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5th Metatarsal Fracture

Injuries > Foot > 5th Metatarsal Fracture

 

(Also known as a Fractured 5th Metatarsal, Base of 5th Metatarsal Fracture, Avulsion Fracture of the Base of the Fifth Metatarsal, Jones Fracture)

 

What is a 5th metatarsal fracture?

A 5th metatarsal fracture is a relatively common condition characterized by a break in the long bone situated at the outer aspect of the foot known as the 5th metatarsal (figure 1).

The foot comprises of many small bones, 5 of which are the long bones known as the metatarsals which are situated beside each other. The 5th metatarsal bone lies on the outer aspect of the foot and forms joints with the 5th proximal phalanx and the cuboid bone (figure 1).

During certain activities such as landing from a jump, a forceful impact to the outer aspect of the foot or when rolling an ankle, stress is placed on the 5th metatarsal. When this stress is traumatic and beyond what the bone can withstand a break in the 5th metatarsal may occur. This condition is known as a 5th metatarsal fracture.

A 5th metatarsal fracture is relatively common among the elderly, but can also occur in the younger patient. Often a fracture of the 5th metatarsal occurs in combination with a sprained ankle or other fractures of the foot, ankle or lower leg (such as following trauma).

5th metatarsal fractures can vary in location, severity and type including avulsion fracture, stress fracture, Jones' fracture, displaced fracture, un-displaced fracture, spiral fracture, greenstick, comminuted etc.


Causes of a 5th metatarsal fracture

A 5th metatarsal fracture commonly occurs in association with a rolled ankle, particularly when the ankle has rolled inwards and when significant weight bearing forces are involved. They may also occur due to an awkward landing from a jump (particularly on uneven surfaces), due to a fall or following a direct blow to the outer foot. 5th metatarsal fractures are common in running and jumping sports involving change of direction such as football, soccer, rugby, basketball and netball and in dancing (e.g. ballet).


Signs and symptoms of a 5th metatarsal fracture

Patients with this condition typically experience a sudden onset of sharp, intense outer foot or ankle pain at the time of injury. Sometimes the patient may have heard an audible snapping sound at the time of injury. The pain often causes the patient to limp or be unable to weight bear so as to protect the foot. Pain is usually felt at the outer aspect of the foot or ankle and can occasionally settle quickly leaving patients with an ache at the site of injury that may be particularly prominent at night or first thing in the morning.

Patients with a 5th metatarsal fracture may also experience swelling, bruising, stiffness and pain on firmly touching the affected region of bone. Pain may also increase during certain movements of the foot or ankle or when standing or walking (particularly up hills or on uneven surfaces). In severe fractures of the 5th metatarsal (with bony displacement), an obvious deformity may be noticeable. Occasionally patients may also experience pins and needles or numbness in the ankle or foot.


Diagnosis of a 5th metatarsal fracture

A thorough subjective and objective examination from a physiotherapist is essential to assist with diagnosis of a 5th metatarsal fracture. An X-ray is usually required to confirm diagnosis and assess the severity of the fracture. Further investigations such as an MRI, CT scan or bone scan may be required, in some cases, to assist with diagnosis and assess the severity of the injury.


Treatment for a 5th metatarsal fracture

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Prognosis of a 5th metatarsal fracture

Patients with a fractured 5th metatarsal usually make a full recovery with appropriate management (whether surgical or conservative). Return to activity or sport can usually take place in weeks to months and should be guided by the treating physiotherapist and specialist. In patients with severe injuries involving damage to other bones, soft tissue, nerves or blood vessels, recovery time may be significantly prolonged. In patients with only very minor fractures that are un-displaced (such as an avulsion fracture) return to sport can sometimes occur in as little as 6 - 8 weeks as guided by the treating physiotherapist.


Physiotherapy for a 5th metatarsal fracture

Physiotherapy treatment is vital in all patients with this condition to hasten healing and ensure an optimal outcome. Treatment may comprise:

  • soft tissue massage
  • joint mobilization
  • electrotherapy (e.g. ultrasound)
  • ice or heat treatment
  • ankle taping or ankle bracing
  • the use of a protective boot
  • the use of crutches
  • exercises to improve strength, flexibility and balance
  • hydrotherapy
  • education
  • activity modification
  • a graduated return to activity plan
  • footwear advice


Other intervention for a 5th metatarsal fracture

Despite appropriate physiotherapy management, some patients with this condition do not improve adequately and may require other intervention. The treating physiotherapist or doctor can advise on the best course of management when this is the case. This may include further investigations such as X-rays, CT scan, MRI or bone scan, periods of plaster cast immobilization, review with a podiatrist for possible orthotics and footwear advice or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the 5th metatarsal fracture. Occasionally, patients who were initially managed conservatively may require surgery to stabilize the fracture and/or a bone graft to aid fracture healing.


Exercises for a 5th metatarsal fracture

The following exercises are commonly prescribed to patients with this condition following confirmation that the fracture has healed or that pain free mobilization can commence as directed by the surgeon. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.

Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms.


Initial Exercises

Foot and Ankle Up and Down

Move your foot and ankle up and down as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 2). Repeat 10 - 20 times provided there is no increase in symptoms.

Exercises for a 5th Metatarsal Fracture - Foot & Ankle Up & Down

Figure 2 Foot and Ankle Up and Down (left leg)

Foot and Ankle In and Out

Move your foot and ankle in and out as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 3). Repeat 10 - 20 times provided there is no increase in symptoms.

Exercises for a 5th Metatarsal Fracture - Foot & Ankle In & Out

Figure 3 Foot and Ankle In and Out (right leg)


More Initial Exercises

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Intermediate Exercises

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Advanced Exercises

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Other Exercises

For other exercises that can help to accelerate recovery from this condition 'Become a Member'.

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Rehabilitation Protocol for a 5th Metatarsal Fracture

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Physiotherapy products for a 5th metatarsal fracture

Some of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with this condition include:

  1. Crutches
  2. Protective Boots
  3. Ankle Braces
  4. Ankle Supports
  5. Ice and Heat Packs
  6. Wobble Boards (for rehabilitation)
  7. Dura Discs (for rehabilitation)
  8. Resistance Band (for strengthening)
  9. Sports Tape (for protective taping)

To purchase physiotherapy products for a fractured 5th metatarsal click on one of the above links or visit the PhysioAdvisor Shop.


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5th Metatarsal Fracture Anatomy

Figure 1 Relevant Anatomy for a 5th Metatarsal Fracture

 

Ankle Braces

 

Ankle Supports

 

Wheat Heat Pack

 

Crutches Ad

 

Wobble Boards

 

Dura Discs

 

Sports Tape 38mm

 

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