5th Metatarsal Fracture

What is the 5th Metatarsal Bone?

The 5th metatarsal bone is the long bone located on the outside of the foot. 


It has a base (tuberosity) where the peroneus brevis tendon and lateral plantar fascia attach, a long shaft and a head where it meets the 5th toe. 


Please see Foot - Anatomy and Imaging for more information on where this bone is in the foot.

Types of 5th Metatarsal Fracture

  • There are several types of 5th metatarsal fracture. 
  • They usually occur due to twisting injury. 
  • Most heal without complication but can take time.

Base (Tuberosity) Avulsion Fracture

  • In an avulsion fracture, a piece of the bone is pulled off the main portion of the fifth metatarsal by the attaching plantar fascia or tendon.
  • These are the most common 5th metatarsal fracture. 
  • They are a cause of persisting pain after what is thought to be an ankle sprain.
  • Treatment is protection in a stiff sole shoe or low "moon-boot" until comfortable. 
  • Surgery is rarely required, unless the avulsed fragment is very displaced and not healing (see images below).

Shaft, Head and Neck Fractures

  • Neck and head fractures (uncommon).
  • Shaft fracture ("dancer's fracture") - these spiral fractures look bad but heal without surgery (see images below). Surgery can actually make them heal slower.

Jones Fracture

  • This fracture occurs in an area between the base and shaft of the fifth metatarsal which has a limited blood supply and is under tension stress on standing (see image).
  • This injury heals slower than a base avulsion fracture. It sometimes does not heal or re-fractures after healing. Surgery may be recommended early in active people.
Interesting fact: this fracture was described by Dr Robert Jones in his own foot back in 1902.

5th Metatarsal Jones Fracture

Stress Fracture of the 5th Metatarsal

  • This stress fracture of the foot occurs in a similar location to the Jones fracture but develops over time rather than acutely from an injury (see image - note thicker "whiter" bone).
  • People with high arched (cavo-varus and metatarsus adductus) feet are more likely to have this stress fracture.
  • Healing is slow and re-fracture can occur. Surgery is usually recommended.
5th Metatarsal Stress Fracture

5th Metatarsal Jones and Stress Fracture - symptoms

People who sustain one of these fractures have:
  • pain,
  • swelling,
  • tenderness,
  • and bruising over the outer foot.
  • Difficulty walking. 
Stress fractures may have had a dull ache and mild swelling during and after exercise for several weeks before sudden pain developed.

5th Metatarsal Jones and Stress Fracture - diagnosis

If a foot injury stops you walking on it, you should seek medical attention as soon as possible for proper diagnosis and treatment.

The diagnosis of a Jones fracture involves:
  • history of injury 
  • examination of the foot.
X-rays are always required and other imaging studies (MRI or bone scan) may be needed.

5th Metatarsal Jones and Stress Fracture - treatment

Initial treatment consists of:
  • rest, ice, compression, and elevation (RICE) to help control pain and swelling
  • a splint or "moon-boot"
  • crutches to keep weight off the foot.
These fractures can heal with prolonged immobilisation and crutches (> six weeks). 
Delayed healing and re-fracture also occur.

If there is an associated foot structural issue, this will need addressing with orthotics (insoles).

Surgical Treatment of 5th Metatarsal Jones and Stress Fractures

  • Jones fracture surgery is recommended when the fracture is not healing well or re-fracture occurs, and in active people or high-risk feet. 



  • Stress fractures of the 5th metatarsal usually require surgery.



Interesting fact: Dr Beamond has fixed these fractures in members of the Adelaide Crows, Adelaide 36ers and Adelaide United clubs.



Surgery involves placing a screw within the 5th metatarsal to stabilise the bone and allow the fracture to heal (see images below). Occasionally a metal plate is required instead. 



Bone graft is used when needed to stimulate healing.

Surgery:

 

  • is often Day Surgery
  • requires a general anaesthetic in most people
  • takes 30 minutes.

 

First 2 weeks:

 

  • bandage
  • "moon-boot" and crutches
  • rest, elevation and ice (RICE)
  • ankle and foot movements
  • post-operative appointment.

 

Next 4 weeks:

 

  • "moon-boot" to stand and walk
  • exercise bike and pool-based activities
  • post-operative appointment and X-ray. 

 

Next 1 to 2 months:

 

  • shoes
  • return to sports specific training then sport
  • post-operative appointment +/- X-ray.

 

Benefits and risks:

 

  • 95% of people are helped by surgery
  • 5% of people need more surgery
  • <1% of people are made worse by surgery.

 

Consequences and complications:

 

  • driving restrictions (2 to 8 weeks)
  • scar numbness is common
  • re-fracture if return to sport before 10 weeks
  • screw or plate is NOT normally removed
  • see General Information about Surgery.

 

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