Nice pics. i need to get some of those for my breaks. Here is what i did on 28 Oct when I fell off a ladder at 16-20 feet.

Left- 4th and 5th metatarsal with a compression break. the fifth has a slight turn to it. 4th is clean

Right- Pinky toe broke. Calcaneous broke. Patella cracked in half.

All breaks were clean so no surgery is expected. i am being real careful of reinjury.

I have been in boots since. I've been getting some really easy biking in (40 watts); hard to do while wearing the boots over the race pedals. Also, deep water running-45 min. This started at the 3rd week. I think this is doing some real good. My feet don't hurt as much from the immobilization.

I had just peaked my running two days before with back to back days of 18 mile runs for a 30K I wanted to complete in December. Thats out now. I get the 4 week X-ray next monday. I am hoping it is clean so I can start doing strength training for my feet. I don't know how fast a person loses conditioning in tendons and ligaments. I know I'll need to go slow. Hopefully after 4 weeks of strength conditioning I can get on a marathon program to do a may marathon. Any longer and I doubt I'll be able to get in shape to do the Rev 3 Cedar Point this year. It would be my first Ironman, so I am a little anxious.

Good luck on your rehab. Let us know what you find out in terms of the physiological recovery your injury will take. Maybe you can be the poster child for "Get it looked at now".

I had a partial avulsion of the 5th metatarsal in June '08. In boot for 3 weeks, no surgery. It took about six months before I was really able to run on it. It still gets sore to this day and I have a tough time putting outside pressure on it (running counterclockwise (left turns) not a problem; clockwise (right turns) is uncomfortable but not painful). I can't wear the right shoe as tight as I used to or the foot gets sore pretty quick. I can run now with no real issues but longer mileage definitely causes some soreness.

I wish I had a better comment for you. Hopefully surgery will eliminate your issues. I have been hesitant to consider surgery because I have heard some horror stories about foot surgery (problems becoming worse rather than better).

Best of luck.

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"Texas is a state of mind. Texas is an obsession. Above all, Texas is a nation in every sense of the word" - John Steinbeck

have you had any x-rays done since?

The pain/symptoms you describe are pretty much what I deal with right now...could you still have a bit of a fracture?


I'm a bit apprehensive about the whole surgery things - primarily because of the unknowns. I know it's very likely to fix it with minimal issues, but there's still a risk.

Right now the pain is pretty minor, and I can deal with it no questions - it's just that it's freakin' broken!

Sounds like you are in good hands. My 2 cents for FWIW having treated many of these (conservatively, pre-op, post-op) over the years in athletes:

I think you have your answer about whether or not to do surgery, sounds like non-union and a very active guy. Blood supply is distal to proximal in these fractures so if you are non-union it will not heal without reduction. At this point the only way to get reduction is internal fixation.

Go with the screw versus K-wires (wires may not even be an option)

Use the smallest screw possible (although not equivocal/statistically significant some association with more failures using larger screws)

Do not return to activity until you have radiographs showing union with healing (I would wait at least 9 weeks). Risk of failure (refracture) is higher when starting back early without full healing

All in all, these usually go well and I would not hesitate to go with the surgery. It sounds like triathlon is your mainstay and this will also reduce issues compared to most other athletes sustaining this injury in field or court sports.

I often call “conservative management” “denial”, yet I am no better! I went all of last season with “conservative management” of a torn plantar plate including racing IM Arizona before surgery in February. I likely made for a slightly more complicated procedure although I knew exactly what I was doing and was under the care of another doc. I too got some online consultation from rroof!

Good luck and schedule the surgery for between the holidays and you will be back at it by the end February! My only regret was waiting until February (12 weeks of nothing) due to work schedule as it delayed my comeback, however, I am going to give IM Arizona a go this weekend.

Good luck & Cheers!

Nice x rays. Lookit how well the sesamoid bones show up. I love x rays.

I can't find the fracture, though?

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maybe she's born with it, maybe it's chlorine
If you're injured and need some sympathy, PM me and I'm very happy to write back.
disclaimer: PhD not MD

I think I might be in the same boat. I got home from a marathon on Nov. 1 and slammed my bare foot into the leg on my couch going to the bathroom. I have yet to go to a doctor because I always think things will heal themselves. I only really have pain when I squeeze the outside of my left foot under my pinky toe. It is not an intense pain but I do feel something when I squeeze. I haven't had any swelling or bruising. I haven't ran since it has happened, but I have been riding my bike on the trainer a few times.

I guess it's time to see a doctor.

http://en.wikipedia.org/...ifth_metatarsal_bone

Go look and see how it's supposed to look :)

LOL! Luv ya TC ... ;)

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Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

Rroof may have a different opinion on this one but due to the styloid fracture and the fracture into the joint space I would probably have the surgery to pin it (if it were me and if you were my patient). If the fracture was in the long bone of the 5th Met perhaps no surgery. I wish you the best! ERIK

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"Spectacular achievements are always preceded by spectacular preparation."

In a month after I see an orthopedist we can play "critique my hip x rays"

or not, but it's a possibility.

