5th Metatarsal Fractures
Sports Medicine Center
Mass General - Boston
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Explore 5th Metatarsal Fractures
What is a 5th Metatarsal Fracture?
The fifth metatarsal is the long bone on the outside of the foot that connects to the small toe. Fractures of the 5th metatarsal are fairly common and can happen in different locations along the bone. Traumatic foot and ankle injuries, including stress fractures, can cause a the 5th metatarsal to crack or even break. Identifying the fracture location and severity is essential in determining treatment, and imaging such as X-rays are important for making an accurate diagnosis.
Ankle injuries and trauma injuries can cause a fracture of the 5th metatarsal, but the bone is also prone to stress fractures.
An avulsion fracture of the 5th metatarsal happens at the end of the bone closest the ankle, the part of the bone attached to the tendon. These kinds of breaks typically occur after an ankle sprain or roll. Most are treated nonoperatively with ice, rest and use of crutches, a cast or a walking boot. In rare cases, surgery is needed to fuse the fractured bone properly.
When a break occurs slightly more distal on the 5th metatarsal, away from the ankle, it is called a Jones fracture. These are often seen in athletes, since they can result from increased training regimens and foot stress, rapid side-to-side movements, and from dancing en pointe (ballet). They can also occur after increased pressure on the feet due to weight gain. This area of the bone has a poor blood supply, and therefore, these breaks and stress fractures take longer to heal. Athletes may consider surgical treatment to improve the speed and strength of healing.
Fifth metatarsal shaft fractures
Fractures to the shaft of the 5th metatarsal are often referred to as "dancer’s fractures." They can appear to look severe on x-rays, but most are treated nonoperatively.
5th Metatarsal Fracture Symptoms
5th metatarsal fracture symptoms are often noticeable on the outside of the foot and include:
- Difficulty walking
Symptoms are generally the same regardless of fracture type. The location of the symptoms may indicate where the fracture has occurred and which type of 5th metatarsal fracture you have.
How Are 5th Metatarsal Fractures Diagnosed?
Our caring providers will ask questions about injuries to the area and any history of pain in the foot. A physical examination can help determine the location of the possible fracture. To get a more detailed analysis, foot imaging may be ordered.
- X-ray: A common diagnosis tool for a fracture of the 5th metatarsal, the X-ray can show the location and type of fracture, although Jones fractures don't always show clearly
- CT or MRI: If a Jones fracture is suspected, detailed scans can provide additional information
5th Metatarsal Fracture Treatment
The treatment of a 5th metatarsal fracture can vary based on the severity and type of fracture. Some fractures may heal with nonsurgical treatments, while others require 5th metatarsal fracture surgery for a full recovery. A patient's age, activity level and health factor into any treatment decisions.
Following an injury, a patient should practice RICE (rest, ice, compression and elevation) until they are able to visit a doctor. A first treatment step, commonly used for an avulsion fracture and potentially for a Jones fracture, immobilizes the foot in a cast or boot. Crutches may also be used to keep weight off the foot. This treatment typically runs six to eight weeks.
In some cases, a bone stimulator is used to accelerate the healing of a 5th metatarsal fracture. This is an external device that can help promote bone growth. This treatment is most common in a Jones fracture but can also be used to assist any immobilization treatment.
When Does a 5th Metatarsal Fracture Need Surgery?
When bones are displaced, or there are multiple breaks, a 5th metatarsal surgery may be the best treatment option. Elite athletes may choose this route. Surgery is common for mid-shaft or dancer's fractures and for Jones fractures if more conservative treatments, like immobilization, prove unsuccessful. 5th metatarsal surgery involves inserting a pin, screw, rod or plate to secure the bone in the desired location.
How long does a fractured 5th metatarsal take to heal?
A 5th metatarsal fracture often heals in six to eight weeks, whether treated by immobilization or through surgery. Weight-bearing activities are significantly reduced for six weeks following surgery. Physical therapy may help the patient recover mobility in the foot and ankle and speed the resumption of normal activities. A full return to sports often occurs in three or four months.
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How painful is a 5th metatarsal fracture?
A defining symptom of a 5th metatarsal fracture is pain on the outside of the foot. Discomfort and difficulty walking accompany the injury.
What are some typical causes of 5th metatarsal fractures?
A 5th metatarsal fracture can be caused by an acute injury or overstress of the bone. An injury could occur after direct impact during an accident, trip, slip, fall or sports injury. Stress fractures result after an excessive load is placed on the bone. Examples of this include extreme weight gain, sudden twisting motions, or dropping something heavy onto your foot.
Can you walk on a 5th metatarsal fracture?
A fracture in your foot will be painful to walk on. You may be able to walk gingerly with a 5th metatarsal fracture, but the fracture needs immobilization to heal properly.
How soon can I run after 5th metatarsal fracture?
Most nonsurgical treatments of a 5th metatarsal fracture allow a gradual return to normal activities within six to eight weeks. It typically takes three to four months for a complete recovery and return to sport.
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