Fifth Metatarsal Fractures
Fractures of the fifth metatarsal are commonly encountered foot injuries. Fortunately, though, fractures of the fifth metatarsal rarely require surgery. There are three different fracture patterns recognized by the doctors at the Foot and Ankle Surgery Department at the Santa Rosa Kaiser Permanente Medical Center. These three fractures patterns include:
- Fractures of the 5th metatarsal neck/shaft area
- Fractures of the 5th metatarsal base area – called the Jones’ fracture
- Fractures of the 5th metatarsal styloid area
Each of these different types of 5th metatarsal fracture pattern differs in terms of mechanism of injury, healing rates, and recommended treatments. Each type is addressed separately in the headings that follow.
Although 5th metatarsal fractures are typically successfully managed with non-surgical care, there are some potential risks of the fracture and the management of the fracture.
General complications of foot and ankle fractures may include:
- Failure of bone healing (delayed or non-healing of bone)
- Malalignment and deformity (malunion of bone)
- Growth disturbance (particularly with growth center injuries)
- Stiffness
- Arthritis
- Limp
- Chronic pain
- Chronic swelling
- Prolonged recovery
- Deep vein thrombosis
- Pulmonary embolism
- Compartment syndrome
- Complex regional pain syndrome (CRPS or RSD)
- Nerve injury
- Numbness
- Weakness
- Loss of muscle control
- Tendon injury or disruption of tendon function
- Circulation disturbance of soft tissues or bone (including avascular necrosis of bone)
- Gangrene
- Loss of toes, foot, or limb
- Infection
- Wound or scar problems (poor or slow healing, thick scar, sensitive scar, unsightly scar)
- Intolerance of hardware or implanted materials
- Failure or breakage of hardware or implanted materials
- Transfer of pain, fracture, or callus to new site
- Change in shoe size or inability to wear desired footwear
Also, keep in mind that there are a number of factors that can impair bone healing. It is possible for these factors to severely slow the bone healing process or even result in non-healing of your fracture:
- Smoking
- Premature weight bearing (when non-weight bearing has been recommended)
- Excess weight bearing (when weight bearing is allowed)
- Some medications (such as prednisone and anti-inflammatory medications)
- Poor circulation
- Some medical conditions
Please click here to read the Foot and Ankle Surgery Department’s comprehensive patient resource on foot and ankle fractures and their treatment.
Typically, 5th metatarsal neck/shaft fractures arise from a stubbing or bumping injury to the outside of the forefoot area.
These fractures can occasionally appear multi-fragmented. In the past, treatment with surgery or non-weight bearing cast would be often employed. That is now seldom the case. The doctors at the Foot and Ankle Surgery Department have evolved their understanding and treatment of this fracture over the years, recognizing that this fracture typically heals very well with a less restrictive approach than in the past.
Treatment:
- Removable walking cast – weight bearing allowed
(note: in some cases, the treating doctor may allow a surgical shoe instead of the removable walking cast)
Duration of above treatment:
- Typically 6-8 weeks
(note: in cases of slower bone healing, the treatment may take another 4-8 weeks)
Typical home care advice:
- Use the removable walking cast for all weight bearing activities as long as you doctor designates.
- It is OK to remove the removable walking cast for: sleep, bathing, icing.
- Ice pack the fracture area for 15-20 minutes, three times per day for at least 2-3 weeks.
- Reduce activity level, rest, and elevate the affected limb as much as possible every day – for at least 2-3 weeks.
- Avoid anti-inflammatory medications (such as ibuprofen, naproxen, aspirin, Advil, Aleve, etc.), because they can interfere with bone healing.
- If you smoke, stop – it can interfere with bone healing.
Work:
The time needed for off work is dependent on:
- The type of work that you do (sedentary off feet vs active on feet)
- The hours that you work
- Your ability to drive / get to work
- Your employer’s policies and capacity to offer modifications of your duties
Recovery management:
- An appointment for x-rays to be taken typically occurs at about 6-8 weeks into the treatment.
- Based on the x-rays and how you are physically coming along, you may be allowed to resume footwear, and start a gradual resumption of your activities.
- However, if the healing is not sufficient to allow the above progression, the doctor may recommend continuing the removable walking cast and repeating x-rays in another month.