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maybe she's born with it, maybe it's chlorine
If you're injured and need some sympathy, PM me and I'm very happy to write back.
disclaimer: PhD not MD

Nope, I definitely almost always use a cannulated screw in large avulsion fractures like this in an athlete because of the high rate of delayed/non-union. If more distal neat the met-diaph jxn (i.e. Jone's) than I always do. Midshaft fractures are almost always spiral type with pretty good displacement and usually need ORIF as well (small plate/screws like from the Synthes Hand Modular set, but I like Arthrex's new set).

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Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

http://www.beginnertriathlete.com/...-view.asp?tid=106874

Had a fracture of the 5th metatarsal, no surgery though.

weeks 1 to 3: hobbled around with no boot.
6th week: "ran" a 10 k race six weeks later, and by "ran" I mean a very very high cadence fast walk/jog in 54 min. That was the first run back.
10th week: ran a 5 k race in 19 minutes (pretty much where I'm at now).

All that being said, it took a full year before my foot felt normal.

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I can take my heart rate from any vein in my body... any vein.

Sentania - lot's of excellent info here. Enough for you to proceed with having the non-union taken down and an intramedulary screw placed. The one thing I'd recommend is to get moving if you plan to race next summer. In contrast to the acute course described by some STer's, following this procedure most surgeons proceed quite slowly to avoid refracture,hardware breakage. I recently did a blog on water running which will be important to you that you might check if interested. Have patience in your postoperative schedule and you'll likely do well. Good luck from all of us.

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John H. Post, III, MD
Orthopedic Surgeon
Charlottesville, VA

Thanks.
I should have the surguery scheduled tomorrow. May be able to get it done as soon as 12/14 - which is later than I would like - but still pretty quick I think.

I hope that things will progress well after the surgery, but I'm expecting it will be March or April until I can well and truly run again. Hope to return to swimming, cycling, and water jogging/precour/etc relatively quickly post op. Not rebreaking or having other issues is the #1 priority IMO - lots of other ways to keep the fitness up without forcing the running.

I'm going to visit your blog to read about water jogging - I tried it the other night for the first time. I was surprised at how hard it was!

Dang it! Why aren't you in my AG?

chris

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"You can quit, and no one will care if you do. But you will know."
~John Collins, Ironman founder

Member HED Mafia

Had a training buddy who fell while riding his bike fx the base of the 5th. Had a screw inserted about 6 weeks after his fx and did very well, give yourself 8-12 weeks and you should be good to go.

Sorry, didn't get notification of your reply for some reason.

I have not had x-rays done since I got the boot off. I don't think it is still fractured because I look a very long time off so there is no real reason it should not be healed by now (17 mos since break). There really is no pain. The only problem I have is some soreness if I run with that shoe laced tight. The right turn thing I described is bizarre... it doesn't hurt it just doesn't feel normal. Hard to explain.

Surgery is not something I have considered because my issue seems too minor to take the time off; spend the money; take the risk of worsening the problem.

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"Texas is a state of mind. Texas is an obsession. Above all, Texas is a nation in every sense of the word" - John Steinbeck

Definately looks and sounds like a non-union. In the acute stage our office joke is: hurry up and surgically fix it....before it heals. After this long it clearly will not heal. You should have good results with surgery as long as you are willing to stay off it as it is healing. We use a canulated threaded screw, only use a K-wire as a guide. Once you get some compression on the fx it will heal nicely. We've fixed several D1 athletes with Jones fx's (this clearly is not a jones fx), one of who is a starter for Penn State Football.

E

To all the docs in this thread (I ask this because I don't meet with my doc again for another week and am impatient) -

What is a "typical" timeline for return to activity Swim/bike/run from this type of procedure assuming things progress typically.


Surgery is set for 12/14!!

I am a bit confused. Are you having surgery because your x-ray is abnormal, or because your foot really hurts, thus impairing your performance or quality of life.

You alluded to 2 IM's in the past 2.5 months. Even after healing, one might expect this to still hurt with that kind of stress. What kind of symptoms do you have now?

Are you getting this fixed because the fracture really impairs your performance or because the xray shows the fracture has not healed? I took the liberty of checking your IM times and noticed your IMFL was significantly better than IMWI. Comparative analysis would suggest that your overall performance was improved, not just because Florida is traditionally a much faster race. Even drafting and a flat course would not explain your significantly improved run time.

Virtually all avulsions heal. This type of fracture is not subject to the vagaries of blood supply found in more distal fractures. Frequently, x-rays will still show the fracture, even if the patient is without symptoms.

Even 6 -12 months after successful healing, one might still have symptoms. With this in mind, you may want to reconsider surgery and its attendant potential complications.

Surgery is going to require activity modification. One might suggest that the same acitivity modification without surgery might lead to disappearance of symptoms in this typically innocuous fracture. Activities that don't cause pain (swimming, biking, water running?) could be continued.

/smart ass on
IMWI and IMFL were blow-outs. Total unmitigated disasters - definately not reflective of my abilities (IMWI08 52/5:25/3:19) or of what I felt was possible based on training leading into the races
/smart ass off (sorry I couldn't help myself, plus you sort of walked into it ;) )

I am getting the fracture fixed because it is broken. It has had nearly 5 months to do it's thing and it hasn't. Granted I have not been kind to my feet by running 750 odd miles since when I think it happened. My day to day pain is minimal - I would call myself nearly 100% adapted to the pain I experience - it's pretty asymptomatic (right word?).

