Feet Don't Fail Me Now - Page 2
Jones Fracture: Fifth Metatarsal
Sometimes, overpronators land very hard on the outside of their foot before rolling inward. They are what I call “forefoot floppers.” Don’t try to look that up because it is merely my own term for this heavy landing that puts strain and stress on the fifth metatarsal bone (the bone behind your small toe bone). When making orthotics for this condition, I place a lateral piece of material on the orthotic to cushion and redirect the landing to take stress off that bone.
Fractures that result from stress usually end up in the proximal end of the fifth metatarsal: the Jones fracture (first described in 1902 by a Welsh orthopedic surgeon, Sir Robert Jones, who sustained this injury while dancing). Because blood flow is irregular in this area, the bones sometimes need a surgically placed screw to allow them to properly heal. Without the operation, you risk a “nonunion” and further surgeries and layoffs may be recommended.
If you feel pain in training, you may be stressing the bone. Instead of ignoring the discomfort, see a sports doc immediately. The stress can easily be prevented by a simple adjustment of your orthotic.
Quick Guide Jones Fracture
Symptoms: Pain along outer side of foot on the bone (fifth metatarsal).
How it occurred: Overpronator slamming outside of foot on ground over time. Not enough correction by orthotic. Not enough cushion in shoe.
What the doctor may do: Palpate area. Gait analysis. X-ray. If X-ray is negative, MRI to look for stress syndrome or stress fracture.
Likely treatment: Orthotic or orthotic adjustment with extra cushion on lateral side. Cushioned shoes. Exogen bone stimulation. No running for six to eight weeks. If bone is broken all the way through, surgery will probably be necessary.
Note: Platelet-Rich Plasma (PRP) shows promise in healing stress fractures faster.
In 1927, a physician named Dudley Joy Morton first described a foot where the second toe is longer than the big toe. Most folks have it the other way around, but 30 percent of the population has the foot Morton described. Actually, people with Morton’s foot have a normal-size big toe but a shorter first metatarsal than usual, and therefore the big toe starts farther back.
This is important for runners because we get our power to move forward off the base of that first metatarsal. Because the Morton’s metatarsal is shorter, the foot is prone to overpronation and thereby stresses the bone. The overpronation can also inflame a nerve that lies between the second and third metatarsals; inflammation of the nerve is called neuroma.
Orthotics can help both conditions by reducing the stress. They must run the full length of the foot and be flexible. The neuroma may need a cortisone injection. Rarely, surgeons remove the nerve if it remains painful; note, however, that with removal goes the ability to feel what your foot is doing. I have never had a case where proper orthotic control and injection did not make the neuroma pain go away, so in my experience, surgery is unnecessary.
Quick Guide Morton’s Neuroma
Symptoms: Inflammation and pain between third and fourth toes.
How it occurred: Chronic overpronation or supination.
What the doctor may do: Physical examination. Gait analysis.
Likely treatment: Full-length orthotic or orthotic adjustment. Cortisone injection. Platelet-Rich Plasma (PRP) injection. In extreme cases, surgery to remove swollen nerve.