The fracture of the 5th metatarsal is one of the most common fractures in the foot. It requires not setting foot for 6 weeks. Rehabilitation sessions with a physiotherapist are essential at the end of this consolidation period.
1. Two main types of fractures of the 5th metatarsal
As the MSD Manual immediately states, there are two main forms of fractures of the 5th metatarsal: the acute fracture and the stress fracture. Note that the 5th metatarsal can also be fractured at its base (epiphysis) or at the diaphysis (central part). In the case of a stress fracture, it is not uncommon for it to occur at the level of the metaphysis (junction area between the diaphysis and epiphysis), and it is then called a Jones fracture. This is a poorly vascularized area.
When the fracture affects the base of the 5th metatarsal (which is more common than a fracture of the diaphysis), we more readily speak of a dancer’s fracture. It is generally a fracture that occurs when the foot is crushed, or during a twist leading to bone tearing by sudden traction of the peroneus brevis muscle. Note that this fracture is one of the most common in the foot, specifies the Union clinic website.
2. Symptoms of a 5th metatarsal fracture
In addition to a shock in a sporting setting, a fracture of the 5th metatarsal can easily occur if you miss a sidewalk or slip on a stair step. When it occurs, we feel a cracking sound and significant pain at the outer lateral edge of the foot. It may be an emergency if we observe bone displacement (quite rare) or skin damage. While waiting for medical treatment, it is recommended to elevate the foot to limit edema.
3. Diagnosis of a fracture of the 5th metatarsal
You must be careful not to confuse a fracture of the 5th metatarsal with an ankle sprain, the mechanism of injury (the conditions of occurrence) of which is quite similar. It is therefore advisable to consult your doctor in all cases. The diagnosis of a fracture of the 5th metatarsal begins from the clinical elements: the location of the pain, the inflammatory symptoms (redness, heat, swelling), the exacerbation of pain upon pressure. To highlight the fracture, the doctor requests x-rays of the foot under load (weight bearing); They are to be performed from the front, in profile and obliquely. An MRI may also be helpful in confirming the diagnosis, particularly in the case of a stress fracture. A CT scan can even be performed afterwards to assess consolidation. This fracture is very rarely displaced, that is to say that the bone, although fractured, remains aligned.
4. Duration of treatment and convalescence in case of fracture of the 5th metatarsal
Treatment of a 5th metatarsal fracture begins with the placement of a short cast (cast/resin splint), or the use of a removable walking boot or hard-soled shoe. Weight bearing on the ground is prohibited for 6 weeks, the time necessary for bone consolidation. It is indeed necessary to avoid flexion and inversion movements of the foot. Crutches are therefore necessary. Anticoagulant injections are also given during the discharge, to avoid phlebitis.
An orthopedist will determine if surgery is indicated. This is rarely useful, since this fracture is generally not displaced. Otherwise, the operation consists of refixing the bone. A surgical operation may also be considered if the fracture has not consolidated properly after 6 weeks of immobilization. This type of intervention with the placement of a screw (which attaches the fractured part to the rest of the 5th metatarsal) is more common in athletes, in whom the risk of recurrence is high. It even happens that a bone graft is carried out. In this case, cells are taken from the heel and placed inside the fracture to stimulate bone reconstruction and promote consolidation. Postoperative follow-up remains the same thereafter.
Initially, the doctor may prescribe analgesics and anti-inflammatories to relieve the pain. The duration of treatment and convalescence in the event of a fracture of the 5th metatarsal can be disrupted by vascular disorders likely to lead to nonunion or failure of union. However, this problem is less encountered in the event of a fracture of the base of the metatarsal, because it is much better vascularized than the diaphysis. Following immobilization of the foot, the recovery of support must be gradual, and accompanied by physiotherapy sessions. These sessions are essential to regain good ankle stability and correct support.
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