CASE 8 – FOOTLOOSE

A 20 year old center for the varisty basketball team comes in to see you for pain on the outside of his left foot which has been worsening.
He doesn’t recall any specific injury, just that it’s been worse with landing and running.
PMhx: Non-contributory

Examination:
There is no evidence of swelling. He points to his 5th Metatarsal as the source of his pain. His 5th Metatarsal is tender to palpation proximally. The remainder of his examination including ankle, foot, and neurovascular exam are normal.

Investigations:
Xrays:

Figures 1,2,3 – AP, Oblique and Lateral of Left Foot

Diagnosis: Stress fracture of 5th MT

Plan:
The xray allowed for differentiation from other diagnoses that can affect the same area. A Jones fracture which is more acute will be more proximal to the location of this stress fracture. Typically Jones fractures affect the neck of the 5th MT at the level of the adjacent 4th MT base. The other potential differential would be an avulsion fracture. These are located more proximal again involving the most proximal segment of the 5th MT base and occur as a result of inversion forcing a stretch of the peroneal tendon which attaches there.

Our patient was placed in a short aircast boot with explicit instructions to perform twice daily range of motion exercises. He was followed up at 6 weeks for removal of boot and progression with strengthening. He then had 4 weeks of asymptomatic progression.
Repeat Xrays: