Fifth metatarsal stress fracture

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Case
A 23-year-old female player presented with an insidious onset of right foot pain. This was initially only present during training but progressed to become sore while walking and at rest. She was found to have localised tenderness over her fifth metatarsal shaft, pain with compression of the forefoot and pain hopping.

The player’s past medical history included prior stress fractures of both the tibia and fibula.  She had been amenorrhoeic for five years, since starting an elite training programme at her current club.

Findings
An x-ray series, taken about three weeks after the onset of pain, is normal with no fracture or periosteal reaction seen. The MRI sequences show that there is a transverse low signal fracture line through the distal diaphysis of the right 5th metatarsal. There is surrounding, low signal periosteal mineralisation, consistent with a subacute stress fracture. There is extensive bone marrow oedema throughout the distal metaphysis and the entire diaphysis of the 5th metatarsal.  Bone marrow signal elsewhere is preserved.

Discussion
After some discussion about the treatment options, this player was managed with a six week period of immobilisation followed by a return to football over a further six weeks. At this point she hadachieved both clinical and radiological union. Given the history of amenorrhoea and that this was her third stress fracture, a DEXA scan was conducted.  She was noted to have bone marrow density that was low for age. She was seen by a dietician and has ongoing follow-up with an inter-disciplinary team to monitor her energy availability.

In general terms fractures of the fifth metatarsal can occur at three sites. These are the tuberosity, the junction of the metaphysis and diaphysis (what is generally referred to as a Jones fracture) or the diaphysis. Fractures of the tuberosity are generally benign and tend to heal predictably. They are caused by an avulsion injury from the pull of the lateral band of the plantar fascia or of the peroneus brevis tendon during plantarflexion and inversion of the foot. These injuries are generally treated with a short period of immobilisation and a progressive return to activity. A Jones fracture occurs at the junction of the metaphysis and diaphysis, approximately 1.5cm from the proximal end of the bone. These injuries are classically the result of an acute inversion and plantarflexion injury. There is a high incidence of non-union and they generally require either 6-8 weeks of non-weight bearing cast immobilisation or early fixation. Most stress fractures, as illustrated in this case, generally involve the diaphysis. This usually occurs distal to the 4th/5th intermetatarsal joint. Surgical stabilisation may be required as these can be difficult to heal with conservative management.

Important notice
FIFA does not bear any responsibility for the accuracy and completeness of any information provided in the “Radiology Review” features and cannot be held liable with regard to the information provided or any acts or omissions occurring on the basis of this information.

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karthick k
11 June 2020 12:55

Yes Thank you

Phumelele
12 June 2020 10:24
Reply to  karthick k

From my side I’ve learned the importance of checking the medical history first yet in my country they don’t take medical department that serious we always have less badget

LishaoTao
16 June 2020 2:31
Reply to  Phumelele

that is madness, medical is important. I do not think people realize the importance of health.

Jennifer Moore
22 June 2020 1:58
Reply to  Phumelele

Good

Jennifer Moore
22 June 2020 1:58
Reply to  karthick k

I wish to talk to you

Ranjith yelleppan
11 June 2020 15:19

Thank you so much for information

Wallid Elhage
11 June 2020 15:28

With MSKUS this can easily be diagnosed
Most Countries do not have acces to MRI
US is an easy and much cheaper diagnostic tool
With any non traumatic injurie I would do US first

Jennifer Moore
22 June 2020 1:59
Reply to  Wallid Elhage

I totally agree

bangoura
bangoura
15 June 2020 12:47

LA FRACTURE DE STRESS OU FATIGUE EST DUE A UNE CHARGE MECANIQUE REPETEE APRES UNE FORTE INTENSITE. LES METATARSES SONT LES OS LES PLUS TOUCHES. LES FRACTURES DE STRESS DE L OS NAVICULAIRE ET DE LA BASE DU 5e METATARSE SONT TRES DIFFICILES A TRAITER.. LE 5e METATARSE EST PLUS EXPOSE ET MOINS IRRIGUE DONC UNE CONSOLIDATION DIFFICILE. IL EST RARE QUE LA RADIO SOIT UTILE 10 JOURS APRES LA DOULEUR. LE MOYEN LE PLUS EFFICIENT POUR POSER UN DIAGNOSTIQUE CLAIR EST L IRM ET LA SCINTIGRAPHIE OSSEUSE.. DANS LE TRAITEMENT LA CHIRURGIE N EST INDIQUEE QUE LORSQUE L OS… Read more »

Jamaleddine almouhandiz
15 June 2020 15:51

التاريخ الطبي مهم

LishaoTao
16 June 2020 2:32

Informative. Thank you

Hossam Mostafa Mahrous
17 June 2020 0:10

Thanks very much for this important information

Dr Sonik Shah
22 June 2020 10:06

can u please draft a chart of how to rehabilitate to return to sports ( like list of exercise , regimes etc)
Thanks in Advance.
Regards,
Dr Sonik

Shiraz
02 July 2020 23:50

Hi
We have produced a metatarsal injury protector which have been tested at the University of Lancashire in the UK. We are happy to send out some free samples and our website is http://www.zock.org.uk

Neodream
18 July 2020 7:04
Reply to  Shiraz

Neat ! I’ll talk to some players, hear what they have to say and see where the road leads.

Hader Abdallah Mohamed Sherif
03 July 2020 13:24

imprtant information

EL HABIB MOUKRIM
06 July 2020 14:01

MRI exam is very important for diagnosis