4 Types of Fifth Metatarsal Fracture

Different Locations, Causes, and Treatments

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A Jones Fracture is one of the several types of fractures of the 5th metatarsal bone. Dr Neal Blitz NYC

Several types of fractures can occur to the fifth metatarsal bone of the foot, each with different characteristic symptoms and treatment approaches.

The fifth metatarsal bone is the outermost metatarsal bone of the foot. Metatarsal bones that lie just beneath the bones of the phalanges (toes). This fifth metatarsal bone is shaped slightly different than other metatarsal bones in that it is bowed in two planes. It is also the only metatarsal bone to have two points of contact with the ground: one at the top of the bone (called the head) and one at the bottom (called the base).

Causes

Fifth metatarsal fractures are generally the result of trauma to the foot, caused either by a direct blow or a rotational injury.

Inversion type injuries of the foot and ankle are the most common maneuvers that lead to fifth metatarsal fracture (and are also a common cause of ankle fractures). There is a powerful tendon that attaches to the base of the metatarsal (called the peroneus Brevis tendon) that can transmit a strong enough force to fracture the bone when twisted.

The four common types of fifth metatarsal fracture are:

Head or Neck Fracture

Head or neck fractures occur at the top of the bone in the anatomic region of the metatarsal head and/or neck. Head and neck fractures are most common with lower force injuries or direct blunt trauma. Sometimes stubbing the fifth toe can result in this injury.

When a head or neck fracture is caused by a more generalized (global) foot injury, you can expect to have other types of foot fracture as well.

The orientation of these fractures lend themselves to instability and may require surgery. With that said, foot surgeons will typically watch the bones for a week or so to see if they shift out of position before making a final decision. 

Dancer's Fracture

The dancer's fracture has become a universal term for any fifth metatarsal fracture, but foot surgeons generally reserve for fracture of a specific orientation.

A true dancer's fracture occurs mostly in the middle tissues of the long metatarsal bone and will be oriented obliquely in the shaft of the bone. The fracture line may even spiral and rotate throughout the bone. Sometimes the dancer's fracture can cause the bone to chip into smaller pieces (called comminution).

Surgery is typically avoided for a true dancers fracture unless the bone ends are separated or angulated (distorted) to an unacceptable degree.

Jones Fracture

The Jones fracture is the most notorious fifth metatarsal fracture because it is very difficult to heal. The Jones fracture occurs near the bottom of the bone at an anatomic location called the metaphyseal-diaphyseal junction. This area of bone is thought to have less blood supply than other bones, impeding the rate of healing (particularly if the fracture further impedes circulation).

Jones fractures can be treated with or without surgery, although most surgeons will recommend surgery if you are physically active. This is especially true for athletes. The surgery generally involves placing a single screw into the canal of the bone to stabilize it. When a Jones fracture is treated without surgery, casting will be required for six weeks to 12 months.

Avulsion Fractures

The avulsion fracture is by far the most common fifth metatarsal fracture. They occur at the bottom-most portion of the bone. They are frequently confused with Jones fractures and are often referred to as pseudo-Jones fractures.

Avulsion fractures are so-named because a portion of the bone has been pulled off (avulsed) from a supporting tendon. The avulsion fracture may involve a portion of the bone or fully fracture the bone into segments. Injuries that cause fifth metatarsal avulsion fractures are typically violent and may cause the bone to fracture into many tiny pieces.

Most avulsion fractures of the fifth metatarsal do not require surgery. They are more often treated with protective immobilization, such as with a fracture boot. When the bones are unacceptably separated, angulated, or displaced, surgery may be needed.

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Article Sources

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