5th metatarsal

[todd]

Just looking for some thoughts and advice please. 12yr old boy, presents today, 3 days post injury. Landed from small height (ie. kicking in AFL game, no twist, or any abnormal landing), sudden pain lateral border, came off, much difficulty weight-bearing. Minimal swelling, nil 'crack'. Now,on crutches, but able to weight-bear, able to perform 1 leg calf raise. No pain with peroneal isometric testing. Tender (moderate) base of 5th metatarsal.
Interestingly, fractured base of 5th metatarsal of other leg earlier this year. Interestingly, sustained similar injury to presenting foot 6 weeks ago, but was back playing in 1-2 weeks. Nil problems since. He has just finished the GPS Rugby season.
Suspect:
1. fracture-but is this likely, considering absence of significant swelling, and ability to weight-bear reasonably?
2. Stress fracture-or would this be a more insidious/slower onset?
3.Apophysitis-or would this be a more insidious/slower onset.
4. avulsion.
I haven't sent him for x-ray as yet, as it has improved markedly, and he has reasonable weight-bearing ability. Should I be doing this immediately?
I am treating as a sprain. He has Grand Final in 2 weeks.
Are there possible predisposing factors, as his parents are asking why has he had the similar injury on three occasions in 6 months.
Thanks.

[injuryupdate]

Thoughts:

Possibly may have growth plate still open (even though the condition - I think called Iselin's disease - is meant to be in younger athletes).

Probably has high arch feet, as this stresses 5th MTs.

Probably doesn't have stress fracture due to quick recovery.

X-ray is worth it if he doesn't settle. Radiation for vital parts of the body minimal when doing the foot, although a 12yo should wear a lead gown.

[todd]

Thoughts:

Possibly may have growth plate still open (even though the condition - I think called Iselin's disease - is meant to be in younger athletes).

Probably has high arch feet, as this stresses 5th MTs.

Probably doesn't have stress fracture due to quick recovery.

X-ray is worth it if he doesn't settle. Radiation for vital parts of the body minimal when doing the foot, although a 12yo should wear a lead gown.


Thanks for reply. He is settling quite well, but will monitor over next few days.