Sports Injury Series: Fractures of the foot

For those of you who don't follow RASC Rockford on Facebook or Google +(and if you do not, why aren't you?), this topic is near-and-dear to my heart and foot, literally. What you are looking at is an oblique view of Dr. Donohue's left foot. As you can see, there are 5 bones that seem to be the longest when looking at the radiograph. These bones are called the metatarsal bones, and there are 5 of them corresponding to the 5 toes. The metatarsal bones are essential in the maintenance of the arch of the foot and providing shock absorption when walking, running, jumping or other activities where the foot is lifted off the ground.

The 5th metatarsal bone, where the "pinky" toe articulates, as you can see is in two pieces currently. This type of fracture is called a Jones Fracture and is common in athletes. The 5th metatarsal bone is the insertion of two tendons that comprise the distal portion of the fibular or peroneal muscles. Additionally, it serves as an articulation of the plantar fascia which is another essential component of arch maintenance. These tissues are essential in the plantar (downward) and dorsal (upward) flexion of the ankle.

As you can see, the fracture is complete and is in the body of the bone, as opposed to either end of the bone. Options for treatment include conservative management which relies on casting, immobilization, crutches, nutritional intervention and general non-weight bearing. Surgically speaking, this is a candidate for surgery should there be no bridging of the gap between the bones.

As an aside, I will discuss the process going forward. Currently, I am in a hard cast with a walking boot cover. I have chosen to go the conservative route for the time-being. In three weeks, another radiograph will be taken to determine how well the osteoclasts (bone-resorbing cells) and osteoblasts (bone-building cells) have performed. If there is a bridge that is formed between the two sections of bone, I will remain in a cast. Should the bridge not have formed in that time period, surgical intervention will be necessary. Should that be the case, there will be no weight-bearing on the foot for approximately 3 weeks. For conservative management, I have chosen to follow the aforementioned protocol, with administration of:

- High Potency Multivitamin q.d.
- High Potency Multimineral q.d.
- Omega 3 Supplement b.i.d.
- 5000 IU Vitamin D b.i.d.
- Calcium b.i.d.
- Increase protein ingested to 1.5 g/kg body weight so approximately 135 g. protein daily
- Reduced carbohydrate intake
- 48 g. CoQ10.