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5th metatarsal stress fracture, metarsal head pain

Discussion in 'Biomechanics, Sports and Foot orthoses' started by the5kdude, Jun 24, 2010.

  1. the5kdude

    the5kdude Welcome New Poster

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    disclosure: I am not a podiatrist, but a pharmacist. I am a patient seeking additional professional opinion and knowledge.

    I am 51 YO runner typically averaging 25 miles per week, I run a 5K in 17:45. 4-5 days of running in typical week, long run of 8-10 miles, no other runs more than 5 miles. Since October 2009 slowly increased long run from 6 miles to 10 miles in preparation of 15K race in late March. In 1981 I ran this 15K in 49:15, wanted to break 60 minutes this year. Completed 15K in 59:03 and then got real stupid, real fast. With the advent of warmer weather, while my son was at soccer practice, I went to my favorite 8 mile loop and ran it at 6:50 pace, in addition to my weekly 8-10 mile long run. On 4/12, I began the 8 mile loop and noticed my left foot was hurting a lot. I ignored it and completed the 8 miles. I had a stress fracture in my femur 25 years ago and forgot what the pain felt like. In retrospect, I should have know that this was the problem. My foot hurt at work that day before running, and I ignored it. Too many miles in too short a period of time, a faily classic scenario for a stress fracture.

    Went to the orthopedic doctor on 4/22, X-rays were negative. When I described where the pain was, he said I have a stress fracture, and an MRI would confirm, but he was pretty certain. On the outside of my left foot I had rather significant callousing and he said that is where the stress fracture was, he said that is where most of the impact is ocurring. He took one look at my 20 year-old orthotics and said it was time to revisit my podiatrist and get them updated.

    My podiatrist is a runner himself. He recasted my feet and made me new orthotics. I had an MRI on 5/25 and here is what the report said:
    " Long- and short-axis far- and water-weighted images were performed. Findings: Marrow edema diaphyseal region of the 5th metatarsal most consistent with grade 1 stress reaction. No periosteal elevation identified. No significant extraskeletal edema noted. The remainder of the bones are unremarkable. No substantive arthropathic change. No evidence of hight-grade ligament injury. Lisfranc ligament and joint space intact. Muscles and tendons intact. No evidence of Morton neuroma. No interstitial bursal inflammation evident. Sesamoid bones normal in height and signal intensity without fracture or avascular necrosis. Flexor hallucis tendon intact. Plantar plate intact. No evidence of mass, cyst, or ganglion. No high-grade soft tissue inflammation or edema. Conclusion: Stage 1 stress fracture 5th metatarsal."

    On 6/3 I returned to orthopedic doctor, explained that the stress fracture pain is still there, I can touch the outside of my foot about 3 inches towards the back of my foot from the little toe 'knuckle'. But the 'knuckles' of my 4th and 5th toe hurt way worse. What is the problem? He said the metarsal heads(?) were bruised, most likely from my altered gait during the 8 mile run, and I was putting all my weight there when I landed. I have an Exogen 4000+ Ultrasonic bone healing system that began using on 6/4/10.

    The stress fracture pain has gone away, but the 'knuckle' pain still persists on my 5th toe. I have been icing extensively for 2 weeks. Between that and the ultrasonic bone stimulation, things has progressed. I have been wearing this darn boot for 10 weeks and I am beginning to lose my mind.

    Does metatarsal head pain typically last this long? Why did that not show on the MRI? (although that is probably water under the bridge at this point) I still cannot walk without altering my footstrike to avoid putting weight on the outside. Is there anything else I can do to speed a resolution? Thank you for your consideration.

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