Running varies day to day - but I typically am very proactive and liberal with my use of Ibeuprofen prior to runs.

My peak pain was probably 1.5 weeks before to 2 weeks after IMWI. It was painful to walk barefoot, and uncomfortable in anysort of shoes - I remember getting out of my car and walking into the IMWI expo limping - thinking to myself "Wow Sunday is going to suck".

All that said - you're right, I could probably let it heal without surgery - however there is something wrong with my foot. It may not hurt (or I've simply blocked it out) - but Swimming, walking (especially work shoes), cycling, sitting, lying down - I can feel that something is wrong with my right foot. Something is out of place, I have a constant urge to try and adjust my foot to get things to fall into their proper position. How long do I keep doing what I've done for the last 5 months before I say enough is enough and get it fixed? Another six months? 8, a year? At what point is it simply not going to heal?

That's what I've asked myself since I found out it was broken back in September and I decided it was better to bit the bullet have it repaired and deal with the potential complications because the outcome and timeline seems more certain in my opinion than either a conservative approach (i.e. boot/cast/etc) or a ignore it and see what happens approach.


In the end it is probably more about piece of mind that it is about a broken bone.


P.S. I read it through and realize that my tone may come across hostile - I apologize for that - it's not my intention - just the way the words come out. I appreciate your insight.

Your key phrase is "it may nothurt."

The only reliable effect of fixing a broken bone that is not healed is pain relief. If you have no pain, or very little pain, surgery is unlikely to provide much benefit.

Some of the symptoms you describe ("I can feel that something is wrong with my right foot. Something is out of place, I have a constant urge to try and adjust my foot to get things to fall into their proper position") may persist for 6-12 months after a successful surgery. And it is real surgery that requires a real recovery (not to mention an incision that may result in persistent local tenderness, particularly in a bike shoe).

Talk to your surgeon, but your recovery may require 6-8 weeks of avoidance of training, especially running, with a slow return to activity afterward. And don't forget about postoperative physical therapy.

I think expectations of recovery after significant injury need to be realistic. There is no quick fix after you break a weight bearing bone.

Had surgery yesterday - the doctor was quite happy with how things fit back together, but was pretty "stern" in providing direction to let my body do it's thing - as if it doesn't heal correctly the alternative - removing the bone fragment - is not a desireable option.

Quite a bit of discomfort and swelling in my foot, but it's manageable.

Here's to 6 to 10 weeks of living a couch potato life and getting better! Maybe I'll finally finish Halo 3 and Assasin's Creed.

I didn't get an electronic copy of the X-ray with the screw in place, but I'll get it scanned once I return to work.

excellent - heal quickly Scott! Assasin's Creed - great game, although my wife frumped a bit as my son (8) and I played ... ;-)

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Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

glad to hear everything went smoothly. keep your head up.

this is week 7 of recovery for me. was i diagnosed with 2 sfx in 4th and 5th metatarsal. i thought id never make it, but im running 3 times a week now. enjoy the holiday season (and the vids). you'll be back at it as soon as your body is ready.

recover well

-jason

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Toro Performance

Best wishes for your recovery.

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maybe she's born with it, maybe it's chlorine
If you're injured and need some sympathy, PM me and I'm very happy to write back.
disclaimer: PhD not MD

+7 days

Things are good. No pain at all anymore, occasionally though I can "feel" the screw. Odd feeling. Biggest problems right now are keeping my tows warm, crutches suck, and I can't drive.

First post-Op on Wednesday to get the dresses changed and the stiches out (? - can't remember if that's this Wednesday or the 30th). Go back on the 30th for another follow-up and to get a walking cast.

Also, I didn't mention it last week, but Dr. prescribed a bone-stim, and my insurance approved it, so I'm slapping that on 3 to 6 hours a day.

Did the hand cycle at the YMCA on Saturday and Sunday.

+44 days after surgery

Well I've survived two weeks in a splint, 4 weeks in a hard cast, and was just "sentanced" to 3 weeks in a boot.

The pictures taken today show that healing is evident in the fracture - with some progress still needed until "healed". But in the boot I was cleared for partial weight bearing and stationary cycling. But any healing is better than no healing - as that could result in another surgery or me doing something stupid.

I won't be able to cycle hard, but as soon as I dig out a platform pedal atleast I'll be able to do that. It will be better than the hand cycle and more motivating than it.


No pain at all any more, just occasional feelings I can best describe as "Wow, it feels like the screw is in the middle of my foot" that I mostly attribute to weather/cold feet etc.

No numbness either - just a hairy, pathetic, skinny leg and foot. At least with the boot I can fix the hairy part ;)

Thanks for the update Scott - will be running soon enough ;-)

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____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

Hang in there. I just had my screw out last week, and once the stitches come out, look out! You'll be in the same place soon.

Astounding how such an apparently minor injury can have such a huge impact, isn't it?

Broke mine at Clearwater and still not able to run. Was not an avulsion so I did not have a pin or screw inserted.

2 more weeks and I see the doc again. Hopefully will finally be able to do light running.

Best of luck with the spinning. I found recumbent bikes at the gym to be the easiest with the boot.

