can't really give medical advice without seeing me, so I'm just asking for any advice you can give in a non-professional setting!
i broke my 5th metatarsal 2 years ago they put a metal pin in it. Which worked and from what i thought got healed. However about one year after first surgery i bent the metal pin and had to get a second surgery. They then put a metal screw in it and put bone grafts on. Its been over a year now and seems to be working very well. I now want to start running, which i have never done, is it ok to start running now?
ReplyDeleteYou can run after fixation as you explained. As with any running program, however, I recommend that you progress slowly to running (or back to running). Listen to your body and allow sufficient time to get running the way you hope.
ReplyDelete