mri is better for soft tissue scanning.
Bone scan would definatevely show bone turnover.

No real point for doing either of these. The treatment for a stress fracture and soft tissu injury is going to be the same... rest.

It is nice to have a definative diagnosis but honestly there is no reason to do either.

I think either an MRI or bone scan would be fine. I agree that the treatment for all of these will be rest - yet if you have a stress fracture - you'll be advised to stop running for at least 2-3 months (I'm not sure of the exact time frame but it will be a long time). Soft tissue you could push a little more. If I was you and the MRI was well-covered by insurance - I'd have it. That way if you have a stress fracture - you know you're done for a while. Soft-tissue - then its a wait and see game. I wouldn't pay for an MRI though - I'd just listen to my body the best I could.....

Activities - swimming is safe. Running is out till you know whats going on. I sometimes get pain at the base of my 5th MT from biking and then trying to run is excrutiating - so that could aggravate it. Most stress fractures are not base of 5th - they are midshaft 3rd/4th MT fractures I believe (March fractures). At least in the short term you have some recovery time from just doing an IM!

Hope this helps....

Sorry for your fracture. I've had a horrible 3 weeks of strange injuries and an ear infection to boot.

I had a stress fracture in my fifth metatarsal in high school during football. The doctor took a tuning fork, whacked it, and then placed the end of the handle on my foot right where he thought the stress fracture was and it seriously hurt... like sharp pain. I can't quite remember if the xray showed the fracture or not. I was only out of practice for about 10 days and I never reinjured it. Of course, I was 17 years old so the healing time would be longer for me now.

I remember the sharp pain/ache during the day. It sucks.

Good luck,

Bo

Thanks for the response Taku and all...

Re: No real point for doing either of these. The treatment for a stress fracture and soft tissu injury is going to be the same... rest.


Several articles I've read so far, including this one: http://footandankle.mdmercy.com/...ubs/pressItem57.html
indicate that 5th metatarsal stress fractures in particular are very slow healing due to limited blood supply, sometimes requiring imobilization for upwards of 20 weeks to get complete healing. Therefore, for active athletes surgery (bone graft of screw fixation) is usually recommended. I know that this is all extremely speculative at this point since I don't even know definitely if this is what I have, but the literature I've read so far indicates that for active athletes the treatment of a 5th metatarsal stress fracture is far different from a soft tissue injury. At this point, what I'm trying to avoid is a mis-diagnosis. I'd hate to be in a boot for 6-8 weeks thinking it's a soft tissue injury, only to find out later that it's a stress fracture that's not closing. I think I better stop the web research... :-)

Surgical intervention is extreme. Conservative treatment is relative rest. Standard treatment is rest woth boot/cast immobilization. I have never heard of surgical intervention without first trying more conservative treatment.

1st diagnostic test would be a second X ray in 2 weeks

I would not look to surgery as my first option at all... to each his own though

i stress fractured my 3rd and 4th metatarcals last year. nothing showed on my x-ray either, so they suspected soft tissue injury. i had one of the physios from the hospital i work at do some ultrasound on it and it hurt like hell, which made them suspect a stress fracture. from there i went to get the bone scan, on which it lit up like the sun. complete rest for about 2 months and got back into running. felt good, so pushed a bit harder. still felt good, then, all of a sudden, the pain was back in full force. funny thing about stress fractures, after a bit of rest the pain subsides a great deal, but the actual injury isn't completely healed and if you're impatient (which i am) you end up re-aggravating it and being out for twice as long. whatever you do, just be careful with it while it's healing. if you even think it throbs or aches, stop whatever you're doing. after the second injury, i took up deep water running while i was waiting for it to heal. lots of studies out there show it's a great thing to help keep running fitness even when you're not injured.

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"I'm happy when life's good,
and when it's bad I cry.
I've got values but I don't know how or why."
- The Who

For what it is worth (general info) :

1: MRI is a better exam for several reasons...a) it will give you anatomy b) it is age independent and c) you can differentiate fracture from another process which could mimic fracture. An Tc99m MDP scan (bone scan) won't pick up a fracture for several weeks in some cases in older persons or those with some degree of bone mineralization and you can get false negatives. A bone scan also can't differentiate from activity related to fracture vs. local inflammation from tendonopathy vs. infection etc. etc.

2. HOWEVER: in the general population, a bone scan is nearly as good and is also (in most cases, but not always) cheaper

3. Unless you need to know NOW however, I would just wait about 7-10 days and get another xray. If it is a stress fracture you should have developed signs of the healing process trying to get revved up. Personally that's is what I would do first. If nothing shows up by two weeks, then I would get an MRI to look for some other etiology of the pain. Rest is the key and giving it time to heal correctly.