+63 days.

Still in a boot. Still @ partial weight bearing, easy cycling and hanging out with my bone stim.

I'm not experiencing any pain right now. There is a region of numbness surrounding the incision, with the incision being quite sensitive. I'm also quite pleased with the appearance of my foot - when I first started with the boot my foot was quite misshapen - it looked like I had just gotten off of a 36 hour plane flight... in the last couple of days it's starting to look more like my foot. The only odd spot yet, is a region around the incision that is like a bump... I'm not sure if it's scar tissue, swelling or what, but it doesn' t hurt (it actually corresponds fairly closely to the area that is numb.

More x-rays on wednesday. On the scale of hope, it would be awesome to start riding without the boot, start the long progression towards running again (i.e. take a nice walk around the block) and thinking about swimming. I'll settle for continued progress and being allowed a setup that will let me drive.

+79 days

Last appointment was 2/17. X-rays looked good - initially when I first saw them it looked like not much improvement from the time before, but the doc zoomed in a bit and did some contrast stuff and it looks great. It's not totally closed, but it's very close - about the size of the tipe of your mouse pointer - compared to what it was initially it's tiny. The doctor was a bit suprised that it wasn't totally filled in after 8 weeks, but was happy that it was continuing to progress. Next appointment is 3/17 - he expected things to be closed up by than, and I can start thinking about running. He also said that if the fracture wasn't fully closed than - we can talk about returning to running as long as I am asymptomatic - because it's likely that between the screw and any fibrous material the fracture is stable, and after 12 weeks it may just be "done".

Still in the boot, but full weight bearing.

Was cleared to start swimming again - no push off's with right left. Continuing to cycle - slowly getting strength back - rode 90 minutes on sunday.


I am starting to feel a bit of apprehension about running - no matter the result on 3/17...how will things feel? how fragile/sturdy is it? etc. Got a big mental block to overcome.

Glad you're healing.

Running will come, I'm sure. I tried running on the treadmill a couple of weeks ago, and it didn't feel great - sort of like the middle of my foot had frozen up. It wasn't pain, exactly, just stiff and not comfortable. I don't have any bone-pain. Just 'frozen-up' stiffness/soreness.

Hang in there - it'll come.

Scott - my experience with 5th met avulsion fx is that there will be radiographic signs of the fx way past when an athlete can run. The other issue is that there will often be some focal tenderness for a long time as well, so waiting until totally pain free can be frustrating. Something to carefully discuss with your surgeon since he has seen your progression, knows how good the fixation felt/went, etc.

Thanks for the updates!

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____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

That's good to know, thanks for the information.

+95 days

I had another followup this past Wednesday. The fracture is still there and ugly as hell, but it's continuing to improve and fill-in. BUT my doctor feels that everything considered everything is stable enough to start progressing towards full activity. Next follow up is on 4/7.

So I'm cleared to walk in normal shoes - Goodbye stupid boot - cycling without my boot in normal shoes, and start a progression to be running by ~3/31 or so. Personally - I'd love to start running now - but my right leg is so damn weak as compared to my left, that'd be a bad idea. I'm going to resist the urge to rush things and follow a steady progression towards that. Walking a lot, water jogging, etc to streghen up that leg system and to start reconditioning my joints/etc.

Beyond that swimming is progressing very well, and cycling is also. I did FTP test last night and the result was 255. I'm thrilled with that considering how conservative I started out on the test and the circumstances. Barring any wussification or set-backs - I am comfortable saying I'll be back up to more respectable 280-290 with a few weeks of work. That's very reassuring.

More updates to come when appropriate.

+112 days (I think)

Not much new since last time. My next appointment/xray is this coming wednesday.

I've did three honest to god runs last week, T/R/Sa. 30 minutes each time. They were hard, but awesome. I'm pacing my self using Daniel's adjusted E-Pace for weight gain, and time off - which puts me at a VDot of 45 for now.

No real pain while running, just soreness and discomfort from a weak lower leg/foot. Had a little extra swelling later in the day after each run, but nothing bad and was solved by a bag of blueberries on the ankle for 15 minutes.

I am planning to try and run a normal frequency this week, but keep them limited to 30 minutes. That plan is pending my foots reaction, pain, and the xrays on Wednesday.

Last week was a great week of training. I did 2x20 on the bike @ 270 watts - so that is coming around nicely. My swim "clicked" on Saturday.

I'm getting very excited to see things starting to come around.

Things are still progressing well.

No pain while running/walking/general activity, although my priopreception (I think I spelled it right) - is horrible.

I still feel like my foot and especially my ankle still need some strengthening and flexibility work, but so far it's reacted well.

out of the boot on 3/17; walked for 2 weeks - 1 day. Ran every other day for a week. Than ran 6x 30 minutes. Last week I ran 45 minutes + 5x30 minutes.

I'm planning to run 60 minutes today, and a few 30 minute runs this week. I'm doing saint anthony's this weekend so that will be fun. I don't plan to push the run and have very low expectations, but I'm just excited to be back at it.

If my run fitness returns like my bike fitness has and is - things will be just peachy.

Glad to hear you are able to race again! I am racing (competing more like it) in St. George next week.

