Joe A Shaw PA-C - 8/12/2008

Question
My wife had a fracture in her 5th metatarsal in Dec 2006. The doctor recommended a cast for her, which was kept on for around 4 weeks. Following this, based on x-rays, we were told that the fracture had healed. However my wife had recurrent pain.

Initially, we thought it was just because the joint was stiff after being in a cast & thought it would gradually subside. However, the pain continues & seems to be increasing even today.

The spot that was injured swells up after some amount of walking or even walking on an uneven surface. Occasionally, she also feels a clicking sound around the spot that was injured.

The doctors have had x-rays again and 2 MRIs - once last year & once again this year and they both show nothing wrong at the injured spot, according to our doctors (we've taken 3 opinions). In fact, they both show some fluid collection around T1 rather than T5 but the pain is still there (at the 5th Metatarsal) along with a swelling and no doctor has even given us an indication of what's wrong.

Can you please help out on this?

Answer
Karthik,
This is a Jones fracture and are classified by 3 types I, II, III..I'm assuming she had type I as these are treated w cast. Usually it is 6-8 wks non wt bearing then 8-12 wks wt bearing with orthosis. It is not uncommon that you have delayed healing with this type of fracture (but not 2 yrs) and it is not uncommon to have a nonunion, where bone doesn't heal back..but this would easily show up on xrays. And MRI should show any ligament tears I would think. There is a rare condition with the sural nerve..a nerve that wraps around the outside of your ankle and branches out to 5th metatarsal area and can get caught up in the union or healing of the bone, but usually the person has numbness and tingling. At any rate I think you need to find a ortho that specializes in feet and ankles. Finally you may be diagnosed with RSD or complex regional pain syndrome..google it for more info