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.
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.
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.
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.
