The 3 Types of Fifth Metatarsal Fractures

The fifth metatarsal is the bone on the outside of the midfoot at the base of the small toe. The proximal end of the fifth metatarsal (proximal means closer to the center of the body) is easily felt as the bump over the outside part of the midfoot. This part of the fifth metatarsal bone is prone to injury. 

The fifth metatarsal is the most commonly fractured of all the metatarsal bones.

Three primary types of fractures occur in the proximal fifth metatarsal, and all have different treatment implications. Like all other medical issues, not every fracture will fall perfectly into one of these three fracture types, but these categories are useful for treatment guidance.

Avulsion fractures, sometimes called a pseudo-Jones fracture, when the tip of the bone is pulled off the fifth metatarsal by the tendon that attaches to this region.

Most often these injuries can be treated similarly to a ligament or tendon injury. Usually, a stiff-soled shoe, such as a cast shoe, is worn for a few weeks until the pain and swelling have subsided. Full healing takes 6-8 weeks.

Jones fractures occur in the metatarsal bone just beyond the avulsion fractures.

If the injury is acute, meaning the diagnosis is made immediately following the injury, then non-surgical treatment is much more likely to be effective. A delayed diagnosis increases the likelihood of nonunion and the possible need for surgical treatment.

In athletes, sometimes surgical treatment is considered even in acute settings, just to ensure the healing process is predictable. Healing time of a Jones fracture is typically 12 weeks.

Stress fractures of the fifth metatarsal are the hardest to heal and are more likely to require surgery.

These fractures often start with vague pain on the outside of the foot, often thought to be tendonitis. Over time, the stress fracture can become a complete break.

Because the body has a hard time healing these fractures, they require surgical treatment much more commonly. Healing time of a stress fracture also is typically at least 3 months.

As stated before, not every fracture is clearly categorized into one of these fracture types. Determining the best treatment is dependent not only on the specific fracture pattern but also the patient's expectations for treatment.