Fifth Metatarsal Fractures Causes, Symptoms & Treatment
Fifth metatarsal fractures are common foot injuries, often resulting from twisting injuries to the foot or ankle or from repetitive stress(stress fracture) Based on location and etiology, they are categorized into avulsion, Jones, and shaft fractures. Accurate diagnosis through clinical assessment and imaging is essential to guide management, which ranges from conservative treatment to surgical fixation.
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The metatarsal bones are in the midfoot between the tarsal (ankle) bones and the bases of the toes (distal phalange bones). A fracture of the fifth metatarsal, positioned on the outer side of the foot, can occur along any part of the bone but most frequently involves the base near the ankle. This type of lateral foot injury represents one of the most common fifth metatarsal fractures.
There are several types of metatarsal fractures, classified by their location:
- Zone 1: Small fractures at the tip of the fifth metatarsal base, where a bone fragment separates from the main structure, known as avulsion fractures.
- Zone 2: Larger fractures at the base near the shaft (the long section of the bone), referred to as Jones fractures. Due to limited blood supply in this region, nonunion or delayed healing is more common.
- Zone 3: Fractures occurring anywhere along the shaft of the fifth metatarsal bone
What causes Fifth Metatarsal Fractures?
What Causes Fifth Metatarsal Fractures?
Fifth metatarsal fractures typically result from direct trauma to the outer side of the foot, such as impact during a football tackle, or from repetitive twisting movements that place excessive stress on the bone(stress fracture). Over time, these forces can lead to weakening and eventual fracture.
- How the Injury Occurs: The injury often occurs when the foot rolls inward or outward suddenly, placing excessive load on the lateral border. This mechanism may also occur during abrupt acceleration, landing, or a misstep on uneven ground.
- Common Everyday Causes: Fifth metatarsal fractures can also happen in daily activities, such as missing a step on stairs, twisting the foot while walking on uneven pavement, or dropping a heavy object on the outer side of the foot.
Fifth metatarsal fractures are most common in these sports:
- Basketball: Sudden direction changes or awkward landings after a jump can cause lateral foot strain and fractures.
- Dance: Repetitive pointe work or high-impact landings increase stress on the fifth metatarsal.
- Football: Tackles and collisions often involve direct contact or twisting of the planted foot.
- Running: Continuous stress from improper footwear or uneven surfaces can create microfractures.
- Soccer: Kicking or pivoting movements and sudden stops heighten lateral foot pressure.
Symptoms
The primary symptoms of a fifth metatarsal fracture include pain and swelling along the outer edge of the foot. Additional signs that may accompany this injury include:
- Pain that intensifies during weight-bearing activities: In the case of a Stress Fracture, discomfort may worsen when walking, running, or standing for prolonged periods.
- A distinct “crack” or “pop” sound heard at the time of injury: In the case of a traumatic injury, a sound may be heard followed by immediate pain and difficulty placing weight on the affected foot.
When to see a doctor
If you experience lateral foot pain and swelling on the outer side of your foot following an injury or after repetitive activities such as walking or running, you must stop any physical activity and consult an orthopedic specialist. Your doctor will discuss how the injury occurred and perform a physical examination to check for signs of fracture, such as tenderness, bruising, and localized swelling near the fifth metatarsal.
An X-ray is typically performed to pinpoint the location and severity of the fracture to confirm the diagnosis. Additional imaging, such as a computed tomography (CT) scan or magnetic resonance imaging (MRI), may be recommended to assess surrounding soft tissue or ligament involvement, particularly when a Jones fracture is suspected.
Non-operative treatment
Zone 1 and Zone 3 fifth metatarsal fractures are typically managed without surgery. Treatment usually involves immobilizing the foot in a protective boot or stiff-soled shoe for approximately six to ten weeks, allowing the bone to heal naturally. Adhering closely to your orthopedic specialist’s guidance is essential to ensure proper bone recovery and prevent complications.
Rehabilitation Exercises
Once healing has progressed, specific exercises may be recommended to restore strength, mobility, and balance. These gentle movements help improve circulation and support a safe return to normal activities.
Try these exercises to help address your condition:
Below is a PDF of the Exercise Program
Surgical Treatment
In cases of a Jones fracture (Zone 2), surgical management may be recommended. The procedure typically involves stabilizing the fifth metatarsal with screws and/or plates to restore proper alignment and promote effective healing. Surgical fixation can reduce recovery time and lower the risk of nonunion or delayed healing.
Recovery
Recovery duration varies based on the type and severity of the fracture. With non-surgical care, healing generally occurs within 8 to 10 weeks, while surgical cases may require approximately 12 weeks for full recovery.
Your orthopedic specialist may perform periodic X-rays throughout the healing process to monitor bone repair. Return to physical activity is advised only after a full range of motion, strength, and pain-free movement are restored. If pain reoccurs after resuming activity, it’s important to stop immediately and consult your doctor, as early return may increase the risk of re-injury.
Dr. Jay Kimmel is a board-certified orthopedic surgeon specializing in sports medicine, arthroscopic surgery, and shoulder and knee disorders. He completed his orthopedic training at New York-Presbyterian/Columbia University Medical Center and a Sports Medicine Fellowship at Temple University.
Dr. Kimmel previously served as the Director of the Connecticut Sports Medicine Institute at Saint Francis Hospital and has held faculty appointments as Clinical Assistant Professor in the Departments of Orthopedics and Family Medicine at the University of Connecticut. He has extensive experience caring for athletes as a team physician for high school and collegiate programs and continues to teach in the athletic training departments at Westfield State University and Springfield College.
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/MonthFrequently Asked Questions
Can I walk on a foot fracture if it doesn't hurt too much?
Sometimes. For simple fifth metatarsal fractures, it is okay to walk on the foot if it does not hurt very much. But walking on a Jones fracture can worsen the injury and delay healing. Always seek medical evaluation if you have questions about walking on your foot.
What are the signs of a pinky-toe bone break or fifth metatarsal fracture?
Common symptoms include swelling, bruising, pain in the outer foot, and difficulty bearing weight. A pinky-toe bone break may feel like a sprain, but it usually causes sharp pain outside the foot.
How long does it take for a fifth metatarsal fracture to heal?
Healing time depends on the type of fracture. Zone 1 injuries may heal in 6–8 weeks, while Jones fractures can take up to 12 weeks or longer, especially if surgery is needed.
What are some common causes of stress fractures of the fifth metatarsal?
Overuse in sports can lead to stress fractures, especially involving the fifth metatarsal. Wearing improper footwear or repetitive strain also increases the risk.