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 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!
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).
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.
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.
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
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).
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.
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.
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!
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.
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.
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.
