5th Metatarsal Fracture

What is a 5th metatarsal fracture?

A fifth metatarsal fracture is a broken bone on the outer edge of your foot and one of the most common foot injuries. Your fifth metatarsal is the long bone on the outside of your foot that connects to your little toe.

What are the types of 5th metatarsal fracture?

There are three types of fifth metatarsal fractures classified into three zones:

• Zone 1 (avulsion fracture): These fractures make up 93% of all fifth metatarsal fractures. In an avulsion fracture, a small piece of bone is pulled off the main portion of your bone by a tendon or ligament. This type of fracture is the result of an injury that causes your ankle to roll. Avulsion fractures are often overlooked when they occur with an ankle sprain.
• Zone 2 (Jones fracture): Jones fractures occur in a small area of the fifth metatarsal that receives less blood. Because of this and is therefore more prone to difficulties in healing. A Jones fracture can be either a stress fracture (a tiny hairline break that occurs over time) or an acute (sudden) break. Jones fractures are caused by overuse, repetitive stress or trauma. They are less common and more difficult to treat than avulsion fractures.
• Zone 3 (mid-shaft fracture or dancer’s fracture): Midshaft fractures usually result from trauma or twisting. These breaks occur at the metatarsal head and neck.

Who might get a 5th metatarsal fracture?

About 5% to 6% of fractures seen by U.S. healthcare providers are metatarsal fractures. Anyone can get a fifth metatarsal fracture, but this type of fracture peaks for men in their 30s and women in their 70s. Women tend to have a higher rate of avulsion and mid-shaft fractures than men.

What causes a 5th metatarsal fracture?

Trauma to your foot causes a fifth metatarsal fracture. This trauma may result from:

• A blow to your foot.
• High arches, resulting in excess pressure on the outside of your foot.
• Repetitive overuse.
• Rolling your ankle and foot inward (inversion injury).
• Twisting or rotating your foot due to an accident or sports injury.

What are the symptoms of a 5th metatarsal fracture?

If you have a fifth metatarsal fracture, you may experience trouble walking. You may also have the following symptoms on the outside of your foot:

• Bruising.
• Pain or discomfort.
• Swelling.
• Tenderness.

How is a 5th metatarsal fracture diagnosed?

Your healthcare provider will ask about when and where the pain started. Your provider will also press gently on your foot to find the location of the pain. They may also request some imaging tests:

• X-ray: This test shows the location of your fracture. Jones fractures sometimes don’t show up on X-rays.
• CT (computed tomography) scan or magnetic resonance imaging (MRI): If your provider suspects a Jones fracture, they may order one of these tests to see your injury in more detail.

How is a 5th metatarsal fracture treated?

Treatment for a fifth metatarsal fracture depends on whether the broken bones have moved out of place. Treatment also depends on your:

• Activity level.
• Age.
• Overall health.

Treatments for fifth metatarsal fractures include:

Immobilization: If your bones are in place (aligned), your provider may suggest immobilization. This is usually the only treatment necessary for zone 1 (avulsion). Providers may also treat zone 2 (Jones) fractures with immobilization as a first step.

During this treatment, you keep your foot stabilized in a cast, boot or stiff-soled shoe while your injury heals. You may also need to use crutches. Immobilization usually lasts from six to eight weeks.

Surgery: If your bones are out of place (displaced) more than 3 mm or if you’re an elite athlete, your provider may recommend surgery. Providers often recommend surgery for zone 2 (Jones) fractures when nonsurgical treatment doesn’t work. It is also often suggested for zone 3 (mid-shaft or dancer’s) fractures.

In this procedure, a foot and ankle surgeon will place a pin, screw, rod or plate into your foot to keep the bone in place. The insertion will stay in place after your bone heals.

Some cases require your surgeon to remove damaged bone around the fracture and replace it with a bone graft. They may also use a bone healing stimulator, which sends an electrical current to stimulate healing.

Are there complications/side effects of treatment?

Complications of treatment vary from person to person. The most common complications include:

• Blood clots.
• Damage to blood vessels or nerves.
• Excessive bleeding.
• Infection.
• Muscle atrophy.
• Nonunion/Malunion.
• Pain.

How do I take care of myself and manage symptoms?

You can improve your recovery time by:

• Elevating your foot while seated.
• Icing your foot for 20 minutes a day as needed, after your injury and before treatment.
• Keeping weight off your foot for the time recommended by your provider.
• Quitting smoking and/or using tobacco products which can help speed your healing time.
• Taking ibuprofen or naproxen the first 24 hours after your treatment to manage pain. Talk to your provider about the best medication for you.

How can I reduce my risk of a 5th metatarsal fracture?

You can reduce your risk of a fifth metatarsal fracture by maintaining a healthy weight and managing diabetes if you have it. People with diabetes and obesity are at higher risk for complications associated with metatarsal fractures.

What can I expect if I have a fifth metatarsal fracture?

If providers treat your fracture with immobilization, you can expect to heal in six to eight weeks. Recovery from fifth metatarsal fracture surgery usually takes up to seven weeks. You’ll need to keep weight off your foot for at least six weeks.

You can typically return to your regular activities, including sports, three to four months after surgery or immobilization. Your provider may recommend physical therapy to help restore mobility in your foot.

When should I see my healthcare provider?

See your provider if you develop a fever or have any of the following symptoms in your foot or leg:

• Increased pain.
• Increased swelling.
• Numbness or tingling.
• Skin turning purple.

A note from Cleveland Clinic

Fifth metatarsal fractures are very common. After your provider treats your broken bone, you can take care of yourself by resting your foot and keeping it elevated when you’re sitting. You can generally return to your regular activities several months after your treatment.