The location of the pain is important to the diagnosis of a 5th Metatarsal fracture or bone stress injury. I have provided my response to you in RED. Your daughter is most likely suffering from a bone stress reaction sometimes called Bone Marrow Edema. The NP and Podiatrist you saw were incompetent as far as being able to accurately diagnose as well as having any common sense. I would “Blacklist” them in the future. The Ortho and Physicians assistant are at least in the ballpark. The Ortho probably mistook her growth plate for a fracture which the MRI disputed but the MRI did note the stress reaction so ultimately her injury needs to be managed as if it were a fracture. In the future I am available for immediate phone consultations by emailing me Drrunco@sdri.net
Dear Dr. Runco,
I’m writing to you about my daughter. She is a level 6 gymnast back in April of 2017 she missed a step and rolled her ankle. She has had pain in her foot since, at the 5th metatarsal base. About 4 weeks after her injury I took her in too see a NP since her doc was not available. She told me my daughter sprained her deltoid muscles and sent her to PT. Pain was still there after 2 weeks and I didn’t agree with what the NP had said so I brought her to a podiatrist, he said that she had severs disease but I explained to him she did not have heel pain, he said pain can be elsewhere. I did not agree with him so I brought her to her actual doctor and she set me up with a child ortho the next day. I brought her in and they gave her an X-ray and said it was a 5th metatarsal fracture, put her in a boot and crutches and told us to come back 2 weeks later. I brought her back 2 weeks later and she was still feeling pain, so he told us to come back in 3 weeks and if it’s still bothering her they would do more imagining. Two days before we had to go back I got a call that the ortho we were seeing was out on medical so we would be seeing a PA in the same office. When I brought her in she was still feeling pain but he told us that he did not see a fracture in the X-ray what the what ugh I was so frustrated so he set us up for a MRI. We went for the MRI and saw him 3 days later today 7/19/17 This was the findings of the MRI. Wow! That is a lot of opinions that all disagree! Based on your description and the location of the pain it appears that the last doctor is most correct (the Nurse Practioner and Podiatrist were not even in the ballpark). Let’s see what the MRI says……….
1. There is mild T2 signal changes along the plantarlateral aspect of the proximal base of the 5th metatarsal. In this location, the findings may reflect anatomic normal variant signal/developmental changes. Mild stress reaction cannot be excluded. No focal displaced fracture seen. OK here we go. It says she has a “stress reaction” at the “proximal base of the 5th metatarsal”. This is sometimes referred to as Bone Marrow Edema and is consistent with your daughter rolling her ankle. Stress reactions or Bone Marrow Edema are treated and managed as if it were a fracture. Typically this injury will take as long or longer to heal than a fracture.
2. In the distal fith metatarsal, there is Mild t2 signal marinating the physes, which appears asymmetrically more prominent as compared to the remainder of the metatarsal. No Frank widening of the physis is seen. These findings may reflect mild stress changes. Clinically correlate. This is a good finding. The physes is the growth plate. No widening means no injury to it.
Tendons all look good. After seeing the doc today I’m not sure what to make of it. On the report it says diagnosis this visit stress fracture of metatarsal bone on left foot. So frustrated she has been in a boot for 6 weeks and this week she’s finally not feeling pain just a thumping as she explains. The “thumping” is the throbbing associated with a bone injury. I asked the doc if a stress fracture was seen in MRI and he said no then how did he come up with that diagnosis? This was done as there was no other probable diagnosis. Confused it was fracture then not now stress fracture. The doc wants to now wean her out of the boot over 15 days and then see him at the end of Aug. It is not unusual for doctors to mistake the growth plate line. In fact it is common so the physicians assistant did the right thing in continuing to treat it as a fracture even though the X-ray and MRI did not see it. This is done because of the nature of the injury and the location of the pain. I provided you a link to read more about diagnosing and management of 5th metatarsal injuries.
Thank you so much for taking the time to read my daughter’s problem. She should recover nicely but if you want to go the extra mile I recommend Alter Gravity Treadmill rehabilitation to help strengthen the bone without risk of further injury.