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5th Metatarsal Avulsion Fracture Experience
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I'm wondering if anyone out there has any experience with having a 5th metatarsal avulsion fracture, surgery to repair it, and a return to running? I have one and am most likely going to have surgery to fix it. I've been conversing with rroof and am pretty happy with the route my local doc and I are probably going to go - just curious if anybody here has had a similar experience and how it went for them.

Background:

Between July 1 and July 12 - inversion while running. Right foot is sore in the peroneus brevis area. Very tender to the touch, but quite managable while running. Pain tends to subside after a few minutes

Converse with rroof and a few local medical friends - I feel safe/comfortable/confident that it's just tendonitis. No issues running long/fast/etc. Pain is pretty minor, ice and ibeuprofen make it hardly noticable.

August - become pretty adapted to it - no improvemet no worse

September 13th - IMWI

September 25th - no improvement after a week of no running, so I get long over due [in hindsight] x-rays. Definately broken. Discussions pursue - decide to continue to train for IMFL because of low pain level, mostly because of substandard IMWI

November 7th - IMFL

November 18th - Visit a different local doc (insurance reasons) - to discuss strategies to heal/fix. Short story is - due to age of break, need to go in freshen it up, and put in screw. Long recovery after.


As I said - wondering what other folks out there with a similar injury have had as a recovery experience - thanks!




Last edited by: sentania: Jun 10, 10 11:56
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Re: 5th Metatarsal Avulsion Fracture Experience [sentania] [ In reply to ]
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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".
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Re: 5th Metatarsal Avulsion Fracture Experience [sentania] [ In reply to ]
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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.


--------
"Texas is a state of mind. Texas is an obsession. Above all, Texas is a nation in every sense of the word" - John Steinbeck
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Re: 5th Metatarsal Avulsion Fracture Experience [lonestar] [ In reply to ]
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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!
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Re: 5th Metatarsal Avulsion Fracture Experience [sentania] [ In reply to ]
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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!

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Re: 5th Metatarsal Avulsion Fracture Experience [sentania] [ In reply to ]
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Nice x rays. Lookit how well the sesamoid bones show up. I love x rays.

I can't find the fracture, though?

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
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Re: 5th Metatarsal Avulsion Fracture Experience [ktm520] [ In reply to ]
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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.
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Re: 5th Metatarsal Avulsion Fracture Experience [tigerchik] [ In reply to ]
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http://en.wikipedia.org/...ifth_metatarsal_bone

Go look and see how it's supposed to look :)
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Re: 5th Metatarsal Avulsion Fracture Experience [tigerchik] [ In reply to ]
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In Reply To:
Nice x rays. Lookit how well the sesamoid bones show up. I love x rays.

I can't find the fracture, though?

LOL! Luv ya TC ... ;)

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: 5th Metatarsal Avulsion Fracture Experience [sentania] [ In reply to ]
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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

"Spectacular achievements are always preceded by spectacular preparation."
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Re: 5th Metatarsal Avulsion Fracture Experience [rroof] [ In reply to ]
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In a month after I see an orthopedist we can play "critique my hip x rays"

or not, but it's a possibility.

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
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Re: 5th Metatarsal Avulsion Fracture Experience [eDeRoche] [ In reply to ]
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In Reply To:
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

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).

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: 5th Metatarsal Avulsion Fracture Experience [sentania] [ In reply to ]
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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.

-----------------------------------------------------------
I can take my heart rate from any vein in my body... any vein.
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Re: 5th Metatarsal Avulsion Fracture Experience [sentania] [ In reply to ]
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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.

John H. Post, III, MD
Orthopedic Surgeon
Charlottesville, VA
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Re: 5th Metatarsal Avulsion Fracture Experience [johnpostmd] [ In reply to ]
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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!
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Re: 5th Metatarsal Avulsion Fracture Experience [sentania] [ In reply to ]
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Dang it! Why aren't you in my AG?

chris

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

Member HED Mafia
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Re: 5th Metatarsal Avulsion Fracture Experience [sentania] [ In reply to ]
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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.
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Re: 5th Metatarsal Avulsion Fracture Experience [sentania] [ In reply to ]
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In Reply To:
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!



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.


--------
"Texas is a state of mind. Texas is an obsession. Above all, Texas is a nation in every sense of the word" - John Steinbeck
Last edited by: lonestar: Nov 22, 09 18:32
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Re: 5th Metatarsal Avulsion Fracture Experience [sentania] [ In reply to ]
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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
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Re: 5th Metatarsal Avulsion Fracture Experience [E-man] [ In reply to ]
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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!!
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Re: 5th Metatarsal Avulsion Fracture Experience [sentania] [ In reply to ]
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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.
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Re: 5th Metatarsal Avulsion Fracture Experience [tribike] [ In reply to ]
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/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.
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Re: 5th Metatarsal Avulsion Fracture Experience [sentania] [ In reply to ]
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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.
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Re: 5th Metatarsal Avulsion Fracture Experience [sentania] [ In reply to ]
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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.
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Re: 5th Metatarsal Avulsion Fracture Experience [sentania] [ In reply to ]
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excellent - heal quickly Scott! Assasin's Creed - great game, although my wife frumped a bit as my son (8) and I played ... ;-)

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