5th Metatarsal Avulsion Fracture

Triathlon Forum
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Hi, I know some of you may have had this injury before and might be able to give me some advice. I have an avulsion fracture on my 5th metatarsal. I was running last week, stepped on a rock wrong and rolled my ankle. My ankle is fine, but my foot is broken. I’m in a walking boot that looks like a ski boot. I can bear weight on it without much pain (if any), it only hurts when I move my foot the wrong way, especially when I invert it. The swelling is pretty much gone, but I have some random bruising around my toes and near my heal. If I press on the bottom of my foot there isn’t any pain, but if I press on the top/lateral part that is where I feel the pain. I can lift my foot up on the ball of my foot, but it hurts to put pressure on it.

My main question is is it ok to move my foot around? I’m not sure if moving the ankle will prevent my bone from healing since it’s right near a tendon. The doc said I can pool run and swim, but sometimes my feet move so I’m afraid I could be making it worse. I would love to start biking soon on the trainer but I’m not sure the motion would be good for my foot. I think if I sat on a stationary bike and pushed the pedals with my heel it wouldn’t hurt my foot, but I’m unsure if I would be making it worse. I’ve read stories about people’s pain going away and then getting another x-ray and nothing is healed. I was hoping the pain would be an indicator of how it was healing or if I was doing something wrong, but from reading other stories it doesn’t seem this is the case.

What has everyone found? I’d appreciate the advice. I know everyone is different in healing, etc.

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I had the same along with a broken ankle in September 2008. I was in a removable cast for seven weeks. I wasn’t encouraged to put weight on the affected (left, in my case) side. I didn’t have surgery, and I was stationary biking a couple days after the cast was gone. I began running on the treadmill in January.
As to your question, it wouldn’t seem wise to move your foot too much, although I can’t see why you wouldn’t do some dorsi and plantar flexion with your ankle so the tendons and ligaments don’t “shrink”.
My final and best advice is ask your doc.
Be patient, Grasshopper! I know it’s a PITA, but you’ll heal. Get yourself to the nearest chin-up bar and do push-ups. It won’t hurt and you’ll look huge!

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Rest! Don’t try to make it worse. I am 12 weeks out from the same injury. I tried swimming after about 1 week and found it to be painful. The water from my pull would go past my foot and cause pain (even when using a pull buoy). I didn’t try it but if I would have tried to pool run it would have been very painful. And yes it is true, the pain will go away but the xray will look worse. This type of injury looks worse on xray before it will get better. After about 8 weeks out from injury I was back on the bike. I encountered no pain whatsoever. I am currently riding 3 times a week at about 150-160 miles a week. I began swimming after about 4 weeks. My best advice would be to hit the gym, rest, don’t over do it and enjoy the time off.

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http://forum.slowtwitch.com/gforum.cgi?post=2593704

Looks like my x-rays got munged up (they show red X’s) (will fix that tonight).

I twisted my ankle last July, and didn’t know my foot was broken until september. I did a half, an olympic, and a Full IM before I knew it was broken, and a sprint and Full after I knew :slight_smile:

I ended up having surgery on 12/14/09 to put a screw in - and was pretty useless from a exercise perspective until 3/17. I was able to start swimming around 3/5, bike on 3/17, and started running around april 1st (exact dates are in the thread.)

To answer some of your questions -
my foot hurt surprisingly little, but when it hurt it was a pretty sharp and at times crippling pain - but I was able to do almost all of my workouts with a constant stream of Ibueprofen. That said - I went around feeling something was wrong with my foot nearly 24/7.

As I said, I did a HIM on it less than 10 days afterwards - and my biggest concern coming in off the bike was that my heel (on the same foot) was still really sore from stepping on a rock during the run into the swim - so while it was sore - it was manageable.

Have you had x-rays yet? If you haven’t I would make sure you get them immediately. I would also recommend only doing the activity you and your doctor deem appropriate for your injury. After surgery my doc didn’t want me swimming or pool running because the ankle flexation would continue to pull on the fracture. So based on my experience you probably want to be pretty careful with moving things around and/or weight bearing.

I ignored advice to get x-rays until nearly 9 weeks post break - and ignored further advice by running on it for another 8 weeks, before finally doing the smart thing.

My advice - listen to your doctor - referencing rroof and perhaps another local doc and follow their advice. Don’t rush things from a fitness perspective - this fracture is a PITA so take it slow in coming back from this. I know it’s hard and you don’t want to lose fitness, but I put my body in a very difficult spot and gave it a very difficult task in fixing this thing - by being a bonehead.

Yes, I missed a lot of training time - but I have also just recently PR’d @ the HIM distance and am pretty much at life best fitness a mere 5 months after being allowed any sort of activity.

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Also - I wish you the best - it’s a crappy injury.

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Thanks for the information everyone! The doc has me in a walking boot, he said I could swim, and I don’t have to wear the boot to bed. That makes me wonder if he is not concerned that I move my foot. I’ll just rest my foot as much as I can until my next x-ray in 4 weeks. You guys are right, this injury is a PITA :slight_smile:

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**sentania **, you’re a tropper. I have no idea how you ran with a fractured foot. Mine feels ok if I do nothing, but I’d scream if I tried to run on it. I did get x-rays the day after I broke it to confirm it was fractured.

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Depending on several factors, young/healthy athletes are often better served to have immediate ORIF of the avulsion fx, rather than waiting for union (since it can take so long) or needing it later. With modern percutaneous cannulated screw fixation, there is very little risk/downside, but can decrease your healing time tremendously.

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TR - my first piece of advice is to be certain that the diagnosis correct. I’m certain rroof will back me up on this that countless times someone is billed as an avulsion injury when they are actually the more complex Jones fracture. And, with respect to using a cannulated screw, I too have noted a decrease in healing time and return to sport. Downside is that it’s an operation- and everything that encompasses - and some folks ultimate request screw removal, also requiring anesthesia.

In short, talk over the options with your surgeon and do what’s right for you. Good luck.

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Thanks John, I’m pretty sure it’s an avulsion fracture, that’s what the doc said and that’s what it looks like when I googled it. It happened at the tuberosity of the bone, not near the neck. I heard these heal quicker than a Jones fracture and normally without any complications. I think I would like to get a second opionion though, because I read if the bones are too far away from each other they won’t heal.

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If you seek a second opinion, get it from someone who cares for this problem on a regular basis, both surgically and non-surgically. Second opinions are good, particularly in a situation where the patient is uncomfortable with the first treating entity. But that doesn’t sound like the case here. Maybe a quick call to your treating physician is all that you need; or possibly a follow-up visit. That said, by the time you actually get seen by the second opinion, heck it’ll be half way healed.