The 5th metatarsal is the one of the most common bones fractured in the foot. Situated just below the 5th toe, the anatomy of this bone influences the type of fracture that develops. The metatarsal itself is comprised of a base, tuberosity, shaft, neck, and head. The tuberosity, which is the posterior-most aspect of the bone near the midfoot, is clinically evident as it protrudes laterally (some people complain that this rubs in their shoes). Tuberosity fractures, also known as avulsion fractures, can be displaced or non-displaced. The position of the fracture will determine the type of treatment. For non-displaced fractures, the treatment is conservative and focuses mainly on symptoms. This includes protected weightbearing in a hard-soled walking boot or a short-leg walking cast. Pain usually resolves after a few weeks, and healing of the fracture fragment itself on x-ray is evident after approximately 6-8 weeks post-injury. These types of fracture generally heal well with no long-term complications. Larger, displaced fragments are commonly treated surgically, which varies from percutaneous pinning (making a small cut in the skin and inserting a screw without having to expose the entire metatarsal) to open reduction with internal fixation (exposing the metatarsal and placing pins, plates, and / or screws across the fracture site).

Another common type of 5th metatarsal fracture is known as a Jones fracture. The location of this injury is slightly more anterior to the tuberosity (1 cm from the joint, closer to the toes than the tuberosity fracture). The Jones fracture takes a longer time to heal because of the poor blood supply at this particular location in the bone. Treatment can be either conservative or surgical, depending on the patient's age, health, and activity level. Conservative treatment involves 6-8 weeks of strict non-weightbearing cast immobilization, followed by a few additional weeks of weightbearing boot or cast immobilization. Surgical treatment, which is similar to that described for tuberosity fractures, is generally recommended for athletes and more active individuals and allows shorter periods of immobilization with faster healing times.

Common to both types of fracture are soft tissue attachments found at the base of the 5th metatarsal. A muscle tendon (peroneus brevis muscle) from the lateral leg compartment courses down into the foot and attaches at the base. The lateral band of the plantar aponeurosis (which can occasionally be the culprit of infamous heel pain known as "plantar fasciitis") also attaches here. These two soft tissue structures have the potential to pull at the fracture fragment, thus causing possible displacement and, unfortunately, complicated fracture healing. This is why it is extremely important to seek treatment with myself or one of our doctors immediately at Advanced Foot and Ankle Care if you suspect that you have sustained a 5th metatarsal fractures.

Dr. Adrienne O’Neill

In my last post, I discussed the common problem of osteoarthritis. This week, I’m going to talk about another joint disease that is often confused with osteoarthritis: Rheumatoid arthritis. Rheumatoid arthritis is a joint disease in which your own body attacking the fluid in your joints. Like Osteoarthritis, it most commonly occurs in the hands and feet.

What are the symptoms?

Rheumatoid arthritis causes joint pain in the hands and feet. A common concern is that the pain is worst in the morning; in the feet, this is especially so while getting out of bed.

Who is most likely to get it?

For unknown reasons, Rheumatoid Arthritis is most likely to affect women in their forties.

How is it diagnosed?

Your doctor will likely examine your joints, and may take an x-ray. In addition, he or she may order blood work to confirm the diagnosis.

How is it treated?

Your doctor may prescribe an anti-inflammatory drug to decrease the inflammation and pain associated with Rheumatoid Arthritis. Newer medications such as Humira may be more effective for advanced cases.

If you have pain in any of the joints of your foot, feel free to make an appointment with myself, or any of our doctors at Advanced Foot and Ankle Care at any of our four locations: Huber Heights, Troy, Piqua and Sidney OH, for an examination and your doctor will discuss all your treatment options.

Jeffrey Carlson, DPM

Osteoarthritis is a degenerative joint disease that affects many older Americans. It is caused by the breakdown of joint cartilage, which acts like a lubricant to allow joints to move fluidly. It commonly affects joints in the feet, hands, knee, and hip; in the foot, it most commonly affects the big toe joint.

 What are the symptoms?

 Most people experience pain, stiffness, crackling, and deformity of the joints. Pain is usually worst at the end of the day and after long periods of activity.

 How is it diagnosed?

 It is diagnosed by physical examination by your doctor and by the use of x-rays. Examination is important so your doctor can differentiate osteoarthritis from other types of arthritis, such as gouty arthritis and rheumatoid arthritis.

 How is it treated?

