Feet > Fifth Metatarsal Fracture

 
What is the Fifth Metatarsal?


Your fifth metatarsal bone is the long forefoot bone that runs along the outside of your foot. The head of the fifth metatarsal begins where your little toe attaches to your foot, and the base meets a bone called the cuboid in the middle of your foot.av=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

People commonly suffer four types of fifth metatarsal fractures:

   Tuberosity avulsion fracture – Occurs at the base of your fifth metatarsal where the peroneus brevis tendon attaches. When your foot twists, the tendon may tear (avulse) a piece of bone off the outside of the base of your fifth metatarsal.

   Fracture of the shaft (diaphasis) – Damage to any part of the long shaft of the fifth metatarsal.

   Jones’ fracture – A crack in the bone where the shaft of the fifth metatarsal meets the wider base. It is the most troublesome fifth metatarsal fracture because this area has a poor blood supply, which makes a Jones’ fracture difficult to heal. Stress fractures in this area also commonly occur and are treated similarly.

   Fracture of the distal neck This is rare.

av=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.


Causes [top]

It is common in sports and activities played on uneven surfaces to twist, or invert, your ankle. When your ankle inverts, you can strain one of the tendons, called the peroneus brevis, which runs from your calf muscle to the base of your fifth metatarsal. A severe ankle inversion injury can pull the tendon and a piece of bone off the base of your fifth metatarsal. The force of objects or other athletes falling on your foot typically causes fractures in the shaft of the fifth metatarsal. Twisting or inverting your ankle also can fracture the shaft. Jones’ fractures commonly are caused by sudden increases in your activity level, such as starting a new sports season without proper training. Changing the surface you run on or prolonged walking or hiking when you have not been active for a while also can fracture the junction of your fifth metatarsal shaft and base.av=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

Considerations

If left untreated, even small fractures in your fifth metatarsal tend to increase in severity until the pain becomes disabling. Without proper treatment, your bones may not heal and be vulnerable to reinjury. Fractures in the base and the shaft of your fifth metatarsal may be treated without surgery. Your bone usually heals properly when your foot is immobilized in a cast or cam walker. If your fifth metatarsal has displaced, which means the bone has cracked and shifted out of position, surgery may be necessary to reposition the fracture. Jones’ fractures and stress fractures, located in the area where the shaft meets the base of your fifth metatarsal, may need surgery because this area has a particularly poor blood supply, which makes healing more difficult. Surgery can stabilize your fifth metatarsal and hold it in proper position. Physicians differ on how soon after the injury to prescribe surgery, but about 50 percent of Jones’ fractures do not heal when treated in a cast. An alternative treatment for a Jones' fracture is a non-weight-bearing cast. You and your physician will need to discuss your individual case and decide on the best treatment option.av=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

Orthopedic Evaluation [top]


There usually are three parts to an orthopedic evaluation: medical history, a physical examination, and tests that your doctor may order.

MEDICAL HISTORY

Your physician likely will ask about your activities, which may have led to the fracture of your fifth metatarsal. You will be asked when the pain began and to describe your pain’s duration and severity. If you have previously broken your fifth metatarsal or had previous foot injuries, your physician will ask about treatments you may have tried in the past. Physicians suspect a fracture when you describe direct contact to the outside of your foot followed by pain and limited motion. Descriptions of increasing pain on the outside of your foot over a span of weeks also could be a sign of a fracture. Physicians also typically ask about other conditions, such as diabetes and allergies, and medications currently being taken. You may also be asked about your physical and athletic goals – information that will help your physician decide what treatment might be best for you in achieving those goals.


PHYSICAL EXAM


Physicians often can diagnose a fractured fifth metatarsal by putting direct pressure on the outside of the middle of your foot. The outside of your foot usually is tender when pressure is applied.

TESTS [top]


X-rays taken from different positions typically are sufficient to show fractures or dislocations in the shaft or base of your metatarsal.av=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.



Treatments
Immobilization
Cast
Closed Reduction and Internal Fixation
 

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