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5th MetaTarsal Issues (Sural Nerve?)

I am a triathlete 4.5 weeks out from participating in Ironman Wisconsin. During training I have been dealing with a particularly nasty pain in the area of my 5th metatarsal on the left foot. I have met with a podiatrist who x-rayed the area and said there was no fracture, but was unable to provide a definitive diagnosis (prescribed shoe inserts with metatarsal pads which have sometimes seemed to have relieved the pain and sometimes not (as well as adding some arch pain at times). The pain began on the bike and has gone through periods of better and worse, and I have at times found relief from trying one thing or the other, but the pain always comes back. It did not impact my running for the first 5 months or so I had the pain, but since has caused more pain on the run than the bike. I have taken time completely off (3 weeks), but that seemed to do nothing to help. As alluded to above, I have tried numerous things including different shoes, different inserts, different meta pads, trigger point therapy, self massage, stretching, etc... Nothing seems to help, at least not for long. Sometimes the pain feels like pain at a point, sometimes diffuse, sometimes right below the 5th meta, sometimes towards the center of the foot, sometimes back towards the peroneal nerve. I am wondering if I just have some sort of nerve dysfunction that could be fixed by cutting the sural nerve out, or if there is a place with experts that could at least get me a fairly definitive diagnosis. Thoughts from anyone?
1 Responses
Avatar universal
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

I am not sure if you have a neurological problem. What you describe may be related to a tendon tear, tendinitis, or a stress fracture (which may not be visible on an x-ray).

I would recommend that you continue following up with a podiatrist. You may benefit from an MRI of your foot to evaluate further.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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