- A home physical therapy rehab program may be recommended by your surgeon, and there is typically no need for formal physical therapy appointments
- The total recovery time (until swelling, tenderness and/or stiffness) have resolved and near-full functional capacity is regained): 4-6 months
Typically, 5th metatarsal Jones’ fractures arise from a pivoting, twisting, or rolling-over injury of the foot. These fractures have a notorious reputation for being very slow healing, due to a number of factors. This type of fracture has been known to take 3-6 months to heal, and has ended some athletes’ sporting career.
Treatment:
- Non-removable cast – typically no weight bearing allowed.
- Often, followed by use of a removable walking cast.
Duration of above treatment:
- Typically, 6-8 weeks of non-weight bearing in a non-removable cast.
- Often, this initial period is followed by use of a removable walking cast on a month to month basis, dependent on exam and x-ray evidence of healing progress.
(note: in cases of slower bone healing, the treatment may take 12-16 weeks)
Typical home care advice:
- Remain strictly non-weight bearing as long as you doctor designates.
- Reduce activity level, rest, and elevate the affected limb as much as possible every day – for at least 2-3 weeks.
- Avoid anti-inflammatory medications (such as ibuprofen, naproxen, aspirin, Advil, Aleve, etc.), because they can interfere with bone healing.
- If you smoke, stop – it can interfere with bone healing.
- Occasionally, a bone stimulator device may be ordered for you to use 20 minutes, two times per day, to enhance the rate of healing.
Work:
The time needed for off work is dependent on:
- The type of work that you do (sedentary off feet vs active on feet)
- The hours that you work
- Your ability to drive / get to work
- Your employer’s policies and capacity to offer modifications of your duties
Recovery management:
- An appointment for x-rays to be taken typically occurs at about 6-8 weeks into the treatment.
- Based on the x-rays and how you are physically coming along, you may be allowed to resume footwear, and start a gradual resumption of your activities.
- However, if the healing is not sufficient to allow the above progression, the doctor may recommend using a removable walking cast and repeating x-rays in another month.
- A home physical therapy rehab program may be recommended by your surgeon, and there is typically no need for formal physical therapy appointments
- The total recovery time (until swelling/tenderness/stiffness have resolved and near-full functional capacity is regained): 4-12 months
Typically, 5th metatarsal styloid fractures arise from a rolling injury of the foot (similar to the motion that could cause a sprained ankle). These fractures may violate the adjacent joint. Typically there are no complications that result from the violation of the joint, but rarely, arthritis could develop there. Sometimes the fracture heals, yet the joint takes a bit longer to become pain free – in a few of these instances, a cortisone injection may be offered to help alleviate the joint pain.
Treatment:
- Removable walking cast – weight bearing allowed.
(note: in some cases, the treating doctor may allow a surgical shoe instead of the removable walking cast)
Duration of above treatment:
- Typically 6 weeks
(note: in cases of slower bone healing, the treatment may take another 4-8 weeks)
Typical home care advice:
- Use the removable walking cast for all weight bearing activities as long as you doctor designates.
- It is OK to remove the removable walking cast for: sleep, bathing, icing.
- Ice pack the fracture area for 15-20 minutes, three times per day for at least 2-3 weeks.
- Reduce activity level, rest, and elevate the affected limb as much as possible every day – for at least 2-3 weeks.
- Avoid anti-inflammatory medications (such as ibuprofen, naproxen, aspirin, Advil, Aleve, etc.), because they can interfere with bone healing.
- If you smoke, stop – it can interfere with bone healing.
Work:
The time needed for off work is dependent on:
- the type of work that you do (sedentary off feet vs active on feet)
- the hours that you work
- your ability to drive / get to work
- your employer’s policies and capacity to offer modifications of your duties
Recovery management:
- An appointment for x-rays to be taken typically occurs at about 6-8 weeks into the treatment.
- Based on the x-rays and how you are physically coming along, you may be allowed to resume footwear, and start a gradual resumption of your activities.
- However, if the healing is not sufficient to allow the above progression, the doctor may recommend continuing the removable walking cast and repeating x-rays in another month.
- A home physical therapy rehab program may be recommended by your surgeon, and there is typically no need for formal physical therapy appointments. The total recovery time (until swelling, tenderness and/or stiffness have resolved and near-full functional capacity is regained): 4-6 months