Feets 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 place 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.
Metatarsal Stress Fracture
Overpronation can cause stress on the other metatarsal bones (the Jones fracture described above affects only the fifth metatarsal). Early recognition of discomfort and subsequent adjustment with an orthotic can prevent a full-blown metatarsal stress fracture and an eight- to 12-week layoff.
Water-running therapy (jogging in water deep enough that your feet don't touch the bottom, also called "aqua therapy") during the healing process is not as fun as being on the trails, so early attention to any metatarsal distress is important. If you do have a stress fracture, all weight-bearing exercise—including cycling—must cease.
You may be given an Exogen bone stimulator; you won't feel the current from the bone stimulator, but in certain cases it can accelerate the healing process considerably.
Quick Guide: Metatarsal stress fracture
- Symptoms: Pain over metatarsal.
- How it occurred: Chronic overpronation or supination.
- What the doctor may do: Palpate area. Gait analysis. X-ray. MRI.
- Likely treatment: Orthotic or orthotic adjustment. Cushioned shoe. Exogen bone stimulation. No weight-bearing exercise for eight to 12 weeks.
- Note: Platelet-Rich Plasma (PRP) shows promise in speeding healing.