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What Causes Pain In 5th Matatarsal Region Of Foot?

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Posted on Sat, 20 Sep 2014
Question: Two months ago pain in the 5th matatarsal region of my foot kept me from walking. No heat, swelling, or discoloration. I am able to touch my foot, rotate ankle, flex and point toes without pain. X-rays showed no breaks. Doctor recommended post-op shoe and although pain is less, I still can't walk without limp. No further diagnosis was given. Any thoughts?
doctor
Answered by Dr. Vivek Chail (27 minutes later)
Brief Answer:
Possible early stress fracture?

Detailed Answer:
Hi XXXX XXXX
Thanks for writing in to us.

I have read through your query in detail.
It is important to know if you are a habitual long distance runner and have been training in the recent past.

The 5th metatarsal is prone to stress fracture which happens from continuous low intensity trauma to the small bones of feet. Your next comment might be, but the X rays are normal. X rays take time to show these low intensity injuries and if you have been taking precautions then the fracture might even be invisible.

Wearing the post op shoe and treatment with Naproxen plus predinisolone should reduce the pain significantly. However, you must take every care not to start regular mobility in the absence of pain.

Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (24 minutes later)
Thank you for your quick response. Here is some additional information: because I had started to feel pain in my foot the end of March due to playing pickleball, the orthopedic doctor thought a stress fracture would have shown up by XXXXXXX when it became too painful to walk. He said I might need an MRI if things didn't change but which I can't afford. Meanwhile it was important to me to wear heels to my son's wedding and dance with him. So on July 26 I danced all night in two inch heels without any pain or meds. The next day the regular pain was back but had not increased. I have no pain when I am not walking. Again no swelling or discoloration. Could this still be a stress fracture?
doctor
Answered by Dr. Vivek Chail (2 hours later)
Brief Answer:
Possible conditions in the foot

Detailed Answer:
Hi XXXX
Thanks for writing back with an update.

To the best of my knowledge, a stress fracture may remain elusive and difficult to be noticed on X rays in may patients. It is the pattern of event following which the pain appears or increases, which gives a possibility of stress fracture. The typical features noticed by the patient are pain that worsens when the foot bears weight or with increased activity, and pain also becomes more severe as the day progresses. If at all present in you, it may be a noncritical fracture which will heal with rest and time.

Other than stress fracture, conditions which may need consideration are
1. Metatarsalgia is a common overuse injury described as pain in the forefoot that is associated with increased stress over the metatarsal head region.
2. Morton Neuroma which is a mechanically induced nerve irritation due to intrinsic and extrinsic biomechanical factors that results in a combination of pain, paresthesias, and numbness in the forefoot.

Other than the above, there is very little room for an alternative diagnosis subject to clinical examination by your doctors.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (5 hours later)
I just want to thank you for your time and prompt replies. I am looking into metatarsalgia, and still pondering the stress fracture. I have looked up avulsion, XXXXXXX and stress fractures. I have never had a broken bone in my body, so this is new. I guess I expected swelling, discoloration, burning, or redness. And I didn't have a specific incident where I remember getting hurt either. The fact that this has been going on for some time concerns me. But again, thank you for your time, wisdom, and experience.
doctor
Answered by Dr. Vivek Chail (7 hours later)
Brief Answer:
Welcome and wish you early recovery

Detailed Answer:
Hi XXXX
You are welcome and for writing back with an update.

Metatarsalgia refers more to the symptoms and stress fracture is a diagnosis. We can say that metatarsalgia can progresses to stress fracture if the concerned foot is not given adequate rest. X rays pick up stress areas on bones after a while, might be upto 3 weeks following regular stress. This kind of injury is seen in marathon runners in training who suddenly start increasing their practice sessions and ignore the pains.

It is certain that you do not have the usual traumatic fracture and therefore no redness and swelling and the absence of an injury.

Wishing you an early recovery.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Vivek Chail

Radiologist

Practicing since :2002

Answered : 6874 Questions

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What Causes Pain In 5th Matatarsal Region Of Foot?

Brief Answer: Possible early stress fracture? Detailed Answer: Hi XXXX XXXX Thanks for writing in to us. I have read through your query in detail. It is important to know if you are a habitual long distance runner and have been training in the recent past. The 5th metatarsal is prone to stress fracture which happens from continuous low intensity trauma to the small bones of feet. Your next comment might be, but the X rays are normal. X rays take time to show these low intensity injuries and if you have been taking precautions then the fracture might even be invisible. Wearing the post op shoe and treatment with Naproxen plus predinisolone should reduce the pain significantly. However, you must take every care not to start regular mobility in the absence of pain. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek