sore little toe

I broke my fifth metatarsal 8 weeks ago. I am now out of the cast and just weaning off the walking boot. However, although the area where the break was, doesn't hurt anymore, it is very painful under my foot when I put pressure on it. It is the area the size of a penny just below my little toe underneath. This wasn't where I broke it. It is a new pain. I fear it is holding up my progress in getting back to normal walking. thank you.

RESPONSE

Hi,

I will assume, based on your description, that the pain is near the junction of where the little toe joins the fifth metatarsal bone.

You do not mention whether or not the area is red or swollen.

Since this particular area was not painful while in the boot and became painful when you started wearing regular shoes again, my first thought would be a possible capsulitis.

Once you got back into a regular shoe, this meant that the toes started to bend again when you walk. What can happen, many times, is that the sudden increased bending of the toe upwards when you walk, strained the ligament that attaches the toe bone to the metatarsal bone. This would occur on the bottom of the foot and this is known as capsulitis.

One test that you could try would be to put the boot back on and see if there is still pain, or at the very least is the pain diminished.

The second possibility is that of a sub fifth metatarsal head bursitis. A bursitis is essentially a sac filled with fluid that the body forms to act as a cushion in areas where there is excessive pressure. The possibility exists that while you were in the cast and boot, there was too much pressure on the head of the metatarsal bone.

Now that you are out of the boot, a regular shoe, or walking barefoot, may exacerbate the pain. In this situation, the painful area may be slightly red and feel a bit spongy to pressure.

A third option and I must say a very remote option, is the possibility that the angle of the fifth metatarsal bone has changed as a result of your original fracture.

You do not mention having had any surgery for the fracture, so I will assume it is what is known as a non-displaced fracture, or more simply put, a crack in the bone, which healed with nothing more than immobilization.

Obviously, I do not have x-rays to look at, but if the fracture were significant enough, it could have changed the angle of the metatarsal bone, just enough to force the bone in a slightly more plantarflexed position, meaning the bone is pointed downward slightly more then it was before the fracture.

If this is the case, it would then create more pressure at the level of the metatarsal head which is the part of the fifth metatarsal that is just behind the toe and would create more pressure (and pain) at the level where you are complaining of pain.

Whether it is a capsulitis, bursitis, plantarflexed metatarsal or any other problem for that matter, I am not sure it is something you can treat on your own.

You could wait a few more days, see if it subsides, take Advil or Aleve (if you can tolerate those types of medication) and see if the pain subsides.

If not, you will have to see the doctor who treated you for the fracture.

Marc Mitnick DPM
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