Fifth Metatarsal tendon problem??

[Hud]

HI

This is the first time I've tried an online site for help. The site looks like it can be very informative.

I've sustained an injury on the proximal head of the metatarsal. We were rolling fairly heavy equipment down a fairly steep smooth concrete ramp for a couple of hours. We had to use our feet to slow the equipment as we traveled down the ramp and sometimes even skidding sideways like a skater stopping. (Shoes were not very heavy duty, don't usually have to do this type of work)

My foot was a bit sore the rest of the day but not too bad. The next morning I couldn't put any weight on it or even touch the metatarsal proximal head. I let it go for the weekend but it was worse Monday. (sept15)Went directly for a standard foot xray. Read it a week later and no break. Went for a bone scan next and 5 days later still indicated no breaks or fractures of any kind. Dr. suggested PT for possible tendon problem until a MRI could be scheduled. (Dec). Started right after Dr. suggested Been going 2x week up to now. Uses Ice, ultrasound, Magnetic stimulation and interferential stimulus. Resistance movement now also. Has improved a ton up till now but just seems to be hanging on and on.

I picked up an air cast and crutches to get around on about 2 weeks after the injury just to be cautious and because it was too painfull to walk.
Its hugely better but I still can't walk with a normal walk to far without the boot cast because the pain seems increase as I continue . I've been back at work doing sedintary work for 3 wks. I walk very flat on my foot to spread the force of walking.

Also I have ankylosing Spondatitis and I also had a planter facia rupture on this foot over a year ago. Before this latest accident I was able to still go out and do some light running without much planter F pain at all.

Can't even go for a walk yet. Is this pretty typical of a tendon problem in terms of time to heal? Tipically how long does a tendon injury of this sort usually take. Sometimes I feel like this is never going away. Can this be tied in the planter facia injury or ankylosing Spond? I still have pain if I try to walk normal. No pain at all if I don't put any weight on it.

Thanks a lot.

[FootDoc]

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Let me first make it clear that diagnoses and treatments which need to be based on diagnoses cannot appropriately and responsibly be offered in forums, as forums do not afford the essentials required for the diagnostic process. So I really can't offer you the specifics which you request. But I would be willing to offer some personal thoughts I have regarding your version of your care to date. In doing so, I will make the assumption that every word you used accurately reflects reality.

First: Although I am not certain, I will assume that when you say, "proximal head of the metatarsal," that you are speaking of the head of the metatarsal, as there is only one head of each metatarsal, not a proximal and distal one as you seem to imply, unless you are incorrectly identifying the base of the metatarsal as the proximal head.

Second: I certainly cannot understand why an x-ray after an injury wasn't read for a week after it was taken. Has a stress fracture been considered? Although such fractures are often not identifiable on x-rays for as much as several weeks, a scan can generally detect them earlier, but they can be missed there too.

Third: In my opinion, when I hear that an x-ray is followed by a scan and then an MRI, I've got to consider that the doctor might not have the slightest idea what he/she is looking for.

Fourth: I have to wonder why is PT being started when the diagnosis is so much up in the air that an MRI is scheduled.

Fifth: You don't mention the facts of your plantar fascial rupture, which, by the way, is not a very common occurrence, and I can't see that your ankylosing spondylitis is relevant.

Sixth: You do not mention which tendon it is or what sort of injury to it is suspected.

[Hud]

Thanks for the response. I respect the fact that diagnoses cannot be made over a forum but would like to thank you for your personal thoughts. Let me go through your points and try to clarify a bit more.

Let me try and describe the location and the anatomy of what we are working on here.
Firstly it is the tuberosity (styloid process) a bony prominence that protrudes laterally and plantarward from the base of the fifth metatarsal. The tendon they think is at fault is the peroneous brevis tendon. Hope this is better.

