Hey Doc I need your Help!
I am an avid, competitive runner. I developed pin point pain right on my 5th metatarsal. I could no longer run because I had pain on the lateral portion of my foot. The doctor suspected a stress fracture, put me in a boot and sent me for an MRI. I got the report back and meet the doctor tomorrow. I have been in the boot a week and a half and I still have the pain right on the bone so no improvement yet. I want to be prepared to talk with the doctor. The report reads:
Findings: There is mild muscular edema involving the abductor DJD minimi muscle along the lateral aspect of the 5th metatarsal. Fairly nonspecific, likely muscular strain. Marrow signal is normal. There is no evidence of fracture or avascular necrosis. No tenosynovitis
There is mild bony spurring at the 1st metatarsal-phalangeal joints and in the sesamoids consistent with mild degenerative change.
Limited visualization of the plantar fascia is unremarkable. Limited visualization of the mid foot is unremarkable.
Impression: There is mild muscular edema involving the abductor digiti minimi muscle along the lateral aspect of the 5th metatarsal. Fairly nonspecific. Question muscular strain/bruise. No bony acute abnormality is seen.
Muscular strain??? Really?? I’m not impressed with this report.
Regarding the MRI report…..strain of the abductor digiti minimi is not a normal running injury. It is possible the report is accurate though and you strained it doing something else. It is also possible that the MRI is inaccurate or the person reading the report made a mistake. Either way the MRI is not going to solve your issue as it is diagnostic and not therapeutic. So lets imagine the MRI report is accurate. At least you do not have a fracture and your injury should heal rather quickly, within 1-3 weeks. It is also not a traditional running injury so perhaps you can run sooner. Now lets imagine the MRI is incorrect and missed your true injury which on the 5th metatarsal could be a stress fracture, bone marrow edema or insertional peroneal tendonitis. In this case the bone injuries would take about 6 weeks to heal and the peroneal tendon 3-4 weeks….with no running. In any case if it hurts to run and gets worse than you should not run…..no matter what the injury is. If you choose to run and the pain gets worse eventually you will stop anyway and most likely not be able to run for a longer period of time. In any case a boot is an overreaction though and is not necessary. There also may be some modifications that could be temporarily done to your shoe insert to support the lateral foot/5th metatarsal area and reduce the pain which might allow you to run. If you were in my clinic I would stress test you on our antigravity treadmill (AlterG) to see if I could make the pain go away while you ran at a lighter body weight. I would also try the shoe insert/orthotic modification to shift stress away from the painful area. My guess is your doctor will do neither of these. If you are in the San Diego area and would like my help email me directly at firstname.lastname@example.org or call 858-268-8525