What Is a Fracture of the Fifth Metatarsal?

Fractures in the foot are relatively common, particularly involving the fifth metatarsal—the outermost bone that connects the little toe to the rest of the foot. The fifth metatarsal’s placement makes it more vulnerable than other foot bones to external threats, and its length and thinness make it susceptible to damage even from routine stress.

What Are the Most Common Types?

The three most common types of fifth-metatarsal fracture are mid-shaft fractures, Jones fractures, and avulsion fractures.

Mid-shaft fractures occur in the narrowest part of the fifth metatarsal, towards its middle. These almost always stress fractures, which begin as a weakening of the bone’s surface and progress into tiny breaks through some or all of the bone. Because they begin as minor injuries in response to known stresses, mid-shaft fractures are often ignored or misdiagnosed until they become serious.

Jones fractures occur a bit farther back on the fifth metatarsal, toward the ankle. They can be either stress fractures or acute fractures caused by external impact. This part of the fifth metatarsal receives less blood than other areas, making Jones fractures especially slow to heal.

Avulsion fractures affect the base of the fifth metatarsal, near its connection with the back of the foot. It usually appears in conjunction with ankle injuries, which can make it hard to diagnose. When the ankle is sprained, for instance after rolling it, a small piece of bone at the back of the fifth metatarsal is sometimes broken off by the attached muscle or tendon and dislodged.

What Are the Symptoms of a Fracture of the Fifth Metatarsal?

Most fifth-metatarsal fractures exhibit the same symptoms. These include pain and swelling, with attendant difficulty in walking. Discolouration may also appear, though bruising does not always accompany fractures of the fifth metatarsal the way it tends to with fractures of larger bones.

Surgeons who specialize in problems of the foot and ankle are best equipped to make a proper diagnosis. Because fractures of the fifth metatarsal can easily be confused with other injuries, doctors will usually start a consultation by asking for details about how and when symptoms began to appear before examining the foot directly. If a fracture is suspected, x-rays will confirm the possibility or rule it out.

How Are Fractures of the Fifth Metatarsal Treated?

As soon as the symptoms of a fracture appear, patients should treat it with the age-old RICE method:

Rest the foot, avoiding all unnecessary activity
Ice the affected area for 20 minutes, remove the ice for 40 minutes and repeat
Compress the injury using an Ace bandage or elastic wrap
Elevate the foot above heart level to control swelling

If a fracture is confirmed, the doctor may recommend continuing the RICE approach while other options are considered.

Nonsurgical treatments for fractures of the fifth metatarsal include immobilization in a cast or walking boot, and/or stimulation of the area using an external device. Stimulation is especially useful for Jones fractures, which are less apt to heal naturally.

A wide variety of surgical options are available for more serious fractures involving multiple breaks or bone displacement. Surgery may also be a last resort for fractures that do not respond to less invasive measures.