5th Metatarsal Fractures

Fractures are common in the fifth metatarsal and normally occur with sporting activities. The metatarsal bones are a group of 5 long bones in the foot. The fifth metatarsal is located on the little toe side (lateral side) of the foot and connects to the little toe. Strong ligaments attach the base of the fifth metatarsal to the cuboid bone and the fourth metatarsal bone. Because of these strong ligament attachments, it is easier for an individual to fracture the fifth metatarsal than to dislocate it.

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source: emedx.com
A fifth metatarsal fracture can occur in several ways and break in several places. There are 2 types of fractures that often occur in the fifth metatarsal:

  • Avulsion fracture
  • Jones fracture

A fifth metatarsal fracture is diagnosed by an x-ray showing a break in the bone. Because a Jones fracture may not show up on initial x-rays, additional imaging studies may be required.

Avulsion Fracture

In an avulsion fracture, a small piece of bone is pulled off the main portion of the bone by a tendon or ligament. This can occur after forced inversion or rolling in of the foot and ankle. Patient with an avulsion fracture experiences tenderness at the base of the fifth metatarsal, often with brusing and swelling at the site.

Treatment of non-displaced avulsion fractures is conservative. Options include elastic bandaging, low-profile walking boots or casts for 4 to 6 weeks. Weight bearing is allowed as tolerated.

However, for displaced avulsion fractures, they are best managed by either open reduction and internal fixation or closed reduction and pinning.

Jones Fracture

Jones fracture was first described by Sir Robert Jones when he fractured his fifth metatarsal in 1902 while dancing around a Maypole at a military garden party. Jones fracture involves a fracture at the base of the fifth metatarsal at the metaphyseal-diaphyseal junction, located 1.5cm distal to the tuberosity of the 5th metatarsal. It can either be a stress fracture (a tiny hairline break that occurs over time) or an acute (sudden) break.

Patients normally present with sudden pain at the base of the fifth metatarsal, with difficulty bearing weight on the foot. Bruising and/ or swelling are often present at the site. The mechanism of the injury is described as a laterally directed force on the forefoot during plantar flexion of the ankle.

Jones fracture is a difficult fracture to get to heal due to limited blood supply to that area and often surgery is required. If surgery is not performed, then a short leg cast can be worn for 6 to eight weeks in nonweight-bearing with progressive ambulation after cast removal. It can take 8 to 10 weeks for this fracture to heal and is not always predictable whether or not full healing will occur. Studies have shown about 70% heal with cast treatment.

On the other hand, sugery for Jones fracture has about 95% success rate. In competitive athletes, these fractures are usually treated surgically. Surgery may include placing an intramedullary screw into the bone’s shaft to stabilize the fractured bone, and hold it securely in place while healing occurs. This internal fixation technique allows healing to occur quite rapidly and walking on the foot with a removable boot is allowed within a few days after surgery. Typically, bike exercise can be commenced at about four weeks. Patients may return to running approximately six weeks post-surgery. – CT

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Comments

  • http://shellywilliams159@msn.com christopher hogg

    hi im going on holiday on the 30th of may and have just fractured my 5th met its a thin crack about 1/4 the way up the shaft near the bottom…ive got about 5 week for it to heal and get the cast off do you think i could be walking in 5 weeks and what can i do to speed up the healing process thankyou for any advise.

  • Cindy Tan

    Dear Christopher,

    Sorry to hear that you have fractured your 5th metatarsal. If you are going to be casted for 5 weeks, you will probably still need to use some form of walking aid such as crutches or walking stick to ambulate when the cast is removed. It will take a few weeks after cast removal before you can weight bear fully on your affected foot.

    Meanwhile, you could do some strengthening exercises for your upper body, hips and knees to prevent weakening in these areas. This will help speed up your recovery when you start ambulating.

    Best Regards,
    The Editor

  • fotini

    Hello!!
    I've got the avulsion fracture, and this is the 5th week of boot-wearing. By the way, the boot is not very low profile, people tend to notice quite a lot! ;-)
    The point is, I am going to the hospital in a few days but my foot and toes are still a bit swollen.
    Is this normal? Is it caused by the foot enclosure or does it mean that it has not healed yet?

  • jmsgas

    hi i have the same problem but i'm still getting pain 18months after mostly if i work off landers and if i kneel down working which between the 2 is 80% of my job (self employed plumber) doctor keeps telling me to take painkillers and anti inflams but also bad at night once the weight comes off it which in turn is disturbing my sleep my consern is i started nodding off to sleep at the wheel while driving on the motor way and just can't keep going on like this can any one help me as i fightened that i may end up crashing or even worst i work on gas and due to being tied and in pain make an error and i don't what this extra stress

  • vicki

    hi i fractured my 5th metatarsal 2 weeks ago and have a cast. for the most part it has been pretty pain free but today I have a very bad pain in the ankle bone and my foot feel s very swollen with pins and needles .what could be the problem?

