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Fifth metatarsal head inflammation and pain

Discussion in 'Ask your questions here' started by pickoranges, Aug 25, 2022.

  1. pickoranges

    pickoranges New Member

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    31M, 5'9", 170lbs

    I've been having foot paint for about the last 6 months that no one can seem to figure out. I've been to a PT x 2, podiatrist, orthopedic, chiropractor, had 2 sets of x-rays and an MRI.

    The pain is on the outside of my foot along the fifth metatarsal of my left foot, concentrated towards the head of the bone. I feel it most when I squeeze my foot so it folds up or stand on the outside edge of that foot. It doesn’t really bother me while walking around, but if I go for a hike or try and run I’ll feel it and it will be much more sore the next day.

    I'm a very active/fit person. I do some sort of running/biking/skiing 5 or 6 days a week, I've run ultras, etc. About 6 months ago I was running regularly, but not a crazy amount for me, 30-40 mpw. My left foot started feeling sore, the best way I can describe it is it felt like I did a really long run the day before, even though I hadn't. I didn't think much of it for a couple weeks. It slowly got more apparent, so I took a few weeks off to let it heal. It really didn't get better at all after a month, so thats when I first went to a podiatrist. They did x-rays and didn't see anything. She thought my cuboid was locked up, so told me to get it adjusted by chiro. That didn't really do anything. I then went to a PT, got some exercises that didn't have much of an effect. (Heel raises but focus on keeping the ankle straight inline and not letting it roll. A month or so later I went to an orthopedic who did x-rays and didn't see anything. They put me in a post-op shoe for a month. The shoe seemed to reduce the pain, but not fully. I was able to get an MRI about 2 weeks into wearing the shoe. Since then went to another PT and have been working on internal hip rotation and big toe strength.

    The results of the MRI were:
    TECHNIQUE: Multiplanar, multisequence MR imaging was performed of the left foot without contrast, using standard sequences. FINDINGS BONES/JOINTS: Faint increased T2 signal in the lateral margin of the 5th metatarsal head compatible with mild degenerative change. No evidence of fracture No joint effusion. No arthritic changes SOFT TISSUES: Mild diminished T1 and T2 signal at the lateral margin of the 5th metatarsal head. Regional muscle and tendon are normal. The subcutaneous tissues are normal. Negative for soft tissue mass. The distal medial and lateral flexor tendons are normal. The plantar fascia and plantar musculature are normal. The midfoot and metatarsal ligaments are normal No perineural fibrosis or intermetatarsal bursal distention OTHER: No significant abnormality. IMPRESSION: 1. Mild callus formation and early degenerative or reactive marrow changes of the lateral margin of the 5th metatarsal head. 2. No acute or healing fracture, muscular, or tendinous abnormality

    After reviewing it with the doctor he basically said there is a stress reaction there and he thought it was a weird spot for it, but there was nothing concerning. He said I should try and keep the activity down until it gets better. I haven't done any activity in almost 4months, and it feels like I'm making little if any progress.
  2. Craig Payne

    Craig Payne Super Moderator

    Based on the info that is probably the most likely cause.
    Typically that needs adequate rest until painfree ... then the slowest and most gradual increase in loads so the bone gets a chance to adapt. Some people need a much longer and slow gradual increase than other.

    The other possibility, but less likely is that it is the cuboid - they are really tricky to get right, so maybe have another go at that with a different clinician experienced in it.
  3. pickoranges

    pickoranges New Member

    Based on the MRI do you think there is also the possibility of arthritis? I've been occasionally feeling a similar, but more mild pain in my other foot. I'm worried it may be rheumatoid arthritis.
  4. pickoranges

    pickoranges New Member

    Based on the MRI do you think there is also the possibility of arthritis? I've been occasionally feeling a similar, but more mild pain in my other foot. I'm worried it may be rheumatoid arthritis.
  5. poddoc

    poddoc Guest

    Different feet load different parts of the feet differently. There are some foot types that put very high loads on the 5th metatarsal head. Look at the liner inside your shoe and see if you are wearing a hole under your fifth metatarsal head. The MRI result is what you would see with high loads on fifth met head.

    Treatment: get the load off the fifth met head.

    There are two different foot types that put high pressure on the fifth met head. What you do for one foot type could make the other foot type worse. What you need is a provider who knows how to change the prescription for your orthoses based on the results of the Coleman block test.

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