Can't move little toe after 5th metatarsal fracture

by Christine
(Dunbar, WV)

I fractured the 5th metatarsal Memorial Day weekend in a fall down some stairs. During the first weeks all the toes would move. However, in mid-August I stopped being able to lift little toe. Gradually the other three toes lost some movement. Foot is still very swollen and painful, walking or not. Ortho released me and said just wait it out. Will it eventually heal and will toe movement return? Thank you!

RESPONSE

Hi Christine,

I am not sure I know what "wait it out" really means. You are now four months post fracture and in that time period most uneventful fractures would be healed in an otherwise healthy individual. I am making the assumption that you are in good health, relatively young, a non-smoker and the fracture was properly immobilized AND you did not have surgery to repair the fracture.

If the above assumptions are not totally true then perhaps that would explain why the foot is still very swollen and tender.

The other issue is where the fracture occurred on the fifth metatarsal. Fractures at the base of the fifth metatarsal can be especially difficult to heal particularly if you do not meet the criteria I mentioned above.

Fractures any where else on the fifth metatarsal should have healed uneventfully in six to eight weeks.

Because it is four months post trauma and your foot is still swollen and painful leads me to believe, as an outsider looking in, that perhaps the fracture is not completely closed. I cannot think of any other reason why you would still be experiencing so much pain and swelling at this point in time.

So the question about toe movement of the fifth toe is almost a secondary issue at this point. You first have to get the swelling and pain to resolve and then address the lack of movement in your little toe.

If you have been in a walking cast for the last four months then that would probably explain why there is no motion in the toe; it is simply disuse atrophy of the muscles that control the little toe. Simply walking in shoes and barefoot (assuming the foot was no longer swollen and painful) would probably return function to the toe. Physical therapy would also be beneficial.

Now, if you had surgery to repair the broken bone that potentially creates other issues. If you did have surgery, there is always the possibility that the tendon was accidently cut or there are adhesions preventing the fifth toe tendons from moving and thus the lack of motion in the toe.

As I have already stated, I am more concerned about the pain and swelling going on and less concerned about the lack of toe motion. Since I can only guess at what might be going on I think the best advice I could ever give you would be to get a second opinion from another local doctor to see what actually may be going on.

If the fracture is closed, regardless of where it occurred on the fifth metatarsal, then a round of physical therapy would probably be very helpful in reducing the pain, swelling in the foot and the lack of motion in your fifth toe.

If you come to find that the fracture is still open, then you will have to make some decisions on a new course of action.

Marc Mitnick DPM
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