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The response to the question below was authored by Marc Mitnick DPM

5th Metatarsal Base pain...

by Chris
(Severna Park, Maryland)

About 3 months ago I started having pains in my left foot around the base of my 5th metatarsal. I knew i should have seen a doctor but just decided to push it off until it got to the point where i could barely bear any weight on the foot without pain. So after a visit to a foot and ankle specialist we thought we had come to the conclusion that i had an avulsion fracture of the 5th. So the foot has been placed in a walking cast. Well a few days after having the cast put on my right foot started giving me the exact same problems/pain except worse. I then learned that my growth plates in the base of the 5th never fused as a child. My left foot has been casted for about 3 weeks now and my right foot for about 2. I am still am having extreme pain in both feet with out any sign of relief. I have been on short term disability for about 3 weeks now and all i have been doing is laying on the couch trying to rest but they don't seem to be getting better... Which leads me to the question i really want to ask. What are my surgical options and how long would the recovery period take. I am a 21 y/o healthy male and i really need to return to work and would like the fastest fix possible. I cant keep missing work .

RESPONSE

Hi Chris,

If the growth plates of the fifth metatarsal base never fused then casting you is not the long term answer. Casting may solve the short term problem of

alleviating the pain, but an "unfused" growth plate will at some time probably fracture again. Simply put, there is an inherent weakness in the bone at that level and you will always be prone to fracturing the fifth metatarsal in the same area. This can occur without any history of trauma. It could occur from nothing more than stepping off the curb the wrong way, or climbing a ladder or any number of innocuous ways.
The problem with fractures in this particular part of the fifth metatarsal is that the bone is poorly vascularized meaning the blood supply to the bone is derived mainly from surrounding soft tissue. Without great circulation, fractures in this area have a tendency to be difficult to heal in the first place.
Because you are young and because you have finished growing and assuming you are in good health I would suggest you give some real thought to having both fifth metatarsals surgically fused.
Depending on how bad the non-fusion is, it may require a bone graft and then fixation with a screw. It is not a very complicated surgery and depending on the degree of fusion and the advice of your surgeon each foot would be "tied up" for around six weeks barring any complications.
Having said that, assuming a successful outcome, you should no longer be bothered by this problem.
When people come into my office with fifth metatarsal fractures in most cases we try casting first, but in your case, with an inherent weakness in the bone, I do not see how casting alone, even if the present fracture heals, will not become an issue once again down the road.

Marc Mitnick DPM
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ADDITIONAL REFERENCES

Mayo Clinic

Johns Hopkins Medicine

MedlinePlus

Arthritis Foundation

University of Rochester Medical Center

Harvard Health

Drugs.com

American Academy of Pediatrics

Penn State Medical Center

National Institutes of Health

Columbia University Department of Rehabilitation

ScienceDirect

Stanford Health Care

Illinois Bone and Joint Institute

Mount Sinai Hospital

Institute for Chronic Pain

University of Florida Health

American Family Physician

Cedars-Sinai

University of Maryland Medical Center

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Unknown location

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New Zealand

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Poland

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location unknown

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New Jersey

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location unknown

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Evansville, IA

Dear Marc

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San Diego, CA

Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!

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Albany, NY

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Whichita, KS

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Boston, MA

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Colorado

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Colorado

Wonderful advice

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This is the best site for foot problem info.

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location unknown

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North Carolina

Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...

KG

location unknown

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Bessie Mae

Florida

Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

location unknown

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New Jersey

Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

location unknown

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Bellevue, WA

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Jodi

location unknown

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