Like others have said, I continue to have some pain from my 5th metatarsal fracture as well. Guess it just takes time. Another suggestion I would have for you is to do a lot of individual leg strength training to make sure both legs are working. I did not do this for the first few months back and it caused several setbacks with IT, hamstring, etc... Every time I tried to up the workouts it seemed I would have a setback. Over the last few weeks I have focused on the strength training and it seems to have helped.

Just my $.02.

Best of luck on your first race back!

Chuck

I broke my fifth metatarsal and ankle in September 2008. It wasn't a Jones Fracture and I didn't have to have surgery. I was in hard cast for a week and then an air cast for seven weeks. I was limping badly for a couple of weeks afterward and felt good enough to try running on a rat wheel in late January 2009. I assume you are or will be in physio soon? Best of luck to you in your training.

Same here, I was in a boot for 6 weeks. Switched from Asics & went to Nike then never had any problems. Of course, 18 years later--I'm using Asics for my latest pair but not having any issues. No surgery needed. But start up slow when you do. Try dirt trails for a while.

Nice job on recovery.

I started running for a while, but then have stopped for the past couple of weeks - the ball of the same foot has been hurting. Go figure.

My ankle and general foot flexibility are still stiff, and the break site sticks out a bit, but doesn't hurt at all.

Hope this is it, for you.

Last post for me in this thread as far as updates goes.

~151 days post op.

Just got home from the triple T, done on 7ish weeks of run training, and 10ish weeks of swim and bike training.

Long story short - happy to be back.


2010 Triple T Race Notes
Friday
The Triple-T prologue always catches me by surprise, despite my background as a sprinter in college swimming – I have a difficult time spinning the engine up to the necessary level. Despite a good warm-up prior to the race, this year was no exception. The swim and the bike went well enough. My plan was to ride the beginning of the ride and the climb just slightly above threshold – get to the turn around and coast back down – than run a mile. The plan worked well and I rolled in a pretty decent time, over a minute and a half back from the winner. Mostly I was glad to get through the race without feeling like I had tweaked any muscles, along with the pleasant surprise of not being completely dusted.
Saturday
The course for Saturday’s first race was changed from the traditional bike course to the Saturday PM bike course due to a tree blocking the road that fell during the storm on Friday night. I think this suited me a bit more as the PM course lends itself to a bit more of rhythm riding – rather than constant up and down cycles.
Even though Matt and I were starting together, the Saturday AM race is an individual TT – since Matt was planning to take it easy on the swim – as soon as we were given the signal to start I left him behind. I went through the swim strong, steadily building into it. Around 5 or 6 hundred meters in I got buzzed by the John Kenny motorboat – I don’t think I’ve someone ever swim that fast in a Tri before. I hit transition in a touch under 20 minutes, and hit my bike. I was able to catch a glimpse of Matt as I doubled back past transition and saw him about a minute behind me.
The Saturday PM course (which we were riding today) – is a long [not]false flat for a few miles, followed by a nice climb, a downhill, a mile or so flat, a nice climb, some rollers, a wicked decent, than a flat section to the turnaround, and then it’s all in reverse. My plan for the ride was to not limit myself at threshold watts, but to limit myself away from insane watts – in short I was counting that my fitness has increased since Saint A’s and my perceived effort combined with a knowledge of what is unrealistic would keep me safe.
I didn’t pass to many people, but was passed by only a couple, I rolled into transition with a split right around 72 minutes – given the hills and the technical nature of the descents average power is pretty meaningless – but my Normalized power was 277 – which is excellent.
Heading onto the run, I was carrying my wife’s Garmin – which I intended to use similar to my SRM on the bike – try and keep things from heading towards insane – and rely on PE. The main goal was to simply get through the run without feeling like I had overexerted myself.
The TTT run course is essentially an uphill trail run for about 2.75 miles, downhill for a half mile, than turn around and run back; Once each for each Saturday race – twice on Sunday. The course itself is hard to describe, but basically each direction of the run course has one climb equal to or worse than Observatory hill on the IMWI run course.
Watching the Garmin I was pretty surprised that my PE was taking me to about 7:30 miles going out, and 6:40’s on the way back yielding a mid-46 for 6.55 miles. Not too bad. I kept waiting for the hammer to fall, but it never did.
Saturday PM
I left the race site Saturday morning with my expectations for the entire weekend already blown away. My bike fitness nearly equal to 2008 and 2009 in terms of FTP – and my run closing down the gap to previous years here. Of course I did have some doubts about my depth of fitness since I was toeing the line with only 7 weeks of run training and 10 weeks of real bike training. But the Saturday PM would help uncover that – I’d either fold spectacularly (and miserable) or I’d hold the line in the sand. Fortunately since the PM race is a team time trial, I would have Matt there to help with any rough spots.
Saturday PM is a unique race format – Bike, Swim, Run. After you’ve done the race, you realize that it’s a much harder format than the traditional one – IMO it’s the way a tri should always be run.
The plan was for me to do most of the wind breaking on the bike since I out split Matt in the AM, and I had brought all my aero toys and Matt was lacking. Matt’s job was to pace me up the hills, and pull through at any key moments or if I popped.
70 minutes after we departed we rolled into transition 100% intact, contrary to 2008 and 2009 where I spent most of the ride suffering in Matt’s draft hoping for the bike to end, I felt as if we had stayed 100% within my fitness. Matt towed me up the hills, and gave me a couple minutes of rest shortly after the turn around as he hauled us up to and past a team up the road.
Matt and I tossed on our wetsuits as quick as we could and headed for the water. Since my run was definitely going to be slower than Matt’s the plan was for me to hit the swim fairly hard and get out onto the run course and let Matt catch up. I got through the swim only a handful of seconds slower than the AM and was leaving transition as Matt came in.
We cruised through the run, again pleasantly surprised. I was waiting for my body to pop the entire run, but it never did. I wasn’t crushing it, but I was holding my own. My run split was actually faster than 2009, and only 3 minutes and change slower than 2008.
I went to bed Saturday knowing we were comfortably in second place OA in the male team division. The first place team was most likely out of reach barring a disaster on their part, and my job for Sunday was to get through the race in one piece.
Sunday
When I woke up on Sunday morning my legs felt sore and tired, but surprisingly ready. The plan for the day was for Matt and me to swim our paces, and for me to wait in transition. I got through the swim without event feeling good – trying to ease into it and use it as a warm-up for the rest of the day.
Matt showed up in transition just behind me and we were out on the bike quickly. Initially the plan was for me to break the wind and pace us through the race at an aggressive Ironman effort with Matt pacing up the 2 climbs on the HIM course, but after 20 minutes or so matt and I settled into 3-4 minute rotations of work. I don’t know how it felt from Matt’s perspective, but sitting in for those 3-4 minutes was a great rest and really made it easy to drive the desired pace when I was in front.
Unlike last year the first loop was ”fairly” uneventful, we made it past the spot of the crash last year without a problem. We did have an interesting moment at the bottom of the Big Run fire road descent, as I went into a right hand turn I realized I had misjudged the angle slightly and ended up riding into the yard bordering it and cyclocrossing it for a bit. Just practice for the Cheq40 I say…
The remainder of the ride was uneventful – we managed to ride a couple minutes faster than 2008 with a 2:58 or 2:59.
The 13.1 mile run was the final test of the weekend. Not only was it going to be a half marathon after a weekend of madness, it was going to be my longest run since last October. My game plan was to use the Garmin to keep away from insanity, and let my PE guide me. I intended to run as if the race ended at 10.5 miles, as that is the point of the run were it is downhill to the finish. I figured I could ring 2.5 downhill miles out of my shattered body – I just needed to make sure I got there.
The first loop went without a problem, I tried to not look at the Garmin often – I was worried that it might start making my brain think too much. My job was to just get my ass to mile 10.5 and then roll downhill – so that was all I tried to focus on. At half way I checked our time and we were right around 52:30 which meant we were on pace for a spectacular run.
Things continued uneventfully until around mile 9 which is a wicked uphill into an aid station and the peak of the run before you plummet to the turn around. I nearly broke on that hill, alarms started going off like crazy in my head. I did my best to ignore them and rewarded myself with a brief couple of walking steps through the aid station and then continued to the top of the run course.
During the downhill towards the turnaround I had a couple doubts about my ability to get back up the hill – fortunately about that time Matt told me to let him know if and when I needed a push. Just a few minutes later I was crusing back downhill past the 10.5 mile mark re-energized and ready to finish.
Matt and I crossed the line with a run split just under 1:47. Which means I faded by less than 2 minutes on the second loop. Best of all Matt and I finished this year, and finished in 2nd OA in the Male Team division.

