5th Metatarsal Fractures: Symptoms, Diagnosis, and Treatment
by Pearson Huggins, OMSII
A fifth metatarsal fracture is a break located in the long, laterally located tubular bone of the forefoot that is attached to the small toe. Fractures of this bone can occur due to direct injury to the outside of the foot or can occur over time. Fractures that occur over a period of time due to overuse are termed “stress fractures.” Patients experiencing tenderness, swelling and pain on the outside of the foot may have suffered a fifth metatarsal fracture. In addition, hesitancy with weight-bearing can contribute to the diagnosis. Treatment options include conservative and surgical methods; however, the type of care varies depending on the patient and the nature of the fracture.
Anatomy and Classification: The foot is a complex structure that has a role in weight bearing and walking. It is composed of seven tarsal (ankle) bones, five metatarsals, and fourteen phalanges. The metatarsals are responsible for bridging the distance between the tarsal bones and phalanges. The metatarsals are numbered 1-5 beginning with the great toe. Therefore, the 5th metatarsal is located on the lateral side of the foot. Fractures of the 5th metatarsal can be classified into three categories including:
Tuberosity Avulsion Fracture (Dancer’s Fracture) – A fracture that occurs when the ligaments and tendons that attach to the head of the 5th metatarsal pull off a part of the bone. Its name originates from its association with dancers who often sustain this injury when excessively twisting or rotating the foot and ankle.
Jones Fracture – A fracture that occurs between the head and shaft of the 5th metatarsal. These fractures have a high frequency of non-union due to their poor blood supply and may require surgery.
Diaphyseal (Shaft) Fracture – A fracture of the 5th metatarsal occurring in the shaft of the bone.
How will the doctor assess my foot? From the moment you take your first step into the office, your physician will begin to assess the injury by observing your gait. Once in the exam room, your doctor will evaluate your range of motion and sensation to the lateral foot. X-rays will also be ordered in order to confirm a fracture and classify it accordingly.
Treatment and Recovery: Fortunately, 5th metatarsal fractures can often be treated conservatively without the need for surgery. In a typical Jones fracture, patients may be placed in a boot and instructed to remain in a non-weight bearing state for 6 weeks. Contrarily, if the patient is an athlete, surgery may be indicated to ensure proper fracture union and to decrease the healing time. In addition, dancer’s fractures tend to follow the same non-operative treatment pattern as Jones fractures. Lastly, shaft fractures can be treated conservatively, but may require surgery if the bone fragments are displaced. Regardless of the form of treatment, the physician may order additional x-rays to ensure proper bone healing.