5th Metatarsal Fractures

December 3, 2008, Editor MCR,

Fractures are common in the fifth metatarsal and normally occur with sporting activities. The metatarsal bones are a group of 5 long bones in the foot. The fifth metatarsal is located on the little toe side (lateral side) of the foot and connects to the little toe. Strong ligaments attach the base of the fifth metatarsal to the cuboid bone and the fourth metatarsal bone. Because of these strong ligament attachments, it is easier for an individual to fracture the fifth metatarsal than to dislocate it.

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source: emedx.com
A fifth metatarsal fracture can occur in several ways and break in several places. There are 2 types of fractures that often occur in the fifth metatarsal:

  • Avulsion fracture
  • Jones fracture

A fifth metatarsal fracture is diagnosed by an x-ray showing a break in the bone. Because a Jones fracture may not show up on initial x-rays, additional imaging studies may be required.

Avulsion Fracture

In an avulsion fracture, a small piece of bone is pulled off the main portion of the bone by a tendon or ligament. This can occur after forced inversion or rolling in of the foot and ankle. Patient with an avulsion fracture experiences tenderness at the base of the fifth metatarsal, often with brusing and swelling at the site.

Treatment of non-displaced avulsion fractures is conservative. Options include elastic bandaging, low-profile walking boots or casts for 4 to 6 weeks. Weight bearing is allowed as tolerated.

However, for displaced avulsion fractures, they are best managed by either open reduction and internal fixation or closed reduction and pinning.

Jones Fracture

Jones fracture was first described by Sir Robert Jones when he fractured his fifth metatarsal in 1902 while dancing around a Maypole at a military garden party. Jones fracture involves a fracture at the base of the fifth metatarsal at the metaphyseal-diaphyseal junction, located 1.5cm distal to the tuberosity of the 5th metatarsal. It can either be a stress fracture (a tiny hairline break that occurs over time) or an acute (sudden) break.

Patients normally present with sudden pain at the base of the fifth metatarsal, with difficulty bearing weight on the foot. Bruising and/ or swelling are often present at the site. The mechanism of the injury is described as a laterally directed force on the forefoot during plantar flexion of the ankle.

Jones fracture is a difficult fracture to get to heal due to limited blood supply to that area and often surgery is required. If surgery is not performed, then a short leg cast can be worn for 6 to eight weeks in nonweight-bearing with progressive ambulation after cast removal. It can take 8 to 10 weeks for this fracture to heal and is not always predictable whether or not full healing will occur. Studies have shown about 70% heal with cast treatment.

On the other hand, sugery for Jones fracture has about 95% success rate. In competitive athletes, these fractures are usually treated surgically. Surgery may include placing an intramedullary screw into the bone’s shaft to stabilize the fractured bone, and hold it securely in place while healing occurs. This internal fixation technique allows healing to occur quite rapidly and walking on the foot with a removable boot is allowed within a few days after surgery. Typically, bike exercise can be commenced at about four weeks. Patients may return to running approximately six weeks post-surgery. – CT

Related posts:

  1. I keep getting stress fractures. Why?
  2. How do I know if my back pain is due to a fracture?
  3. Fracture Healing
  4. My bunion is stopping me from running! Help!
  5. Ankle Replacement Surgery


Creative Commons License
This work by Musculoskeletal Consumer Review is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 Singapore License. This article was contributed by Core Concepts - Musculoskeletal Healthcare Group. In the spirit of promoting health education, you may copy, distribute and transmit the work under the conditions specified by the license. For articles re-printed with permission, copyright remains with the original copyright holder (author or publisher). MCR's Creative Commons License does not apply in such cases.


Filed Under Ankle & Foot (NonSport), Ankle and Foot, Peripheral (NonSport), Sports Injury 

Comments

  • jmsgas
    hi i have the same problem but i'm still getting pain 18months after mostly if i work off landers and if i kneel down working which between the 2 is 80% of my job (self employed plumber) doctor keeps telling me to take painkillers and anti inflams but also bad at night once the weight comes off it which in turn is disturbing my sleep my consern is i started nodding off to sleep at the wheel while driving on the motor way and just can't keep going on like this can any one help me as i fightened that i may end up crashing or even worst i work on gas and due to being tied and in pain make an error and i don't what this extra stress
  • fotini
    Hello!!
    I've got the avulsion fracture, and this is the 5th week of boot-wearing. By the way, the boot is not very low profile, people tend to notice quite a lot! ;-)
    The point is, I am going to the hospital in a few days but my foot and toes are still a bit swollen.
    Is this normal? Is it caused by the foot enclosure or does it mean that it has not healed yet?
  • Cindy Tan
    Dear Christopher,

    Sorry to hear that you have fractured your 5th metatarsal. If you are going to be casted for 5 weeks, you will probably still need to use some form of walking aid such as crutches or walking stick to ambulate when the cast is removed. It will take a few weeks after cast removal before you can weight bear fully on your affected foot.

    Meanwhile, you could do some strengthening exercises for your upper body, hips and knees to prevent weakening in these areas. This will help speed up your recovery when you start ambulating.

    Best Regards,
    The Editor
  • christopher hogg
    hi im going on holiday on the 30th of may and have just fractured my 5th met its a thin crack about 1/4 the way up the shaft near the bottom...ive got about 5 week for it to heal and get the cast off do you think i could be walking in 5 weeks and what can i do to speed up the healing process thankyou for any advise.
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