Stay on Your Toes: Treating a Fifth Metatarsal Fracture

The fifth metatarsal is a bone that extends from the cuboid bone near the ankle to the base of the little toe. Run your hand along the outside of your foot, and you will feel a bump or tuberosity on the fifth metatarsal. This bump and the area just in front of it are prone to injury. Fractures of the fifth metatarsal are common in dancers and in sports where athletes pivot forcefully. They can be difficult to heal because the blood supply is poor in the region where the fractures occur.

There are three main types of fifth metatarsal fractures: avulsion fracture, Jones fracture and stress fracture.

  • In an avulsion fracture, a chip of bone is pulled off when the tendon attached to the metatarsal is overstressed. Avulsion fractures usually occur when the ankle rolls inward. They cause pain, swelling and bruising along the outside edge of the foot, especially in the area where the bone bumps out. Avulsion fractures are treated with immobilization and stiff boots or a weight-bearing cast. Healing usually takes six to eight weeks.
  • A Jones fracture is a sudden fracture three-quarters of an inch (1 cm) beyond (proximal to) the metatarsal. Jones fractures often occur when the toe is pointed down, the heel is off the ground and pressure is applied to the outside of the ankle. Symptoms are similar to an avulsion fracture. Jones fractures are treated with a non-weight-bearing cast for six to eight weeks, followed by physical therapy. We can help you learn to use crutches during the non-weight-bearing phase.
  • A stress fracture develops over time from the repeated application of force (produced by jumping or running, for instance), overuse or weakening of bone caused by osteoporosis. Low-grade pain and swelling are often present for weeks before a diagnosis is made. Stress fractures are difficult to heal. They may be treated like a Jones fracture with a non-weight-bearing cast for up to 20 weeks, or they may require surgery. During the healing period, he patient may maintain fitness by cycling, aqua-running or resistance training on equipment that does not involve the affected area. Physical therapy is always needed after the stress fracture has healed.

A fracture of the fifth metatarsal is a common and disabling injury. After your fracture has healed and the cast has been removed, we can work with you and you physician to design a program to safely restore strength and flexibility to your ankle.