  • Army98

    hi i fractured my 5th metatarsal 7 weeks ago and at 6 weeks had an xray done and saw no healing at all!  i ws nn weight bearing for 4 weeks per dr orders then to weight bear as tolerated then when i cam e in for my 6 week xray all excited found ut that there was n healing yet.  very discuraging very!  i have been using crutches this whole time and had to withdraw from school! i have also felt pins and needles when i had a fiber glass cast on but it didnt last lng it was abut 1 to 3 weeks in, then it left.  i see a phys therapist 3x a week and he has managed with gods help to minimize my swelling however we are baffled at how there is no bone growth, im nt that young am 34 yet usually pretty healthy?  i pray alot and i believe that helps i do.

  • Geminiseven

    i broke my 5th metetarsal 7 weeks ago and was told to only put weight on heel when pain allows.  its in a fibre glass cast and is stil very painful, shud i try to weight bear or not???  all very confusing and is driving me nuts!!

  • vanessa

    i broke my 5th metetarsal 7 weeks ago and was told to only put weight on
    heel when pain allows.  its in a fibre glass cast and is stil very
    painful, shud i try to weight bear or not???  all very confusing and is
    driving me nuts!! also it hasnt been rexrayed since i 1st did it is that normal?

  • Dr_sameermalik

    just read on your condition.     i will suggest a couple of blood tests for uric acid and 25 HYDROXY vitD.          they can be responsible for lack of recovery..   i would suggest calcuium supplimentation and an injection of vit D..           they will help you recover                                         regards. dr sameer

  • Jazzygirl

    i broke my 5th metatarsal bone in august and little by little it felt like it was starting to get better i still had pain but only if i would walk on it too much but I have been doing my normal activites and im not really on it alot and it started hurting really bad i dnt know if the winter cold has anything to due with it but when i tippytoe to reach something or if i squat to pick something up theres so much pain. and they said i didnt need surgery because it was a hairline fracture it broke in place and its really annoying i basically cant do anything. im so mad because i feel like its gonna b a problem like it happend like four months ago and they said i should b ok now? but then all the pain came bak again??? the physhical therapy sucked it didnt help at all/. any suggestions?? thank u!

  • Jan

    Hi, I broke my 5th metatarsal 9 days ago. I walked on it for nearly 3 days before I knew it was fractured. Its is non-displaced hairline fracture. I’m worried that I may have displaced it by walking on it for 3 days before xray and casting? They put me in a half cast, back and sole of the foot. I changed it to a cam boot fitted by a physio. I use the boot to get around, but mostly am resting my foot. I use the cast at night. I still have pain in my foot, is this normal? Are these boots really non-weight bearing? I am mostly just walking on the heel of the boot. I’m going overseas in 6 weeks, will I be okay to walk normally by then?

  • Roxy

    I fractured my 5th metatarsal and was told I needed surgery for repair.  How long is it safe to wait before having this surgery done?

  • Choldie

    Hi Vanessa’  have had mine in a cast for seven weeks with increase in weight bearing from week one to seven,but only to 50% WB.I have the cast removed next week, and have been told by the surgeon that at that stage the bone should be at the halfway stage of healing.I still experience a fair bit of pain when I only lightly weight bear.I will get xray’s two day’s before the apptm.

  • Jlchadrick

    What if the fracture is at the top (near the toe)?  I keep reading about things involving the BASE of the metatarsal.  Is there anything out there about the other end?  haha!  Thanks!

  • Anonymous

    I had mine broken – Jones Fracture by a heavy object falling on my foot. This happened 09/15/2011, x-ray showed the break. 11/17/2011 another visit and another x-ray still showed the break, but now more pronounced and no sign of healing. ANOTHER visit 01/03/2012 and ANOTHER x-ray shows an even larger fracture and still no healing. BUT this “doctor” says there is “small” signs of “healing” I didn’t see it on the x-ray and they have scheduled ANOTHER visit for 03/23/2012.
    Granted I am in no hurry to get cut into by surgery; and YES I am not a doctor; BUT I am of a mind that putting that screw would “fix” the fracture and promote healing finally?
    Taking the time involved SIX MONTHS including the pending visit.
    My employer has been open minded about this; BUT they are starting to question my ability to do my job.. I have been on “lite Duty” since 09/15/2011.
    I have asked this Doctor about the surgery and they are against it.
    I asked about that bone stimulator and they stated it is very expensive equipment and ignored it further and not answered any additional questions.
    They have also seen where the break is a lump on the side of my right foot.
    There is also semi numbness as well of the skin in that area.
    This is the SECOND Doctor.
    Same stupid HMO though…
    I don’t have the money to go to a “private” orthopedic Doctor; I spent all my money on this HMO in medical premiums.
    I am not an elderly person and “used” to have a very active life style until this happened.
    I have been gimping around on crutches in a air cast since this started.
    Is there anything I can do to light a fire under this “doctors” butt and get them to do their job?

