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fifth metatarsal fracture with nonunion
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Mar 19, 2025
The doctor answers a question about a patient who suffered a fifth metatarsal fracture and got poor advice from her doctor. The doctor offers suggestions as to what can be done about the problem. Learn more at https://www.foot-pain-explained.com @marcbarry1000
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here's a question from Sally in Los
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Angeles she's asking about a displaced
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fifth metatarsal
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fracture she states I fell down the
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stairs landing on my right foot Twisted
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it and was diagnosed with a displaced
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commuted fifth metatarsal fracture I was
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put in a non-weightbearing cast for one
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week and then an aircast boot the doctor
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said I could start to walk with the boot
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as much as pain could be
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tolerated after 1 month I went back for
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another xray but it looked exactly the
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same as before the doctor had previously
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told me that my bone would be able to
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heal in proper alignment but obviously
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it wasn't going to happen without any
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external
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reinforcement so I asked him what
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options I had to realign the bone he
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said it was only possible with
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surgery however he didn't seem to
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recommend the surgery citing the
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possible complications and a need to
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remove whatever bone callous that had
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formed so he just told me to continue
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wearing the aircast boot and let the
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bone heal in its misaligned position I
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was concerned about the long-term
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problems of leaving the foot like that
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so I went to seek a second
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opinion this time the doctor recommended
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surgery to put in bone grafts to allow
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the bone to heal in proper
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alignment however due to various reasons
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I was not able to do the surgery
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immediately and now my x-ray shows a
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malunion otherwise known as a non Union
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this is about 4 months after my injury
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occurred I am off the aircast boot now
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and I'm walking with normal shoes the
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doctor says to put off the surgery and
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continue walking and let the bone
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rebuild there are occasional aches at
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the side of my foot where the bone is
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injured and there was once a sharp pain
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that occurred followed by one week of
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recurrent tingling pain at the side of
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my foot since then I didn't dare to flex
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my foot too much as I was afraid the
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sharp pain was due to nerve injury or
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something like that I am not sure if
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this is the right direction to go to
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continue walking and hoping that there
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won't be any problems down the road and
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whether the bone will be able to regain
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enough strength for me to return to
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normal sports activities like running I
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am female 28 years old don't smoke and
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drink and have lost some weight since my
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injury it seems I'm losing bone density
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in the area and the doctor said I can
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sleep slowly recover it by putting
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weight on my foot thank you for any help
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my response hi Sally I do not want to
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sound like a Monday Morning
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Quarterback but had you walked into my
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office with the first x-ray I would have
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explained to you that you had a very
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slim chance of that fracture healing
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properly you have less than 50% bone to-
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bone
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approximation and the distal end of the
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bone which is the front end of the bone
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has displaced down onto the proximal
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back portion of the bone this means that
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if by some miracle the bone had actually
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healed your fifth metatarsal bone would
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have ended up being excessively short
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which down the road you would have had
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additional foot problems simply because
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the architecture of the metatarsal bones
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would now be
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misaligned at 28 years of age and good
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health you are a perfect candidate for
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surgery the potential for success far
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outweighs any potential
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complications the main complication of
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this type of repair is a non-union and
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you have that anyway if for whatever
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reason you decided not to have surgery
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at the very least you should have been
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totally non-weightbearing on
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crutches and should have been given a
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bone
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stimulator this combination should have
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been instituted for a minimum of 6 weeks
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with the possibility of a longer period
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of time depending on your
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progress having said all that broken
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bones can heal in an abnormal position
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and people can function it all depends
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on what your definition of function is
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if you never fall again or even trip or
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stub your foot the bone might not
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refracture if you never participate in
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any sport or workout again the bone
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might not
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refracture in other words if you change
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your lifestyle and accommodate this
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problem you might get by for the next 60
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years or so but truthfully I doubt it
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this does not take into account the
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potential problems that can occur from
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the new position I of your fifth toe and
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the resulting fifth metatarsal bone
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which is now
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shorter my opinion is that you should
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consider having
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surgery it will probably require a bone
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graft and a fair amount of Hardware to
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keep the bone in alignment you will need
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to be off the foot for a period of time
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but once you have made the commitment to
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fix this problem and put in the time
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involved you should be able to resume
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your life good luck with your decision
#Injury