Secondly being in Alberta Canada this unfortunately is pretty typical of what is reasonable care. They usually start with the most inexpensive diagnostic method being an Xray. It has to be read firstly by the Radiologist and is sent back to my Doctor. That takes 2 or 3 days in itself to read and for me to get an appointment it takes another 2 to 3 days.(I don't like this either). Then we went for a bone scan which took the same amount of time and I was told that after 72 hrs even small stress fractures sould show up. I always thought like yourself that it may take quite a bit longer to show up, possibly a couple of weeks. Or it may not show up at all. So now the MRI is being scheduled and it takes a couple of months to get in for an angio with the Dyes. F

From what I've been reading I was leaning toward a tiny stress fracture based on the description of the pain and location.

I think the Dr's just can't make a definate diagnosis until they actually see something, so they are leaning more toward the tendon attachment and treating it with physio. (Possibly tendonitis)An educated guess from what they saw while manipulating and palputating the area I suppose.

The Plantar facia rupture was from playing soccer in doors over a year ago.. It was a definate snap and was verified with an MRI. Surgeons said there is really nothing that can be done for this type of injury. After time it didn't seem to bother me too much. I had some orthotics made for my shoes while it was healing. As for ankylosing spondylitis I was told that tendons can become a bit weak???(physio told me this).

I agree I don't think they really know what is going on yet. I hate waiting just because maybe I'm making it worse. Workers comp has sent me back to work based on the Dr.s and physio's reports. Workers comp is saying that the planter facia rupture probably contributed to this??? I know myself that this isn't the best situation to be in but I've got to go along with it.

I'm still putting on the cast for any amount of walking and I am trying to keep as much weight off as possible by adjusting my gate as I walk. Anyway it sure stresses me out.

Thanks Again Foot Doc

[Hud]

Thanks for the response. I respect the fact that diagnoses cannot be made over a forum but would like to thank you for your personal thoughts. Let me go through your points and try to clarify a bit more.

Let me try and describe the location and the anatomy of what we are working on here.
Firstly it is the tuberosity (styloid process) a bony prominence that protrudes laterally and plantarward from the base of the fifth metatarsal. The tendon they think is at fault is the peroneous brevis tendon. Hope this is better.

Secondly being in Alberta Canada this unfortunately is pretty typical of what is reasonable care. They usually start with the most inexpensive diagnostic method being an Xray. It has to be read firstly by the Radiologist and is sent back to my Doctor. That takes 2 or 3 days in itself to read and for me to get an appointment it takes another 2 to 3 days.(I don't like this either). Then we went for a bone scan which took the same amount of time and I was told that after 72 hrs even small stress fractures sould show up. I always thought like yourself that it may take quite a bit longer to show up, possibly a couple of weeks. Or it may not show up at all. So now the MRI is being scheduled and it takes a couple of months to get in for an angio with the Dyes. F

From what I've been reading I was leaning toward a tiny stress fracture based on the description of the pain and location.

I think the Dr's just can't make a definate diagnosis until they actually see something, so they are leaning more toward the tendon attachment and treating it with physio. (Possibly tendonitis)An educated guess from what they saw while manipulating and palputating the area I suppose.

The Plantar facia rupture was from playing soccer in doors over a year ago.. It was a definate snap and was verified with an MRI. Surgeons said there is really nothing that can be done for this type of injury. After time it didn't seem to bother me too much. I had some orthotics made for my shoes while it was healing. As for ankylosing spondylitis I was told that tendons can become a bit weak???(physio told me this).

I agree I don't think they really know what is going on yet. I hate waiting just because maybe I'm making it worse. Workers comp has sent me back to work based on the Dr.s and physio's reports. Workers comp is saying that the planter facia rupture probably contributed to this??? I know myself that this isn't the best situation to be in but I've got to go along with it.

I'm still putting on the cast for any amount of walking and I am trying to keep as much weight off as possible by adjusting my gate as I walk. Anyway it sure stresses me out.

Thanks Again Foot Doc

hi
i need some advice the ball of my right foot hurts when i walk and run and even when i stand what could this be?
and also i play football and i got stood on and they stood on my 5th metartarsal and since that it hurts more to walk, stand and even run. the pain is like a pin prink when i do activities and when i lay down the pain goes away. what could this be. should i get an xray?
thanks alot.