  • Trashacres

    I broke my 5th metatarsal 6 weeks ago and was told after one week to use a moon boot or normal shoes as pain allows. I did this and wore normal shoes but still had a bit of pain. I started walking a couple of kilometers a day last week and started getting pain. I got an X-ray done this week which showed that it hasn’t healed. I am back in the moon boot and will see the fracture clinic next week. My question for this forum is should I use a crutch to walk with till I see the fracture clinic or is weight bearing ok? Am off to a fairday on Sunday and will be on my feet all day so planning ahead.

  • Brandonlublin

    I broke my 5th metatarsal on the 21st of december and was put in a clay cast until the 31st of january. there was a sufficient amount of healing but still not enough to go without a cast. I am a full time student and i use a scooter to get around but usually have to hop up stairs, etc. If i rest on my heel when im standing or take a few steps with putting weight on ONLY my heel, is there a strong chance that it will digress the healing process? 
     I am NWB (as much as my right leg can stand alone, that is).  Im taking vitamin d and calcium pills and i have a radiation device i use 2 times a day for 30 minutes. Im going in again on march 6th to HOPEFULLY get my cast off for good. all things considered, would anyone say that my bone should be healed by then? or is standing on the heel going to slow the healing process to much?

  • Guero_arroyo

    Ihave a fracture one as well ive wore it for 5 weeks now> my options are surgery but i dont know how long it would take for it to be heeled?

  • Asim Iqbal

    I broke my 5th metatarsal.. avulsion frcture. this is the 5th week running.. i went to the doc after first 2 weeks and then 4 weeks… it never  healed… on my second visit with was 4 weeks after the injury… he said he will remove the cast after 2 weeks… it 1 week left for that now.. and i have started developing a needle pin pain on my fracture site… only in the morning when it is cold… otherwise the entire day it is ok… no worries… dont know wat to expect

  • Finally Healing

    I broke my 5th metatrsal almost 5 months ago.  I walked on it for a month thinking it was just badly sprained.  I went to the dr and had xrays the day before Thanksgiving when it was diagnosed as broken.  I was given a short cam boot.  After 4 weeks I had another xray and it had not healed at all.  I asked to go to a specialist and went about the middle of January.  She put me in a knee high cam boot and ordered a bone stimulator.  I went yesterday (5 weeks since getting the bone stimulator and a lot of healing had begun.  Where the bones were completely separated before, they now had grown back together about halfway.  I am thrilled.  Will be wearing the boot for couple  more weeks, then told to try walking without it at home.  I will continue using the bone stimulator another month or two past that.  The bone stimulators work!!

  • Kat

    Jan 1, 2012 stepped on a a stool tipping it falling on side of my right foot. Walked on it for three weeks teaching. Swelling, bruising went away almost completely in three weeks. Still had pain..x-ray showed Jones fracture. Jan 20th went into a cast being told it could take 3-6 months to heal. I am a 59 non-smoking female. A friend loaned me an Electromagnetic simulator. I’ve been wearing it 10 hours a day or night and using a scooter to teach. First appointment, Feb 28th it looked so good they took me out of the cast and into a removable pump up boot, still no weight bearing…hoping March 27 I’m done….Electromagnetic simulators are  3-5 thousand dollars..I happen to talk to someone that just had (8mts) trouble healing a bone, worked for govt so she split the cost and it worked for her so she lent it to me….WELL worth renting to help right off on a Jones fracture….really seems to help blood flow….who knew!!!

  • Love_bird_2005

    i broke my 5 metatarsals like the second week of feb and i had a cast on four two weeks and i had a xray the xray said that the bone split father apart so im in a walking boot and said no baring weight and i go back monday he said if it no better monday i goin to have surgury

  • Anonymous

    hi i broke my arm  a week ago and had a half cast put on because of all the swelling. i am not having the cast off untill a  weeks time. but im a bit worried as the cast has started to become loose and i am still getting pins and needles everyday. also the tips of my finger nails are white, and which i thought they was ment to be pink. im a bit worried on what to do. can any1 help please  

  • mer adame

    I broke my metatarsal bones all but my pinky so 1 to 4 in a fall it is very painful and because of my crappy insurance I haven’t had surgery or a cast put on but I have a soft wrap with a fiber glass splint, I’m actually really scared to have surgery, the dr. Said I might have to but he’s not to sure because he’s was not a ortho doctor hes a er doctor I have yet to see a ortho doctor, the bones are broken starigh across from what I could see in my xrays, does it sound like I would need surgery?

