Sinus Tarsi Syndrome Advice
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5th Metatarsal fracture is a very common cause of foot pain. Located along the forefoot, there are 5 metatarsals in a foot. The 5th metatarsal is the smallest of these and sits on the outer side of the forefoot. It is a long, narrow bone between the tarsal bones of the midfoot and the toes.
One of the 5th metatarsals’ main attachments is the Peroneal muscles and it is a common site of fracture in the foot. There are two main types of 5th metatarsal fracture in an injured foot, these are a 5th metatarsal avulsion fracture and a Jones Fracture.
The Peroneal muscles attach to the outer edge of the 5th metatarsal bone. On some occasions, these tendons or surrounding ligaments can be injured, and rather than tear in the middle of the tissue they can tear off the bone. This action pulls small fragments off the bone and when this occurs in the 5th metatarsal it is called a 5th Metatarsal Avulsion fracture.
An avulsion fracture is commonly caused by a sudden incident such as an ankle sprain or a fall. It is commonly misdiagnosed as a lateral ligament sprain.
A Jones fracture is a small fracture on the 5th metatarsal in an area of limited blood supply. This type of fracture occurs in the little toe, closer to the ankle bone. As a result of poor blood supply, it is slow to heal. In the general public, a Jones fracture is placed in a walker boot.
In the athletic population, this type of fracture would be considered for surgery. It can take up to 3months for a Jones fracture to heel non-operatively while surgery can reduce this time to 8 weeks. If a Jones fracture is suspected, a consultation with a foot and ankle surgeon is recommended.
This is a fracture in the mid-shaft of the 5th Metatarsal. It is commonly caused by rotation or twisting motion and therefore it is frequently seen in dancers. This action can also cause a stress fracture or a greenstick fracture of the 5th metatarsal. This is typically managed in a walker boot for 4-6 weeks followed by physical therapy for 3-6 weeks.
This can occur anywhere along the 5th metatarsal. It typically involves a medial or lateral displacement. Depending on the location or size of displacement these types of fractures can be managed non-operatively or in some instances, surgery is required.
The symptoms of a 5th Metatarsal fracture are variable with some people reporting no pain, bruising, or swelling while others are unable to walk on a 5th Metatarsal Fracture. When there is pain present, this is usually along the 5th metatarsal with pain on palpation of the bone. It is usually painful to hop on the affected foot and it is painful immediately on weight-bearing with pain ease in a non-weight bearing position.
If you suspect that you have a 5th Metatarsal Fracture we recommend seeing a Physical Therapist who will be able to carry out a clinical examination to determine if you have a suspected fracture or if you symptoms are the result of another condition such as Peroneal Tendonitis.
X-rays for a stress fracture have been found to be initially negative in up to 82% of cases, illustrating how poor it is as a diagnostic tool for 5th Metatarsal Fracture.
An MRI or CT Scan is the most accurate form of imaging for a 5th Metatarsal Fracture.
Nearly all forms of 5th Metatarsal Fracture are managed conservatively in the first instance. They are normally placed in a walker boot for 4-6 weeks or sometimes longer if the individual has low Vitamin D levels, Osteopenia or Osteoporosis. It is very uncommon to be placed in a cast.
While in a walker boot, Physical Therapy can commence. This usually involves massage on the calf muscle to reduce tightness from being immobalized in the boot. It is possible to do self massage using a foam roller but we would recommend avoiding a massage gun.
Any form of taping such as KT Taping or strapping is not beneficial in the rehabilitation process. We have created a Physical Therapy rehabilitation protocol below:
Maintain soft tissue mobility of the calf and surrounding muscles from massage therapy. Stay in the boot all the time.
Introduce some light theraband strengthening exercises for the Calf, Peroneal and Posterior Tibial Muscles in a non-weight bearing position. Continue with massage therapy.
Begin to wean out of the boot indoors, progressing to outdoors as pain allows. Progresses to weight bearing strength exercises including balance and stability exercises in standing. Ensure full ankle mobility with Gastrocnemius and Soleus Stretches.
Introduce hopping and plyometric exercises. Carry out sport specific rehabilitation.
This is not medical advice and we recommend a consultation with a medical professional such as James McCormack to achieve a diagnosis. He offers Online Physiotherapy Appointments for £45.
How long does it take a 5th Metatarsal Fracture to heal?
In most cases, 5th Metatarsal fracture recovery takes 4-6 weeks in a walker boot. This is usually followed by 3-6 weeks of treatment from a Physical Therapist. For a Jones fracture, recovery non-operatively can take up to 3 months in a boot followed by Physical Therapy. If this is surgically managed, it often takes about 8 weeks.
Why does my 5th Metatarsal Fracture still hurt?
If you are in a boot and your broken 5th metatarsal still hurts, then it may be worth considering if the sizing is correct for your boot. Recovery time frames are generic and sometimes it can take longer for a fracture to heal and become pain-free. Contributing factors to slow bone healing include low vitamin D levels, relative energy deficiency in sports (RED-S), smoking, anemia, and diabetes.