Just my nickel

Lance Faler

MSK Radiology

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That is just one more group of people that should be thrown screaming from a helicopter- George Carlin

I had a stress fracture of the 5th met in '98. Showed bright yellow on a bone scan. I could tell it was there when looking at the results. I had 2 months off and it was healed.

I did have weakness in my foot, and eventually developed peroneal (sp?) tendonitis in the same foot. I was diagnosed with the tendon actually trying to detach from the bone, (felt great at IM Wisconsin last year). All of this was actually due to my running style/pronation. The stress fracture may have been also, but I was playing college soccer at the time, so they really didn't worry about that kind of stuff then. We thought it corresponded with one of the cleat placings on my soccer shoes. (Soccer solution : saw off the cleat).

Since then I have had orthotics and have no problems. A little weird feeing every now and then, but it could just be mental? I've worried about stress fractures and tendon problems ever since then.

This is a bit out of my field nowadays, but I used to be an orthopaedic technition in the busiest fracture room in Toronto. In fact that's how I worked my way thru chiropractic college.

The tuning fork on the fifth metatarsel is probably almost as good an indication as anything. I've used it a few times for a diagnosis. Also quite often a stress fracture may not show up on x-ray for a week or so after it happens.

One standard treatment was to be immobilized in a below the knee walking cast for ten days s and then re x-ray. The other is tape and crutches and no weight bearing for this duration of time and then also do another x-ray. If it is a stress fracture it should show up at this time. If so it's back into the below the knee walking cast. If my memory is right, it was usually about six weeks in a cast for for this fracture.

Since you're getting the benefit of high tech imaging, you just wait for the results and see what the ortho guy says.

I went in to the doc with a foot problem last year - pain in the 5th metatarsal on my right foot. I thought it might have been a stress fracture, but he thought otherwise. I also had shin splints in the upper part of my shin by my knee. He took a look at my walking style, running shoes and work shoes. He sent me off to get some firm orthotics - off the shelf at Fleet Feet - no problems since.

Broken 5th Metatarsel?

I'd have stopped after 2 or 3....but that's just me :-)



TriDork

sorry, I couldn't resist.

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TriDork

"Happiness is a myth. All you can hope for is to get laid once in a while, drunk once in a while and to eat chocolate every day"

Bone scan is the way to go. im in the bussiness here. MRI is expensive and has long waiting time. bone scan will conclusively show if there is bony injury. you need to know this. If no bony injury you still need to rest but can train- ie swim. no pinning required no surgery no cortisone.

rad man

Hey rad man (and all),

Thanks for the reply. Aside from the cost and wait time of the MRI, is it as good at diagnosing stress fractures? The orthopedic surgeon that I saw says that it's actually better than a bone scan because you get to see the anatomy of the area, and it's just as sensitive at seeing fractures. Cost isn't really an issue because it's covered by my insurance, and oddly enough the wait time for an MRI is actually shorter than the wait for a bone scan at my hospital, so his recommendation is the MRI.

I'm currently in a removable e-boot, so I can walk on it and take it off to shower/sleep, etc. If it's confirmed to be a stress fracture, should I have a cast put on? The doc was 50/50 on this, but I think that most of the patients that they see are non-athletes that are content to wear the boot for as long as it takes to heal, even if it takes longer in the boot vs a cast. I'd rather put up with the misery of a cast and crutches if this means the foot heals faster. If it's the same time to heal, obviously I'll take the boot over the cast.

As far as training goes, since I'm currently in an e-boot, and was told by the doc that even if it's a stress fracture I can still swim (no kick drills) but obviously no running/cycling until it heals. Does this seem prudent, or do I just become a couch potato for a few months? Sorry to bombard you with more questions. I've found that I really need to manage my HMO to get decent care out of them, so I'd like to hear what has worked for others.

Just give it a week and have another xray taken. If nothing shows up by then, I would get the MRI. Bone scans are an okay test, but it is an old technology that offers no advantages over MRI with regard to trauma.

Lance Faler

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That is just one more group of people that should be thrown screaming from a helicopter- George Carlin

interesting. i can fit you in for a bone scan today but the wait for an MRI is 6 weeks. you arent interested in seeing anatomy, only physiology. The fracture may be too small to see on MRI but it will be "hot" on the bone regardless of sze

I am out of my depth with the e-boot thing. it probably depends as much on which will keep your foot most constricted, and thus aid healing