Fifth Metatarsal Fracture

Written By: Chloe Wilson BSc(Hons) Physiotherapy
Reviewed By: FPE Medical Review Board

What Is The Fifth Metatarsal?

The fifth metatarsal is one of the five long bones in the middle of the foot. It is located on the outer edge of the foot, running between the cuboid bone in the midfoot and the base of the little toe.

The fifth metatarsal serves as an essential structural component for balance and mobility, playing a key role in weight-bearing and providing support during walking, running, and jumping.

Structurally, the fifth metatarsal can be divided into three main parts and fractures can occur in any of these locations:

Types Of Fifth Metatarsal Fractures

There are a number of different types of fifth metatarsal fracture depending on whereabouts the break occurs:

1. Avulsion Fracture

2. Jones Fracture

3. Dancer's Fracture

4. Stress Fractures

Metatarsal stress fractures are small cracks, usually in the shaft, neck or zone 3 of the base of the fifth metatarsal, from repetitive stress and overloading.

Also know as March Fractures, symptoms of stress fractures usually develop gradually and get progressively worse. You can find out loads more in the foot stress fractures section.

5. Head Or Neck Fractures

Fractures of the head or neck of the fifth metatarsal are usually caused by low-impact injuries such as stubbing your little toe. Fifth metatarsal head and neck fractures are often unstable and require surgery.

What Causes Fifth Metatarsal Fractures?

The most common causes of a fifth metatarsal fracture are:

• Twisting Injuries: Twisting or rolling the foot inwards (inversion) is the most frequent cause of fifth metatarsal fractures. This type of injury is often seen in activities where the foot suddenly turns, such as stepping awkwardly, pivoting, or landing incorrectly from a jump. Twisting injuries typically causes fractures in the base or shaft of the fifth metatarsal
  
  
• Trauma or Direct Impact: A sudden blow or impact to the outer side of the foot can cause a fracture of the fifth metatarsal. Examples include dropping a heavy object on to the foot, being stepped on, or a direct hit during contact sports like soccer or rugby.
  
  
• Overuse and Stress: Repetitive stress on the foot from activities like running, dancing, or hiking can lead to fifth metatarsal stress fractures. These fractures develop gradually over time as the bone becomes fatigued and unable to repair itself from repetitive forces.
  
  
• High-Impact Sports or Activities: Sports that involve jumping, rapid changes in direction, or intense physical activity increase the risk of fifth metatarsal fractures due to the high forces placed on the outer edge of the foot. Activities like basketball, football, and gymnastics are common culprits.
  
  
• Poor Footwear: Wearing shoes without proper support, especially during high-impact activities, can increase the risk of fractures. For instance, unsupportive footwear can lead to poor foot alignment and increased strain on the fifth metatarsal.
  
  
• Weakened Bones: Conditions like osteoporosis or other bone-weakening disorders can make the fifth metatarsal more susceptible to fractures, even with minor trauma or stress.
  
  
• Avulsion Injuries: Avulsion fractures occur when a tendon or ligament, typically peroneus brevis tendon, pulls on the base of the fifth metatarsal with excessive force, detaching a small piece of bone. This often happens during an ankle sprain, where the foot twists sharply inwards.

Diagnosing Fifth Metatarsal Fractures

Fifth metatarsal fracture diagnosis involves a thorough evaluation by a healthcare professional, including a physical examination and imaging tests. Accurate diagnosis is crucial to identify the type and severity of the fracture and to guide appropriate treatment.

Medical History

Your doctor will begin by asking about your injury, including how it occurred, the symptoms experienced, and any previous foot injuries or conditions. They may also ask about your activity levels and any recent changes, as repetitive stress or overuse can sometimes lead to a broken fifth metatarsal.

Physical Examination

A physical examination of the foot is performed to check for swelling, bruising, tenderness, and deformities along the outer edge of the foot. They may also assess the range of motion and look for signs of instability or alignment issues. Pain when pressing on specific areas, such as the base of the fifth metatarsal, can help pinpoint the location of the fracture.

Imaging Tests

If your doctor suspects a fifth metatarsal fracture they will send you for imaging studies to confirm the location and severity of the break.

• X-rays: X-rays are the most common and reliable imaging tool for diagnosing a broken fifth metatarsal. They can reveal the location, type (e.g. avulsion, Jones, or stress fracture), and extent of the break, as well as any displacement of the bone fragments.
• MRI or CT Scans: In some cases, especially if the fracture is small or difficult to detect on an X-ray, an MRI or CT scan may be ordered. These advanced imaging techniques provide more detailed views of the bone and surrounding soft tissues, helping to confirm the diagnosis.

Differentiating Fracture Types

Distinguishing between the different types of fifth metatarsal fracture is essential for treatment. For example, a Jones fracture occurs in an area with poor blood supply, requiring more aggressive management, while an avulsion fracture near the base often heals more easily.

By combining a detailed clinical assessment with imaging tests, healthcare providers can accurately diagnose a fracture of the fifth metatarsal and develop an effective treatment plan. Early diagnosis is key to ensuring proper healing and preventing complications.

Fifth Metatarsal Bone Fracture Treatment

Treatment for a fifth metatarsal fracture depends on the type, location, and severity of the fracture, as well as your activity levels and overall health. Options range from conservative approaches for less severe fractures to surgical intervention for complex or poorly healing injuries.

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1. Conservative Treatment

Many fifth metatarsal fractures can be treated without surgery, especially if the fracture is non-displaced or involves minimal bone separation. Non-surgical treatment for a fracture of the fifth metatarsal includes:

• Rest and Immobilization: Resting the foot and avoiding weight-bearing activities is crucial for healing. Immobilization with a cast or walking boot helps stabilize the fracture and protect it during the recovery period. The duration of immobilization typically ranges from 4 to 8 weeks, depending on the type and severity of the fracture.
  