This weekend exceeded every one of my expectations for it – I did not expect it to go nearly as well as it did. It’s impossible to describe how much this weekend reaffirmed my love for the sport of triathlon and my motivation to continue the love/hate relationship with it. I have a great deal of excitement for the remainder of the season; I just need to temper the enthusiasm with continued hard work and consistency.

Great job at the TTT Scott! Sounds like you are back for sure ;-)

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Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

Despite the fact that I said after the Triple T I wouldn't bump this thread anymore, I can't resist the urge to bump it.

I have a few reasons for this:
1> To demonstrate that you can return from injury and a long break to a very high level of fitness in a short period of time.
2> To demonstrate that you can develop a very high level of run fitness without running very fast in training.
3> To toot my own horn - Toot!

http://www.scottbowe.com/...nman-wisconsin-2010/

Summary:
54:27/5:25/3:09 - Going to hawaii; 10 minute PR - all on the run.

Key Facts:
No running from 11/8/2009 until 3/27/2010 (3.5 minutes)

• I logged less than 90 minutes faster than 7 minute miles in training, and probably less than 3 hours faster than 7:30 - not counting races

No swimming from 12/12/2009 until 2/23/2010
No biking from 12/13/2009 until 1/27/2009 - although until ~2/23 I was pretty limited in what I could do since I was in a boot. Rides were along the lines of 30 minutes @ 100 watts (.3 IF)


Key Take aways:
Breaks are Good.
If you have a major injury - be patient, listen to your doctor - you will be ready before you know it.
When you can start training again - take your time - rushing things will only get you hurt again.
Listen to your body when training and racing - avoid injuries in the first place whenever possible.
Rappstar is going to destroy the world when he starts racing again.

