The Fifth Metatarsal                                                                                                                                                                                                                                  

In athletics breaking the foot’s fifth metatarsal bone is surprisingly common.  Often a metatarsal break begins as what is deemed a sore foot that can last several weeks.  The athlete may limp, have some swelling, maybe bruising and when medically examined a stress fracture is discovered.

Early recognition is not always easy and the MRI has become the most sensitive tool for detection.  Due to the blood supply in this region, it can be difficult to get these fractures to heal.  Depending on the severity, the individual, the location of the break, the injury is treated with or without surgery.  Non-operative treatment consists of a prolonged cast or boot immobilization, both of which are followed by loss of muscle mass throughout the leg.

The soleus muscle is the largest of the calf’s three muscles with the second largest being the gastrocnemius medialis and the smallest the gastrocnemius lateralis.  After several weeks of immobilization the gastrocnemius muscles are the most affected of the group.  The good news is once the fracture is healed muscle strength returns rather quickly with the appropriate rehabilitation of the foot and ankle.

While the bone is healing the quadricep muscles and hamstrings are losing size and strength though not immobilized.  What is interesting and important to know is that even though the calf is immobilized the rate of loss of tissue is greater in the quadricep muscles than in the casted calf.

All four quadricep muscles atrophy and the vastus lateralis, vastus intermedius and vastus medialis tend to lose the most tissue as the fourth quadricep muscle rectus femoris tends to be the least affected as it crosses the knee, as well as, the hip and is used to move around while healing. 

The Pendulum Leg Extension

With medical permission knee exercises can be done while the ankle is immobilized, sometimes by periodically removing a boot or training above the cast.  Knowing the quadricep will be highly effected and the hamstring loses strength as well with the appropriate permission do these two exercises religiously while the fracture is healing.  Keeping the quadriceps and hamstrings strong will allow the athlete to return to activity much sooner.

 The Pendulum Leg Curl