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5th metatarsal shaft fracture - recovery advice
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Hello all, I unfortunately managed to sustain a spiral fracture of the 5th metatarsal of my foot from an inversion planter flexion injury when i tripped down the stairs. I've been putting in the hard yards for a big climbing cycling race in March. The orthopod was 50/50 on whether it needed a plate and a couple of screws, or to just try conservative management which often has good results. I'm still trying to make up my mind. Has any one else had surgery on these injuries? How long until they could start to turn the pedals on a bike trainer? I've been told a minimum of 4 weeks non weight bearing but was hoping i might be able to get on a trainer sooner, but don't want to risk non union.....
Last edited by: Stiphodon: Jan 9, 21 13:35
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Re: 5th metatarsal shaft fracture - recovery advice [Stiphodon] [ In reply to ]
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I did that a few years ago when I was 40ish. Spiral fracture that looked worse than yours. (I can still remember the crunching sound when I did it. Ugh.)

I didn't bother with surgery, recovered to walking shape pretty fast (a couple of weeks to light load bearing) in a tight boot. Probably six weeks before biking on a trainer, 8 before running (being conservative). Don't recall any issues on the bike. Only long term effect has been a bit of discomfort in hockey skates, and being able to predict the weather a few days out.

***
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Re: 5th metatarsal shaft fracture - recovery advice [M----n] [ In reply to ]
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Glad to hear you recovered well without surgery. The snap was pretty loud with my break too! I'm 41, so healing should be similar. I tried getting on the trainer in the moon boot but didn't end well pain wise 🙄
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Re: 5th metatarsal shaft fracture - recovery advice [Stiphodon] [ In reply to ]
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Get the surgery. I broke my foot almost the same in the 2019 70.3 WC. It was 2 months before I started riding again with a slow, cautious ramp up. Your March race is in play, but not at top performance and only if you get it fixed ASAP.

My doc did the fix with screws only. Odds of healing without surgery are low, and the union may not be right.
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Re: 5th metatarsal shaft fracture - recovery advice [Stiphodon] [ In reply to ]
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Same for me in September 2019. 5th metatarsal in left foot while doing a trail run. Rolled the ankle and heard a godawful snap. Pain was manageable and still hobbled back to car.

X-ray the next day and Orthopedist recommended 6 weeks in boot. Called it a “Jones fracture” and quite common. Hes a specialist and runner also and definitely recommended against surgery. No running and no swimming. I was allowed to bike on a trainer using only one leg.

First few weeks rode sparingly on Zwift. Managed to stuff left foot in shoe with buckles totally open; like stuffing a burrito into a shoe. Rode with no left leg pressure, just trailing along. At 4 weeks, started swimming with buoy and then Roka neoprene short. Virtually no kicking. At 5 weeks follow up appointment and X-ray show it was about 80%healed. Started running a few days later, 1 mile on track. Slowly built up mileage from there.

Managed to do a turkey trot 10k with about 3 weeks of training. Imbalance was noticeable. Left leg significant smaller than right. Even now, running does not feel natural and has a hitch. But it’s getting better. Just got to focus on weaker leg while running.

Good luck.
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Re: 5th metatarsal shaft fracture - recovery advice [talegater] [ In reply to ]
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talegater wrote:
Same for me in September 2019. 5th metatarsal in left foot while doing a trail run. Rolled the ankle and heard a godawful snap. Pain was manageable and still hobbled back to car.

X-ray the next day and Orthopedist recommended 6 weeks in boot. Called it a “Jones fracture” and quite common. Hes a specialist and runner also and definitely recommended against surgery. No running and no swimming. I was allowed to bike on a trainer using only one leg.

First few weeks rode sparingly on Zwift. Managed to stuff left foot in shoe with buckles totally open; like stuffing a burrito into a shoe. Rode with no left leg pressure, just trailing along. At 4 weeks, started swimming with buoy and then Roka neoprene short. Virtually no kicking. At 5 weeks follow up appointment and X-ray show it was about 80%healed. Started running a few days later, 1 mile on track. Slowly built up mileage from there.

Managed to do a turkey trot 10k with about 3 weeks of training. Imbalance was noticeable. Left leg significant smaller than right. Even now, running does not feel natural and has a hitch. But it’s getting better. Just got to focus on weaker leg while running.

Good luck.

Sound advice for Jones fracture (avulsion), however, his x-ray to me warrants an open correction (surgery) and does not look like a Jones with a single plane of involvement.
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Re: 5th metatarsal shaft fracture - recovery advice [Stiphodon] [ In reply to ]
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I would treat that as a fairly serious injury and accept the loss of fitness from pursuing a complete recovery

I had an avulsion fracture, which was not nearly as bad, and regret not taking complete precautions to the healing process. After a year it still lingers from time to time...

Strava
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Re: 5th metatarsal shaft fracture - recovery advice [Stiphodon] [ In reply to ]
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This is neither a Jones fracture, nor an avulsion fracture. And an avulsion fracture and Jones fracture are different, with higher rate of non-union in Jones fractures. This looks displaced enough that I would consider surgery... my 2 cents.

Colorado Triathlon Company, CO2UT 2021, Crooked Gravel 2022, Steamboat Gravel 2022
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Re: 5th metatarsal shaft fracture - recovery advice [Stiphodon] [ In reply to ]
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I sustained the same type of 5th met fracture back in March and my X-rays are almost identical to yours. Avulsion-type sprain ( history of ankle instability and long-since ruptured anterior tib-fib ligament), immediate sharp pain in my 5th met shaft, and displacement and gap was almost identical to yours. Went to a highly respected foot & ankle ortho, he was fairly confident with the alignment and healing of this type of fx. He did spend some time measuring and discussing the Fx gap, and in hindsight he may have gone with the conservative approach because this was right when Covid was ramping up in the US.

Initially, I did take about 2 weeks completely off in a Fx boot as there was some significant swelling, then transferred to a rigid, carbon insole placed in a running shoe as my boot caused some intense ITB flare-ups. Couldn't fit in my cycling shoes at first ( luckily had an older, wider-fitting Bont on hand), but as soon as I could I started some light cycling.

Keep in mind you want to minimize motion at the fracture site, as you prob know. I ended up having a delayed union, despite using an Exogen bone stim. My doctor had me add Vitamin D and calcium and the next visit after that the healing was significant. Ended up using the bone stim for a good 4 months or so, the doctor and PA both thought that was helping.

By the way, if you happen to be a size 12-13 shoe I may still have the carbon sole around. ( I take a 12 dress shoe, 13 run shoe and 47 cycling shoe). As far as the Exogen, look for a used one on Ebay, and get one with the orange button as you can replace the battery in those older models. The newer ones have the purple button and I am not sure you can swap out the battery as easily. Any questions on that let me know!

Good luck!
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Re: 5th metatarsal shaft fracture - recovery advice [Stiphodon] [ In reply to ]
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I will also add that when you are ready for some cycling stick to the trainer only. And do not, I repeat, do not twist that foot to unclip from your pedals as that can really cause some unwanted motion at that site. Just keep that shoe clipped in the pedal and take your foot out of the shoe while still clipped in.
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