Very nice post/bump Scott! And another congrats on a stellar IM performance with obviously great bike pacing and smokin' run!

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____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

Thanks for your story and abundant information on this topic.

Yesterday - car packed for IMCDA, go out for a quick "shake out" run for 25-30 mins, BAM! step on a small rock, roll left foot to the outside, nearly fall. Think its a bad sprain so drive from Salt Lake City to Missoula, MT for 7 hours. Pain worsening, get x-ray at ER in Missoula. Busted 5th metatarsal...no mistaking it. ER doc and on call Ortho say because I'm young and healthy I can rehab this in 2-3 weeks (sounds real optimistic) and be running again in 3 weeks. Pull plug on IMCDA, turn around and drive home all night. Crutches and boot. Devastated...

I was afraid of that from your initial post ...

At any rate, get a 2nd opinion from a specialist who treats runners. There is NO way this will heal in 3 weeks. I'm pretty aggressive in treating these in runners (i.e. Charlotte screw fixation right away, etc.) since they heal so slowly. Also, you posted "busted 5th metatarsal". Treatment recs will also change whether it is an avulsion fracture or a Jone's fracture or a midshaft fracture (less likely).

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____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

That recovery time sounds optimistic. My doc told I'd be in an Air Cast for 6-8 weeks. I had the 5th metatarsal break in addition to an avulsion fracture of the ankle 2.5 years ago. Apparently 6-8 weeks is standard. That being said, I wish you a speedy recovery, and I hope that you can indeed be rehabbed very soon.
I type this as I have an Air Cast on my other ankle now from a break 4 weeks ago. Duh.

It's confirmed avulsion.

Sorry to hear about your foot, I broke my 5th metatarsal (Avulsion Fracture) last year on a run too. It took 10 weeks for mine to heal. Doc had me only pool running and swimming the first 4 weeks (pushed off the wall with my good foot), after that I could start biking and then start running around week 10. I couldn't imagine it healing in 2-3 weeks (as nice as that would be!) Good luck with your recovery and see what the doctor will and will not allow you to do for exercise.

Thanks for the words of encouragement. I have a feeling that the ER doc said "2-3 weeks and you could be back running again" because he wanted me to definitively bag the race and clear out of his exam room. Or, he saw that the severity of the break was less than others. I don't know. Bottom line, I've got an appt next week with an ortho who treats runners and athletes with this thing. I will commit myself to his care and do whatever I'm told.

I read your post on begtri. Interested in your thoughts since it's been about 18 months. How's it recovering? Did you really swim and bike on the trainer during your recovery from this?

I fractured it back in March 2008, so it's been about 40 months now, and it feels completely normal now. Yes, I really swam and biked during recovery. I remember that two months after it happened, I was jogging/running on the seawall, probably between 10-12 kph, and some random guy came up to me and wanted to race. I told him I broke my foot, but he didn't seem to believe me.

Even up to a year later, it felt like there was a clicking in my foot, so I had it re-xrayed and the x-ray showed the bone was filled in. So if you have this type of injury it may take awhile for your foot to feel completely normal, but it will get there.

Just updating this thread with some photos. I'm 13 days post with a 5th metatarsal avulsion fracture. I appreciate all of the help that rroof and sentania have provided thus far as I've been trying to heal. And that's all I can do right now is sit, wait and heal. As far as I can tell I'm on one of the more conservative and strict healing programs - I'm pretty much locked down for 8-10 weeks. Even swimming is questionable until about the 4 week mark.

Sorry to hijack the thread, not technically a triathlete but definately an elite athlete looking for some help. My daughter who is 11 sustained an avulsion fracture of the 5th metatarsal last week. It looked like a complete break from one side to the next with a gap between both sections of bone. We have a follow up appointment at the fracture clinic tomorrow and I am a bit overwhelmed as to what I should be asking! She is a 2016 hopeful and I am worried because of her age her level of sport won't be taken seriously and she will be treated as a normal kid. I am assuming kids heal quicker than adults and I have no idea of recovery time as doc in A&E was very vague, but if they cast her for 5 weeks as suggested she is going to lose a lot of her fitness and muscle strength and flexibility in her foot during that time. Any help or advice will be much appreciated so I can go in well informed. Reading up on the Internet is freaking me out a bit as people are talking about months of time off before it heals. Thanks for reading and hope you guys don't mind.

If you've caught the injury early enough - she should be able to return to pretty normal levels of activity within 3 months or so.

A few thoughts:
While your daughter may be on the track for being a 2016 hopeful - don't second guess the potential for an injury like thi to have lasting problems if not handled properly.
A month to three off of specific fitness building will not make/break things for 2016.
A injury is your body telling you something - don't force yourself (and especially your daughter) through it.

I was shocked by the speed with which my fitness returned.


As a side note - I believe 2012 Olympic Triathlete Gwen Jorgenson had some injury problems recently (2009 or 2010) - and it didn't impact her level of performance much.

I'm a 41 yr old male. I'm very healthy and I have all of the lifestyle factors in my favor for healing bone quickly. Having said that the process and time for healing this injury is anything but fast. I'm on track and early healing is evident from my latest xray. I'm nearly 7 weeks post injury and still feel discomfort. Still in a walking boot. I fully expect the rehab process to be lengthy. Meaning getting back to full speed, power and pace will be a year in the making. The advice sentania gave is solid.

