Fifth Metatarsal Fractures: Healing, Recovery, and Rehabilitation

Fracture of the fifth metatarsal bone?

Hello Doctor: On June 8, 2016, I fell while going up the stairs and went to the hospital for an X-ray.
The doctor said that I had a fracture in the fifth metatarsal and needed to have a half-cast applied.
On June 22, 2016, two weeks later, I returned for a follow-up appointment, and the doctor said there was no sign of healing in the bone, as I had been walking due to attending classes.
On July 13, 2016, three weeks later, the doctor said the bone had shown some growth but still had a crack.
However, I could remove the cast.
After returning home, I reviewed the X-ray and noticed that the crack looked almost the same as it did on June 8; the fracture was still visible.
Since the doctor said I could remove the cast, I practiced walking that same day.
My foot is still swollen, so it hurts a bit when I walk.
I would like to ask: 1.
Is it normal for my foot to still hurt a bit while practicing walking? 2.
If I walk, will the fracture not heal properly and continue to worsen? Will there be any long-term effects? 3.
How long will it take for the bone to fully heal? 4.
What rehabilitation exercises can I do for my foot? 5.
How long until I can start running? 6.
How long until I can perform toe raises?

Chen, 10~19 year old female. Ask Date: 2016/07/15

Dr. Shi Guozheng reply Orthopedics

It is normal to experience pain before a fracture has healed, so avoid walking too much.
If the fracture is displaced, it can lead to complications.
Healing typically takes at least six weeks, but it may be possible to start moving the ankle joint and toes after two weeks.
Running should be avoided for more than three months, and toe raises should also be limited to over three months.

Reply Date: 2016/07/15

More Info

Understanding Fifth Metatarsal Fractures: Healing, Recovery, and Rehabilitation
Fifth metatarsal fractures are common injuries, particularly among active individuals. These fractures can occur due to various reasons, including falls, sports injuries, or repetitive stress. The healing process and rehabilitation are crucial for a successful recovery, especially considering the complexities involved in bone healing and the potential for complications.

1. Pain During Walking: It is not uncommon to experience some pain while walking after a fifth metatarsal fracture, especially if the fracture has not fully healed. Pain can be a sign that the bone is still in the healing process. However, if the pain is severe or worsening, it is essential to consult your physician. Mild discomfort may be expected as you begin to bear weight on the injured foot, but significant pain could indicate that the fracture has not healed adequately.

2. Risk of Further Injury: Walking on a healing fracture can pose risks. If the fracture has not healed sufficiently, putting weight on it may exacerbate the injury, potentially leading to a nonunion or malunion (where the bone heals improperly). It is crucial to follow your doctor's advice regarding weight-bearing activities. If your doctor has cleared you to walk without the cast, it generally means that the fracture is stable enough for some weight-bearing, but caution is advised.

3. Healing Time: The healing time for a fifth metatarsal fracture can vary widely depending on factors such as the fracture's location, the patient's age, overall health, and adherence to rehabilitation protocols. Generally, these fractures can take anywhere from 6 to 8 weeks to heal, but complete recovery may take longer. Regular follow-up appointments and imaging studies (like X-rays) are essential to monitor the healing process.

4. Rehabilitation Exercises: Rehabilitation is critical for restoring function and strength to the foot. Initially, focus on gentle range-of-motion exercises to prevent stiffness. As healing progresses, you can gradually introduce strengthening exercises. Common rehabilitation exercises include:
- Toe curls: Using your toes to pick up small objects.

- Towel scrunches: Scrunching a towel with your toes to strengthen the intrinsic muscles of the foot.

- Ankle pumps: Moving your foot up and down to improve circulation and flexibility.

- Balance exercises: Standing on one foot to improve stability.

5. Returning to Running: The timeline for returning to running varies. Generally, you should wait until you can walk without pain and have regained sufficient strength and range of motion in the foot. This could take anywhere from 8 to 12 weeks post-injury. A gradual return to running is recommended, starting with short distances and low-impact activities before progressing to more intense running.

6. Performing Toe Raises: The ability to perform toe raises (standing on your toes) will depend on your pain level and the healing status of the fracture. Typically, you can start practicing toe raises around 6 to 8 weeks after the injury, but only if you can do so without pain. Start with small movements and gradually increase the range as tolerated.

In conclusion, while some pain during the recovery process is normal, it is essential to listen to your body and consult with your healthcare provider if you have concerns about your healing progress. Adhering to rehabilitation protocols and following your doctor's advice will significantly enhance your recovery and help prevent long-term complications. Always prioritize safety and gradual progression in your activities to ensure a successful return to full function.

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