Fifth Metatarsal Fracture

What is a fifth metatarsal fracture?

The metatarsals are the long bones of the feet. The fifth metatarsal is the outermost foot bone and connects to the little toe. A fracture is a break in a bone.

How does it occur?

A fifth metatarsal fracture can occur several ways and break in several places.

• Avulsion fracture: This occurs when the foot or ankle rolls in (an inversion injury). When this happens a tendon that attaches a muscle to the fifth metatarsal can pull off a piece of the bone.
• Mid-shaft fracture: This usually occurs from a violent twist of the foot, but can also happen if a heavy object lands on the foot.
• Jones fracture: This is a stress fracture caused from overuse. Because of overactivity, the bone gradually wears out and breaks.

What are the symptoms?

Symptoms include pain, swelling, and tenderness on the outer side of the foot. There will be difficulty walking.

How is it diagnosed?

Your provider will review your symptoms, ask how you injured your foot, and examine you.

A fifth metatarsal fracture is diagnosed by an X-ray showing a break in the bone. Some X-rays do not detect stress fractures, and a special test called a bone scan may need to be done.

How is it treated?

The treatment depends on the type of fracture you have. There are several ways to treat each type of fracture.

• Avulsion fracture: This can be treated by wearing a stiff-soled shoe or a removable cast boot for 4 to 6 weeks. You will usually be on crutches until you can walk without pain.
• Mid-shaft fracture: This can be treated by wearing a stiff-soled shoe, a removable cast boot, or a cast for 6 to 8 weeks. You will usually be on crutches until you can walk without pain.
• Jones fracture: These fractures sometimes take a longer time to heal. A stress fracture can be treated with a removable cast boot or cast worn for 6 to 8 weeks. You may need to have surgery and have a screw placed in your bone to hold the broken bone together. You will usually be on crutches until you walk without pain.

Treatment will also include:

• Elevating your foot by placing a pillow underneath it. Try to keep your foot above the level of your heart.
• Taking an anti-inflammatory medicine or other pain medicine prescribed by your provider. Adults aged 65 years and older should not take non-steroidal anti-inflammatory medicine for more than 7 days without their healthcare provider's approval.

If you are not in a cast, you should apply ice packs to your foot for 20 to 30 minutes every 3 to 4 hours for the first 2 to 3 days or until the pain goes away. Thereafter, ice your foot at least once a day until the other symptoms are gone.

How long will the effects last?

Fifth metatarsal fractures usually heal within 6 weeks. Jones fractures may take longer to heal and may need surgery.

When can I return to my normal activities?

Everyone recovers from an injury at a different rate. Return to your activities will be determined by how soon your foot recovers, not by how many days or weeks it has been since your injury has occurred. The goal of rehabilitation is to return you to your normal activities as soon as is safely possible. If you return too soon you may worsen your injury.

You may start rehabilitation exercises when your provider has taken a follow-up X-ray and see that your fracture has healed. You may safely return to your normal activities when, starting from the top of the list and progressing to the end, each of the following is true:

• You have full range of motion in the injured foot compared to the uninjured foot.
• You have full strength of the injured foot compared to the uninjured foot.
• You can walk straight ahead without pain or limping.

How can I prevent a fifth metatarsal fracture?

Most fifth metatarsal fractures are caused by accidents that cannot be prevented. However it is important to wear proper fitting footwear and avoid playing or running on surfaces that are uneven.