Fifth Metatarsal Base Fractures: Treatment Options and Recovery

Transverse fracture of the base of the fifth metatarsal?

Hello! Over a month ago, I injured myself while running, resulting in a transverse fracture of the base of the fifth metatarsal in my left foot.
The doctor advised me to wear a boot similar to a snowshoe and to continue working as usual.
Four weeks later, I noticed a hard protrusion at the injury site, although it doesn't appear very pronounced on the surface.
The X-ray results indicated a displacement.
The doctor mentioned that it was due to too much walking.
He suggested surgery with a steel pin for treatment or allowing the displaced area to heal naturally, but warned that there would be a higher chance of degeneration in the future.
I sought a second opinion from another doctor who had a different perspective; he believed there was no displacement and that the current situation was a normal healing process, with the protruding part being bone tissue.
He recommended that I continue wearing the boot.
Ultimately, I chose not to undergo surgery.

Which doctor's opinion is correct? Will my condition be prone to degeneration? I am a marathon runner; will this affect my running in the future? Should I shorten my running distance, such as to 10 kilometers? When can I start running again? Can I do strength training? Should I switch to other forms of exercise? Please advise.
Thank you!

Zenme ban?, 40~49 year old female. Ask Date: 2018/03/01

Dr. Li Yongheng reply Orthopedics

Hello, since I haven't seen the X-ray, I cannot determine if there is any displacement of the fracture.
If the displacement is not obvious, there may be a higher chance of degeneration in the future.
Six months later, if there is no significant pain, you can gradually increase your running distance.
Currently, swimming is allowed and will not affect the healing of the fracture.
Wishing you a speedy recovery.

Reply Date: 2018/03/01

More Info

Fifth metatarsal base fractures are common injuries, particularly among athletes and active individuals. These fractures can occur due to various mechanisms, including direct trauma or twisting injuries, as you experienced while running. The treatment and recovery process can vary significantly based on the specific characteristics of the fracture, including whether it is displaced or non-displaced.

In your case, it seems that you initially received a conservative treatment approach with a walking boot, which is often recommended for non-displaced fractures. However, the subsequent X-ray indicated a possible displacement, which can complicate the healing process. The decision between surgical intervention and conservative management is crucial and should be based on several factors, including the degree of displacement, your activity level, and the potential for future complications.

Treatment Options
1. Conservative Management: This typically involves immobilization with a boot or cast, rest, and gradual weight-bearing as tolerated. If the fracture is non-displaced, this approach can lead to satisfactory healing without surgery. However, if there is significant displacement, the risk of malunion or nonunion increases, which can lead to chronic pain and functional limitations.

2. Surgical Intervention: If the fracture is displaced or if there is a concern about improper healing, surgery may be recommended. This usually involves internal fixation with screws or pins to stabilize the fracture. Surgery can help ensure proper alignment and reduce the risk of long-term complications, such as arthritis or chronic pain.

Recovery and Rehabilitation
The recovery timeline for fifth metatarsal fractures can vary. Generally, if treated conservatively, you might expect to return to normal activities within 6 to 8 weeks, but this can be longer if the fracture is complicated. Post-surgery, recovery may take 8 to 12 weeks or more, depending on the severity of the fracture and the surgical technique used.

Concerns About Degeneration and Future Activity
Regarding your concerns about degeneration and the impact on your running, it is essential to understand that while some studies suggest that fifth metatarsal fractures can lead to a higher risk of future issues, many athletes return to their pre-injury levels of activity without significant problems. However, this is contingent on proper healing and rehabilitation.

- Running: If you are a marathon runner, it is crucial to listen to your body. Gradual return to running is advisable, starting with shorter distances and low-impact activities. You may want to consider cross-training with low-impact exercises (like swimming or cycling) during your recovery to maintain fitness without stressing the injured area.

- Strength Training: Engaging in strength training can be beneficial, but it is essential to avoid exercises that put excessive strain on the foot until you have fully healed. Focus on upper body and core workouts, and consider lower body exercises that do not involve weight-bearing on the injured foot.

Recommendations
1. Follow-Up: Continue to monitor your symptoms and follow up with your healthcare provider. If you notice increased pain, swelling, or difficulty bearing weight, it may warrant further evaluation.

2. Physical Therapy: Once the fracture has healed sufficiently, consider physical therapy to regain strength and mobility in your foot. A physical therapist can provide tailored exercises to help you return to running safely.

3. Gradual Return to Activity: When you feel ready to return to running, start with shorter distances and gradually increase your mileage. Pay attention to how your foot responds, and do not hesitate to take breaks or reduce intensity if you experience discomfort.

4. Consultation: If you have ongoing concerns about your recovery or the risk of degeneration, consider seeking a third opinion from a sports medicine specialist who can provide insights specific to your athletic goals.

In conclusion, while both physicians presented valid points, the best course of action depends on your specific circumstances and how your body responds to treatment. Prioritize communication with your healthcare team and take a cautious approach to your return to running and other activities.

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