  
• Elevation and Ice: Keeping the foot elevated e.g. on a leg elevation cushion, and regularly applying an ice pack for 15-20 minutes can reduce swelling and pain, particularly in the first few days after the injury.
  
  
• Pain Management: Over-the-counter pain relievers, such as acetaminophen/paracetamol or ibuprofen, may be recommended to manage discomfort and reduce inflammation.
  
  
• Physical Therapy: After the fracture heals, physical therapy is usually recommended to restore strength, range of motion, and balance in the foot.

2. Surgical Treatment

Surgery is often required for certain types of fifth metatarsal fractures, such as:

• Displaced Fractures: When bone fragments are misaligned.
• Jones Fractures: Due to poor blood supply in this area, these fractures have a higher risk of delayed healing or non-union.
• Complex Fractures: Including comminuted fractures (multiple fragments) or fractures involving joint surfaces.

Surgical options include:

• Open Reduction and Internal Fixation (ORIF): The surgeon realigns the bone fragments and secures them with screws, plates, or wires to promote proper healing. This technique is commonly used for Jones fractures and displaced shaft fractures. Internal fixation is the most common type of fifth metatarsal fracture surgery
  
  
• Bone Grafting: In cases of delayed healing, a bone graft may be used to stimulate bone growth and ensure stability.

3. Weight-Bearing & Rehabilitation

Once the bone begins to heal, you may transition to progressive weight-bearing activities under the guidance of your doctor, gradually taking more weight through the affected foot.

Fifth Metatarsal Fracture Recovery Time

The recovery time for a fifth metatarsal fracture varies depending on the type and severity of the fracture, the treatment method, and individual factors like age, overall health, and activity level. On average, recovery can take anywhere from 6 weeks to several months.

1. Simple Fracture Recovery

Non-displaced fifth metatarsal fractures, such as pseudo jones fractures or minor shaft fractures, typically heal faster as they have a good blood supply, so they rarely require surgery.

With immobilization in a cast or walking boot, fracture healing usually occurs within 6–8 weeks. During this time, weight-bearing may be limited or gradually increased, depending on the doctor’s advice. Full activity is often resumed by 8–10 weeks.

2. Jones Fracture Recovery

Jones fractures, which occur in an area with poor blood supply, generally take longer to heal. Without surgery, these fractures may require 8–12 weeks of immobilization, with weight-bearing restricted for much of this period.

Surgery is usually recommended with Jones fractures due to the high risk of non-union. If surgery is performed, healing is often faster, but you can still expect at least 10–12 weeks before returning to full activity, depending on how the bone heals.

3. Complex Fracture Recovery

Fractures requiring surgical intervention, such as open reduction and internal fixation (ORIF), may have a longer recovery time. Bone healing typically takes around 12 weeks, followed by several weeks or months of rehabilitation.

Recovery timelines can extend to 4–6 months for severe or comminuted fifth metatarsal fractures, especially if complications like delayed healing occur.

4. Stress Fracture Recovery

Stress fractures of the fifth metatarsal may heal within 6–8 weeks, provided you rest and avoid high-impact activities. Prolonged or untreated stress fractures may take significantly longer to recover.

Key Factors Influencing Recovery

Most people make a good recovery from a fifth metatarsal fracture but there are a few things that can impact recovery:

• Blood Supply: Fractures in areas with limited blood supply, like Jones fractures, take longer to heal.
• Adherence to Treatment: Following medical advice, avoiding premature weight-bearing, and attending rehabilitation sessions can significantly improve recovery time.
• Complications: Delayed union, non-union, or re-injury will prolong recovery.

After the bone has healed, you are likely to need several weeks of physical therapy to restore full strength, flexibility, and balance in the foot.

Athletes and individuals with high physical demands may require additional time to regain full performance after a fifth metatarsal fracture.

Most people can return to light activities within 2–3 months following a broken fifth metatarsal, while more strenuous activities, like running or sports, may take up to 4–6 months, depending on the fracture type and treatment. Regular follow-ups with your healthcare provider are essential to ensure proper healing and prevent complications.

Fifth Metatarsal Fracture Summary

Fifth metatarsal fractures are a common injury of the foot, accounting for around 5-6% of all fractures in the United States.

There are lots of different types of fracture of the fifth metatarsal depending on the location and type of break.

• Avulsion fractures are the most common type of fifth metatarsal fracture, where a small piece of bone is pulled off the metatarsal base.
• Jones fractures are considered the most serious type of fifth metatarsal fracture as they are the slowest to heal with the highest complication rate.
• Dancers fractures are spiral fractures that occur in the middle part of the metatarsal bone, typically from twisting injuries or landing awkwardly.
• Stress Fractures are caused by repetitive overloading and strain through the fifth metatarsal which causes small cracks to form gradually in the bone.

Treatment for a broken fifth metatarsal will depend on the location and severity of the fracture. Many can be treated conservatively with a combination of rest and reduced weight-bearing in a cast or boot, but more complex fractures or those in zone 2 often require surgery.

Rehabilitation is essential whether or not you have surgery to regain full strength, mobility and stability in your foot or ankle.

Fifth metatarsal fractures are just one possible cause of pain on the outer side of the foot, you can find out about the other causes in the Outer Foot Pain section.

You may also be interested in the following articles:

• Top Of Foot Pain
• Lump On Side Of Foot
• Foot Pain Walking
• How To Reduce Foot Swelling

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Page Last Updated: 9th December, 2024
Next Review Due: 9th December, 2026