With all due respect, there is huge difference between a fracture at 11 and 41. My concerns regarding your daughter's condition are this: an 11 yr old will have a growth plate at the base of the 5th met that will be misdiagnosed as a fracture many times by nonspecialists, so make sure you get that straight. Secondly, dont be concerned by the lack of activity, casting, immobility, etc. If, in fact, it is a fracture ( digital xr post would be great ) it must be treated properly. Proper peri and post op therapy and training will insure a rapid recovery.

Thankyou all for your reply's.

I have no intention rushing her back into her sport, my biggest concern is if it's not treated properly it may re fracture, or she will have ligament damage that is not given adequate attention or rehabilitation. In Britain you don't have a choice of physician, you see who ever is lucky enough to get you, so no credentials to look at or possibility of asking for someone with a background of sports injuries.

My daughter is a gymnast so puts her body through a fair amount of stress anyway, she trains 25 hours a week and is looking to peak at 16. She hurt her foot falling off the beam and landing on her toes and turning her ankle. (so much for thinking crash mats are safe lol)

Having gone through a number of stress injuries with her I am becoming a bit of an expert on growth plates and docs thinking they are fractures. On the X ray you could clearly see the apophysis slightly on the side and the fracture going straight across the bone. It also looked as though there was a chip or bone fragment floating between the 2 ends. She is currently in a non weight bearing back slab and are waiting to see what plan the doc has tomorrow. I have seen a number of people saying they have been treated with a removable boot and very few having a below knee cast. Is there a reason for one or the other, or is it general practice to treat children conservatively with a cast? Are any of these fractures indicative of surgery (not that I want to go down that route, just want to be prepared).

Sorry for all the questions, but I can't find any other useful forums, it has been great being able to read other peoples experiences. Thanks again for the responses.

We went back to the doc today and was told it definately is broken and isn't the growth plate. It has been put in a cast for another 4 weeks then no physical exercise for a further 3 weeks.

I have some photo's but am having probs uploading them to the forum.

One might pose the question, would a period of rest followed by appropriate rehabilitation have had the same result in treating a fracture that almost never needs surgery?

I would guess that's a possibility.

However I looked at it as: I did the unwise thing and ignored this injury for ~4 months - continued to train on it. How likely is it that it will heal properly after 8 to 12 weeks off and conservative treatment, vs will I take 8 to 12 weeks off which turn into 16 to 20 - and then maybe still need surgery.

Now that I am 2+ years from injury and nearly 2 years from surgery - my only regret is that I didn't deal with it sooner.

 
Tried to upload x ray hope it works this time. Doc expects this to be healed in 5 weeks and back to gymnastics in 8, does this sound realistic? Wondering if we went private to see a sports injury specialist whether it would be treated any differently.

Nearly 4 weeks in a cast now and still getting swelling and bruising when weight bearing for a while with pain at night requiring pain killers. Does this sound normal or is it worth seeing someone sooner rather than later?

That sounds about like my experience. I'm 9.5 weeks post-injury. I've started to wean out of the boot. Honestly, at 6 weeks I had no idea how I was going to be able to walk on it but I am. I think it's safe to say that there's a pretty noticeable improvement that takes place during the 6-8 week time period. Even 9.5 weeks I still feel some discomfort (nothing requiring pain medication or aspirin but still some pain). The swelling in my foot didn't start to really get better until about 5+ weeks.

Hang in there.

Thanks Jim, it's really frustrating as got little advice from doc apart from should be ok in 5 weeks! Not holding my breath.

Nope. I'd be surprised, even with a younger person, if you'd be back doing activities like gymnastics in less than 3 months. But don't have any medical training, just first-hand experience with this kind of fracture.

Caveat: Not evaluating the patient.
Opinion: 6 weeks non weight bearing. Weeks 6-9 guarded progressioin to full weight bearing, weeks 9-12 gradual return to preinjury activities. Progression obviously dictated by individual progress.
JMHO

Thanks, that sounds far more logical to me! Was told to weight bare after a week, which is painful if done for too long and causes bruising!

Thanks for the advice will try to keep her off it as much a possible.

Looks like I'll join in the conversation here. I was running this past weekend and hit the side of the path on my way down (kind of a glancing step), so the full weight of my body landed on my 5th metatarsal. I wasn't specifically told what type of fracture I had (except that it wasn't a jones fracture), but from looking at everyone's pictures, it looks as if it's on the shaft of the bone. So that rules out avulsion fracture. Hurt like hell when I did it, can't put any weight on it right now(haven't tried) and the doc told me "no weight for two weeks". His prognosis was that I had a good two weeks without weight bearing activity and then see where I was at. Possibly take the immobilizing boot off then, and get into a walking boot. Does this sound feasable? Is this being too optimistic? Or is it just a "wait and see" how it is healing type of game? Thanks for any input.

Eric

I am a little concerned that you would seek medical information for your daughter from a triathlon forum. If your 11 year old daughter has olympic aspirations, perhaps you should seek a comparable caliber of medical advice. That caliber of advice is unlikely to be found from a 40 year old triathlete working in finance.