Stress and other fractures of the fifth metatarsal

RECURRENT pain in the foot is one of the commonest complaints among footballers.
The pain can be attributed to many factors.
The only time the player will seek help is when the pain is unbearable.
Stress fractures are painful and it is in this respect that the foot and more importantly fractures of the Fifth metartarsal have to be discussed.
A metartarsal problem is always talked about by many people because of its importance in football players.
Neglected pain in the foot will result in the sportsmen or women not enjoying training.
This will have a direct and negative effect on their performance. Sports disciplines that involve a lot of movement and contact like soccer, rugby, basketball and also volleyball and basketball will often have players suffering from problems with the feet.
Pain in the foot can be as a result of trauma, blisters, tight fitting shoes, and infection as some of the causes.
It is from this point that I want to discuss one important problem affecting the fifth metatarsal (5th Metatarsal).
Athletes neglect pain on the side or lateral part of the foot most of the time.
The main issue is that the pain is on and off and associated with exercise.
For this discussion, I will use football as a prototype to highlight some of the signs and symptoms of a fractured 5th metatarsal as a result of overuse.
Problems affecting the 5th metatarsal are neglected many times by football players.
The pain is on and off until it reaches a time when a complete fracture has occurred.
The player will ignore the pain at first because it will seem like any other ordinary pain resulting from participating in normal training or competitive match.
Players will tend to ask for pain killers.
This problem might go on for some time until it reaches a stage when it is no longer possible to continue with football participation.
It is at this point that a player will be examined and other radiological investigations done that a fractured 5th metatarsal will probably be discovered.
A fracture of the fifth metatarsal bone can be of distress to a player just like it can be to a coach who is expecting so much from a player. In the past ten years, I have seen many players who have suffered from this problem.
Metatarsals are the small long bones of the foot that connect the other bones of the tarsal to the phalanges or bones that make the toes.
There are five metatarsal bones in the foot and out of them all the fifth one is the one that is commonly injured.
Functionally speaking the ankle and the foot have two principle functions of mainly support and propulsion.
Metatarsal bones are involved in all the functions.
A fractured 5th metatarsal is important when considering ankle sprains because of the very close association.
The metatarsals act like a rigid lever for propulsion and then acts like a flexible structure when aiding balance thus keeping the body supported.
Metatarsals are important and any problem or fracture will result in impaired propulsion and reduces balance and these will make it difficult for a player to continue with their activities.
It will be interesting to note that the fractured fifth metatarsal is not only common in soccer but also occurs in basketball, rugby volley ball, in runners and has also been documented in barret dancers.
Fracture of the metatarsals can be caused by direct trauma or force to the foot, excessive rotational force or overuse.
In football, fractured metatarsals can occur when a player kicks the boot of another player.
The second, third and fourth metatarsals are the ones which get injured via this mechanism though the fifth metatarsal is the one that is more often fractured.
Fractures of the base of the fifth metatarsal are quite common and occur as result of turning and twisting at the ankle joint.
The ankle roles inwards and there is a strong ligament that attachés to the base of the fifth metatarsal and this result in the pulling off of a small bone fragment.
This injury is mainly associated with sprains of the ankle.
This is at times referred to as an avulsion fracture because it involves a tendon pulling away a bone fragment.
Apart from the avulsion fractures then we have the stress fractures which are apparently a result of overuse.
This type of fracture as I have observed in some players are made worse by a hard playing surface and a player wearing a wrong pair of boots for the particular playing surface.
The stress fracture will only be apparent when the fracture site is disturbed.
Most of the players ignore this pain and little do they realise that they are having a weaker point which will in no time become obvious.
I am sure the hard playing surfaces in our country could be viewed as important factors contributing to the frequent occurrence of fractured 5th metatarsals.
The questions asked by players are those concerning the warning signs.
Apart from the obvious traumatic causes, the symptoms will consist of increasing pain on the side of the foot with time.
The foot will be swollen at the affected site and players ought to be weary of the sprains to the ankle joint.
Sometimes there will be bruising at the affected site.
In some cases, a player will suddenly stop running and will complain of having heard a crack in their foot or a popping sound.
When the foot is examined, it will appear swollen.
A player will find it difficult, if not impossible to bear weight on the affected leg.
When a player has got all these complaints, they should be completely withdrawn from a game.
Continuing with physical activity might end up complicating a simple non-displaced fracture into a complicated fracture with displacement, and this will have an effect on the modalities of treatment.
Treatment of a fractured metatarsal is a challenge to the attending physician especially in the initial stage when the diagnosis is not certain.
It is vital that complaints in the foot are completely investigated and treated.
The important thing to do is to make a correct and timely diagnosis. The treatment of fractures, especially simple ones is basically the same irrespective of which bones are involved.
The fifth metatarsal fracture can be immobilised in plaster of Paris for six weeks.
The healing process in most of these fractures is good if all the principles are followed.
However in some cases this bone can have a fracture which is displaced and as my colleague Dr Owe Ngwata will tell you ‘INTERNAL FIXATION’ is always a better option.
The good thing about the internal fixation is that surgery always brings the two parts of the fracture site into close contact and this enhances the healing process.
In one area of the fifth metatarsal, the blood supply is not as adequate and surgery becomes inevitable.
Regardless of which type of fifth metatarsal fracture one has and the treatment modality employed, it is important that you follow the physicians’ instructions.
For questions and contributions write to Dr Kabungo Joseph
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