Time to discuss a clinical topic Section

Old injuries turn up later (metatarsal fractures and the mid foot)

A 57 year old healthy patient injured herself when younger, fracturing her (second/third) metatarsals. It is wise to bear in mind any athletic person engaging in performance activities stands a chance of having problems later on. While the fracture healed, the small joints in the mid foot were loosened so the ligaments failed to control chaffing over several more decades. A ridge of bone made the top of the arch look high and yet this was only protective spurring. The joint at surgery (second MCJ) was open and very damaged. Our investigation considered her bone scan which lit up like a christmas tree. The heavy inflammation settled a little with a steroid injection but the damage was irreparable. The foot was stabilised by a small plate and screws plus a small bone graft to make the joint solid. Injuries can be managed earlier to avoid such degeneration arising. After all if we want to be active for longer we must look after our injuries sooner – and feet are no exception. The procedure mentioned here is called a mid foot arthrodesis.

Comments (2)

  1. Hello Mr Tollafield

    I recognise myself in your post of 11 Feb 2014. Just to give you an update on my progress.

    I still suffer from mild metatarsalgia, which appears to be decreasing as the nerves mend. The drop 2nd metatarsal that appeared after the surgery still restricts my ability to run any lengthy distance. I have improvised a metatarsal lift as a temporary solution, until a proper orthotic insole is made.

    I started running in August, approximately 6 most post operation. I am able to run up to 4 miles. I am not at the same speed or length prior to the operation and injury. I still hope that I can run at least half a marathon, if not a marathon.

    The orthotist who is preparing my insole, informed me that less than 5% of patients who had mid-foot arthrodesis are able to run again. My question is why is that so?
    In order to minimise future damage to the rest of my foot, majority of my runs are on trails, I rest between runs, and I wear stabilise trainers (shoes with a stiffer sole). I do notice that I don’t have the same “bounce” in that foot as my other foot. Can doing certain exercises improve the bouncing-ness of the foot?

    • Thanks Debbra for sharing your feedback. Surgery does take a while to settle and there is always a chance while improving the condition, some elements of symptom can remain. There is no reason why the smaller mid foot joints cannot function effectively in running at the level you desire, although higher performance running certainly is more unpredictable. The source of your orthotist’s reference is unclear and statistics does run the danger of being taken out of context so one cannot answer that directly without more information. I think reference to bounce if correct. Loss of reciprocal movement is a side effect of stiffness. Treatment balances the reduction of pain for some function inevitably. There is every chance the improvement has reached a point where no further exercises are likely to increase the effective bounce. Orthoses (which no doubt you use) would be the only other way of helping.

Leave a Reply

Your email address will not be published. Required fields are marked *