Non-surgical Management Of A Proximal Fifth Metatarsal Fracture in an NCAA Football Player

Abstract

HISTORY: A 23 year-old male presented to the sports medicine clinic with complaints of left foot pain following a play on the practice football field. He states that he was turning to catch a pass and pushed off with his left foot and he felt a pop and had immediate pain. He was seen by an athletic trainer and placed in a walking boot and was non-weight bearing with crutches. Patient has no history of injury to his foot previously. PHYSICAL EXAM: Upon presentation, he is tender to palpation over the base of the fifth metatarsal with associated edema appreciated. Patient had normal strength, tone, and sensation in his left lower extremity. There was full active range of motion. He was neurovascularly intact. DIFFERENTIAL DIAGNOSIS: 1.Avulsion fracture of the base of the fifth metatarsal 2.Jones Fracture 3.Fifth Metatarsal Fracture TESTS AND RESULTS: 1.X-ray of left foot revealed a transverse fracture at the proximal shaft of the left fifth metatarsal that was nondisplaced. 2.Vitamin D level drawn and was 42.1 ng/mL 3.Repeat x-ray showed callus formation and internal healing FINAL/WORKING DIAGNOSIS: Proximal shaft of the Fifth Metatarsal Fracture TREATMENT AND OUTCOMES: Long leg cast placed on the left lower extremity and non-weight bearing, followed by a walking boot with continued non-weight bearing, then weight bearing in a walking boot. Vitamin D was replaced. Patient started rehabilitation exercises with athletic trainer with no pain and obtained orthotics. Patient was cleared for full participation in football. Patient was placed on a bone stimulator to affected area during entire treatment.