 Since there really is no cure, the primary treatment is to relieve pain and inflammation. Tylenol can be used for pain relief but does not treat the underlying inflammation, so it is best for mild cases. If the pain cannot be controlled by Tylenol alone, your doctor might recommend the use of a non-steroidal anti-inflammatory drug such as Aleve or Motrin.

 Your doctor may prescribe orthotics which can re-align the foot and relieve pressure on sensitive areas. Surgery is usually reserved for more severe cases.

 If you have pain in any of the joints of your foot, feel free to make an appointment with myself, or any of our doctors at Advanced Foot and Ankle Care for an examination and your doctor will discuss all your treatment options.

 Jeff Carlson, DPM

    With the Summer Olympics fast approaching I remember one of the greatest and most memorable Olympic moments in history.   For the 1996 US women’s gymnastics team to have a chance at gold, little Kerri Strug would have to nail her vault.  The unthinkable happened as Kerri completed her first of two vaults; she fell while landing, ripping ligaments in her ankle.   She then ignored her injury and stuck the landing of her second vault.  Who can forget her collapsing to the floor in pain after securing the American team its first ever Olympics gymnastics gold?!?  Kerri Strug went on to become one of the most recognizable faces of the 1996 games.  What a great ending, right?  Well, if this really was the end of the story, it would be.  But it wasn’t.

     In 1997 Sports Illustrated wrote about Strug, “A year after her Olympic vault to fame, Kerri Strug now carries herself stiffly and walks with a trace of a limp.  Physical therapy took a backseat to making appearances.”   A lot of people are like Kerri Strug and see a sprain as a minor injury that they can struggle through without treatment.  They don’t take time out of their busy lives to treat the injury, and they end up paying for it later.  This time of year is the height of the ankle injury season at Advanced Foot and Ankle Care, and we have all of the experience, diagnostic and treatment tools to get you back on your feet and enjoying the rest of your summer.    

To understand how to adequately treat an ankle sprain first we should start at the beginning and understand the injury itself. 

Anatomy of an Ankle Sprain:

The ankle bones are held in position by ligaments.  The ligaments protect the ankle against abnormal movements like twisting, turning, and rolling of the foot.  Ligaments are elastic within their limits, but when they are forced beyond their normal range, a sprain occurs.  Sometimes the ligaments even tear, and you may hear a popping sound.  Pain and swelling soon follow.  Sprains are given grades 1, 2, and 3, increasing in pain and swelling along with ligament injury from stretching to complete rupture.

Diagnosing the Sprain:

The first step in treating an ankle sprain is properly diagnosing it.  At Advanced Foot and Ankle Care we have several techniques to properly diagnose ankle injuries.  The most important technique we employ is the history and physical examination.  By listening to our patients’ mechanism of injury and examining their injured foot and ankle we usually have a good idea of what we’re dealing with.  We also take x-rays to rule out a break in the bones.  The diagnostic ultrasound machine is often used to evaluate tendons and ligaments for ruptures and tears.  It’s also possible that an MRI might be ordered to confirm our diagnosis if we suspect injury to the joint surface, a small bone chip, or a very severe injury to the ligaments and tendons.

Treating the Sprain:

We treat ankle sprains based on their severity or grade. 

Grade 1 sprains should be treated with rest using a special boot called a CAM boot, icing, a compressive wrap, and elevation.  After a patient has healed enough that a CAM boot is no longer necessary they may find a non-custom brace helpful as they transition back into normal physical activity.

Grade 2 sprains are again treated with rest using a CAM boot (possibly with the addition of an assistive device such as crutches), icing, compressive wraps, elevation, non-custom bracing, and physical therapy.  Physical therapy is an invaluable part of treatment to regain strength and range of motion after ankle injury.  Adequately rehabilitating an ankle sprain goes a long way toward preventing reinjury to the ankle.

Grade 3 sprains may be treated the same as Grade 2 sprains but could possibly require surgical repair.  Physical therapy is of even more importance in these high grade injuries, and a custom brace may be helpful for walking on uneven surfaces or performing sporting activities that require sharp, sudden turns (cutting activities) like tennis, basketball, or football. 

Healing an ankle sprain can take as long as healing a broken ankle bone.  Lower grade sprains usually take 4-6 weeks to heal, and higher grade sprains can take months to feel back to normal.  It may even be several months before you are able to return to sporting activities.  40% of those with acute ankle sprains will develop chronic symptoms of ankle dysfunction such as pain, swelling, recurrent injury, and weakness.  The healing process can be slow, but it’s so important to be patient and seek the proper treatment to avoid these problems.   

Hillarie Amburgey, DPM