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Fifth Metatarsal Fractures

The metatarsal bones are bones in the middle foot located between the tarsal (ankle) bones and the base of the toes (distal phalange bones). A fracture in the fifth metatarsal (located on the outside of the foot) can occur anywhere along the bone, but most often happens on the tip of the base of the bone, closer to the ankle.

Fifth Metatarsal Fractures Hero Image 2

The metatarsal bones are bones in the middle foot located between the tarsal (ankle) bones and the base of the toes (distal phalange bones). A fracture in the fifth metatarsal (located on the outside of the foot) can occur anywhere along the bone, but most often happens on the tip of the base of the bone, closer to the ankle.

There are different types of metatarsal fractures, each one defined by the location:

• Zone 1: Small fractures of the tip of the fifth metatarsal base. The fragment of bone that is fractured pulls away from the main bone. These types of fractures are also called avulsion fractures.
• Zone 2: Larger fractures of the fifth metatarsal base closer to the shaft (the long section of the cone), also referred to as Jones fractures. Because this area of the bone has poor blood supply, nonunion (poor bone healing) occurs much more frequently in zone 2 fractures.
• Zone 3: Fractures that occur anywhere along the shaft of the metatarsal bone.

What causes Fifth Metatarsal Fractures?

Fractures to the fifth metatarsal occur with direct trauma to the foot, such as crushing in a football tackle. They can also be caused by repetitive twisting movements that stress and weaken the bone.

Fifth metatarsal fractures are most common in these sports:

• Basketball
• Dance
• Football
• Running
• Soccer

Symptoms

The most common symptoms of a fifth metatarsal fracture are pain and swelling on the outside of the foot. Other symptoms associated with this injury include:

• Pain that increases with weight bearing
• A “crack” or “pop” that is heard at the time of injury

When to see a doctor

If you have sustained an injury to the foot and have pain and swelling on the outside of the foot, stop all activity and make an appointment with an orthopedic specialist. During your appointment, your doctor will ask you to recount what happened at the time of your injury. He/she will examine the foot for signs of a metatarsal fracture, such as tenderness, swelling, and bruising along the fifth metatarsal.

In order to make a diagnosis, your doctor will order an x-ray to identify the fracture and determine exactly where the fifth metatarsal has broken. While usually not necessary, your doctor may sometimes order a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan to check for damage to the surrounding ligaments.

Non-operative treatment

Zone 1 and zone 3 fifth metatarsal fractures can generally be treated non-operatively, by stabilizing the foot in a special shoe for six to 10 weeks to allow the bone to heal. In order to promote proper bone healing, it’s important to follow all instructions given to you by your orthopedic specialist.

Surgical Treatment

If you sustain a Jones fracture (zone 2), your doctor may recommend surgical intervention. The goal of surgical intervention for a fifth metatarsal fracture is to fix the position of the fifth metatarsal using screws and/or plates. Surgical intervention can improve recovery time and ensure proper healing of the bone.

Recovery

The time it takes to recover from a fifth metatarsal fracture depends on the severity of your injury. With conservative treatment, it may take up to 10 weeks for the foot to heal. Following surgery, the foot will need at least 12 weeks to heal completely.

During the healing process, your orthopedic specialist may want to take follow-up x-rays to ensure proper healing of the bone. You can return to play when you have regained full range of motion and strength without any pain. If you experience pain after returning to play, stop all activity and call your doctor, as re-injury can occur if you return to normal activities too soon.

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