In this section Cypress Foot and Ankle Expert Dr. Christopher Correa discusses Fifth Metatarsal Base Fractures. The 5th metatarsal is a long bone that is located in the lateral (outside) of the foot that connects to the pinky toe. The base of the 5th metatarsal normally is a palpable lump on the outside of the foot. While this lump on the side of the foot is larger in some people and smaller in others, it is absolutely a normal part of your anatomy and is completely normal to be able to feel it (I get this question once a week). A 5th metatarsal base fracture refers to a break or fracture that occurs at the base of the fifth metatarsal bone. These fractures typically occur with a twisting of the foot in a very similar motion that may happen during an ankle sprain (rolled ankle). Classic examples are stepping off of a curb or downstairs causing a twisting of the foot.
There are three types of 5th metatarsal base fractures, including:
Avulsion fracture: This type of fracture occurs when a small piece of bone is pulled off from the base of the fifth metatarsal due to the forceful pull of the peroneus brevis tendon, which is one of the tendons that attach to this area. These fractures usually heal very well with appropriate treatment.
Jones fracture: This type of fracture occurs in the metaphyseal-diaphyseal junction of the fifth metatarsal, which is a relatively narrow and vulnerable area with poor blood supply. Jones fractures are typically caused by direct trauma or repetitive stress, and they are often associated with a higher risk of non-union (the bone not healing properly) due to the limited blood supply in the area. Because of this Jones fractures need to be identified early and treated by a medical professional for the best outcome. These fractures tend to occur in the “watershed” area of the bone which is approximately 1.5 – 3cm distal to the proximal base of the bone.
Stress fracture: This type of fracture is a hairline crack that occurs due to repetitive stress on the bone, often from overuse or repetitive impact activities.
The way in which 5th metatarsal base fractures and Jones fractures occur is very similar and usually cannot be determined by physical example alone. The only way to know the difference between these types of fractures is to have a physician x ray and evaluate your foot.
The symptoms of a 5th metatarsal base fracture can vary depending on the type, location, and severity of the fracture, as well as individual patient factors. However, common symptoms may include:
Pain: Pain is a typical symptom of a 5th metatarsal base fracture. The pain may be sharp, localized to the outer side of the foot, and aggravated by weight-bearing or movement.
Swelling: Swelling around the base of the fifth metatarsal may be present, and the area may appear visibly swollen and feel tender to touch.
Bruising: Bruising (ecchymosis) may occur around the site of the fracture, and the skin may appear discolored.
Difficulty bearing weight: Walking or bearing weight on the affected foot may be difficult or painful due to the fracture.
Deformity: In some cases, there may be a visible deformity or abnormal alignment of the fifth metatarsal bone, depending on the type and severity of the fracture.
Limited range of motion: There may be reduced range of motion of the affected foot or toes, depending on the location and extent of the fracture.
Tenderness: Tenderness may be present at the site of the fracture or over the affected metatarsal bone.
Diagnosis and Treatment of 5th Metatarsal Base Fractures
Diagnosis typically involves a physical examination, X-rays, and sometimes additional imaging studies such as MRI or CT scans to determine the type and severity of the fracture. Treatment for 5th metatarsal base fractures depends on the type, location, and severity of the fracture, as well as patient factors such as age, activity level, and overall health. 5th metatarsal base fractures tend to respond well to conservative care and only require surgical fixation in cases of delayed healing or excessive displacement. Jones fractures in generally need to be treated “more aggressively” with lower thresh holds for surgical stabilization and longer periods of non-weight bear.
Non-Surgical Treatment: Non-surgical treatment may be considered for Jones fractures with minimal or no displacement, good blood supply to the affected area, and no signs of healing problems. Non-surgical treatment may involve immobilization of the foot in a cast or a walking boot to allow for healing, protection of the foot from weight-bearing or impact activities, and possibly the use of crutches to offload the foot during walking or activities. Non-surgical treatment may be appropriate for certain stable Jones fractures or for patients who may not be suitable candidates for surgery due to various reasons, such as underlying health conditions or patient preferences.
Surgical Treatment: Surgical intervention may be considered for Jones fractures with significant displacement, poor blood supply to the affected area, or other factors that may affect healing. Surgical treatment options may include:
Internal fixation: This involves the use of screws, wires, or plates to stabilize the fractured bone and promote healing. Internal fixation may be used in cases of displaced or unstable Jones fractures, and the choice of fixation method may depend on the specific characteristics of the fracture.
Bone grafting: In some cases, a bone graft may be used along with internal fixation to promote healing, especially in cases where there is a delay in healing or poor blood supply to the affected area.
Other surgical techniques: Other surgical techniques, such as tension band wiring, intramedullary screw fixation, or other methods, may be considered depending on the specifics of the fracture and the surgeon's preference and experience.
Rehabilitation: Following non-surgical or surgical treatment, rehabilitation and physical therapy may be recommended to help restore strength, flexibility, and function to the foot and ankle. Rehabilitation may involve exercises, gait training, and other modalities to aid in the recovery process and prevent complications.
It's important to note that the treatment approach for depends entirely on what type of fracture is present. In either case compliance with the prescribed treatment plan, including follow-up appointments, weight-bearing restrictions, and rehabilitation, is crucial for successful healing and recovery. If you recently suffered a foot injury give the experts at Select Foot and Ankle Specialists a call and take the first step towards recovery today!