  • mark

    I broke my 5th met. about 8 weeks ago.had a x ray at 6 weeks ,the doc said it1s 85%  healed .This last week feels like it`s not healing ! pins and needles where i had the fracture see doc tomorrow should i be worried ? or is that the feeling when it`s healing ?

  • Nan

    HELP!! Hi Now 10 wks since I fx my 5th tarsal (jones fx) and todays dr visits showed min healing! Now Dx w/Non-Union fx. In addition to Sesamoiditis caused by the splint’s raised hard edge pressing up on the 1st tarsal sesamoids. (Dr chose not to cast) I’m still in a splint! I’m a heathy 50 yr Female. Athlectic, non smoker, no drugs. Not even meds.
    Dr once again sentenced me to another 4-5 additional wks of non bearing NO Walking wt on it. There is “Again, NO Guarentee recovery after this time period.
    With a 70% chance of Non Union dx with this type of Fx and 95% recovery post surg. why would a dr chose to hold off on surg? Now I’m told to wait (as I said) an add’l 4-5 wks, though this time with  “bone stimulator” treatments. My question is; What are the chances I will heal in 4-5 wks with a bone stimulator? What time frame am I realisticly looking at?
    VS.. . Should I just request surgery, with the 95% recovery within 4 wks?
    I am frustrated, broke at this point and need to get back to work!! BTW, I’m a former nurse, currently physical therapist. PLEASE ADVISE :)

  • Teddybear38

    I have the same thing. Dr said he did not want to put a cast on it becuse it does nothing. Sent me to work no restrictions. Told me i need to be walking on it. Now my fthurts worse and u can barelt touch it. Dr will not listen to me. I was wondering if i should find a different dr.

  • Rooftile

    i wasn’t paying attention so fell down the stairs at home, twisting my left ankle badly and breaking my fifth metatarsal. I’ve never hurt so much! I’m a little less than 60 and not exactly an athlete so didn’t know what to expect.
    My leg was bound up in a plaster cast, heel weight bearing allowed after the first few days and crutches provided. Xray at just under four weeks showed hard callous now formed. Foot looked like something from the mummy’s cave when cast removed but with time, exercise and patience it regained it’s shape and colour.The colourful bruises disappeared and the swelling subsided. 6 months from the injury, a few twinges but i danced for three hours at a party last night, and it isn’t complaining today. So please take heart, The thing is to take it seriously, eat properly, rest a lot, don’t try and rush the healing and then exercise with stretches and ankle circles when you can.

  • Louis101

    Hi I have just had my cast taken off after 4 weeks (I broke my faith metatarsal) and I’m getting pain there and I have this lumb where the break was… My doctor said that it should be healed but even with the boot and cast on I was still getting pain I have a appointment in 3 weeks but I have been getting frequent pain there ,.. What should I do

  • florence

    the lump is the sign of the bone healing; it’s the ‘hard callus’ that the bone first makes when it joins up, before it reshapes. That’s good news. It will hurt for quite some time but it will get better. Mine did and I’m nearly 60.

  • hollanda

    Hi i broke my 5th metatarsal 6 weeks ago now after falling off a step i was put into a cast for 6weeks and recently returned to fracture clinic hoping to have cast removed. I was frustrated as the doctors ere very busy with another patient and was left waiting for results of xray , the doctor just told me to remove the cut cast and walk up and down in the room and he went off , it did not hurt me but i felt unsafe when i truned the foot when the doctor returned he looked at the two xrays and asked how it felt i asked if the first xray was when i actually first did the injury as the other looked better he said that no it was the xray that they had just done and the facture was more open than last xray ! he said that people can still walk about even if it has not healed just to be very careful ! he left the room again and when he returned he brought up all my xrays which was clear that the break had spread wider he then said that i was to go into anotber cast for a further 6weeks . i was very upset as earlier he was saying that i would manage and nearly left on his words! at one point him coming and going he asked me to make the decision that last thing i wanted was to remain in cast but looking at the xrays was a concern that it may have done futher damage if i had not questioned the xray , i am hoping that the bone heals and wondered if there are people who have had this injury that have not and have managed a normal life also what are the outcomes if bone does not heal.

  • Steph

    I broke my fifth metatarsal two weeks ago while I was running and 3 days after I broke it I went my doctor and he sent me for immediate xrays and when he got them back that same day like an hour later and he told me I fractured my fifth metatarsal. The next day he sent me to an orthopedic doctor who put me in an aircast short boot and told me I would be in it for 8-12 weeks with no jumping or running during those weeks. Im also weight bearing in the boot only.

  • Taha Shaikh

    hi all i broke my 5th matatasul bone from base around 3 weeks ago was put in a cast after 3 weeks dr removed the cast even in X-ray it was showing that my bone is still broken
    now i am into my 4th week but i cant walk due to pain in my ankle and sweling
    SO sugest me what to do ? can i put my cast back or is it ok to walk and bone will heal ??

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