of the Fifth Metatarsal
Fractures of the fifth metatarsal are common
especially at the proximal portion (the
base of the metatarsal). They are also referred
to as tuberosity avulsion fractures. The
tuberosity is the bony prominence that protrudes
at the base of the metatarsal. An avulsion
fracture refers to an injury to the bone
in a place where a tendon or ligament attaches
to the bone. When an avulsion fracture occurs,
the tendon or ligament pulls off a piece
of the bone.
The patient will complain of pain at the
base of the fifth metatarsal. Localized
swelling and bruising may be present.
Non-displaced fractures are treated conservatively.
Non-displaced fractures are cracks in the
bone seen on x-ray, but with the bones remaining
in their proper position and alignment.
Most non-displaced fractures of the 5th
metatarsal can be treated without surgery.
However displaced and comminuted fractures
require surgery. A comminuted fracture is
where there is splintering of the bone ends.
This results in a situation where exact
reconstitution or reconstruction is difficult
or impossible. This situation is usually
caused in cases of direct trauma to the
There are three types of 5th Metatarsal
1. Tuberosity avulsion fractures
2. Fractures within 1.5 cm of the 5th metatarsal
tuberosity are called Acute
3. Stress Fractures
It is important to understand which structures
are involves especially when a sporting
activity was a precursor to the fracture.
Associated soft tissues that may be affected
include the lateral band of the plantar
fascia, peroneus brevis tendon and peroneus
The lateral band of the plantar fascia
inserts into the proximal tip of the fifth
metatarsal. The peroneus brevis inserts
in a fan like pattern across the proximal
end of the metatarsal.
Tuberosity avulsion fractures
These are the most common fractures and
usually heal well with conservative treatment.
If the fracture is displaced or comminuted
the treatment options may vary.
• Sudden onset of pain at the base
of the fifth metatarsal.
• Often occurs due to a ankle sprain
• Tenderness and swelling at site.
• Fractures appear perpendicular
to the long axis of the fifth metatarsal
• Radiolucency located at the proximal
metaphyseal-diaphyseal junction (metatarsal
• Accessory ossicles
For non displaced tuberosity fractures:
• Non weight bearing cast for 6-8
• Ankle splints
• Walking casts or boots.
• After immobilization orthotics and
For displaced fractures:
• Internal fixation or closed reduction
and pinning surgery.
Acute Jones Fracture
A Jones fracture is located within 1.5
cm distal to tuberosity of 5th metatarsal.
A Jones fracture occurs in the mid portion
of the foot. Patients who sustain a Jones
fracture have pain over this middle/outside
area of their foot, swelling, and difficulty
• Sudden pain at the base of the
fifth metatarsal with difficulty putting
any pressure on the foot
• May be substantial swelling at site.
• Occurs often when force is applied
to the foot during plantar flexion (foot
pointing down ward) i.e pivoting in football
Depends on the type of fracture, there
are three types of Jones fractures:
• Classified as a fracture line with
sharp margins and no widening of the fracture.
Minimal evidence of periosteal reaction
to chronic stress. A periosteal reaction
is the formation of new bone in response
• Non weight bearing cast for 6-8
weeks or walking boot.
• Fracture line that involves both
cortices with an associated periosteal bone.
The fracture will have a widening fracture
line and there will be evidence of intramedullary
• A non weight bearing cast may be
on for longer than 8 weeks.
• In athletes these fractures are
usually treated with screw fixation.
• Widening fracture line with complete
obliteration of the medullary canal (this
is the cavity containing bone marrow in
the long part of a metatarsal) at the fractures
• Treated with screw fixation
• Healing times are much longer in
this type of injury and there is a higher
risk of a re-fracture.
• Often occurs in younger patients
• Dull pain and swelling at the base
of the fifth metatarsal
• Symptoms may be intermittent and
only occur during exercise until the pain
• Non eight bearing casting for up
to 20 weeks may be necessary. However a
non weight bearing cast for such a long
period of time can result in muscle wasting.
• Surgery may be necessary for athletes
and patients who are reluctant to remain
in a cast for prolonged periods.
here to view the Aircast Walker
Aircast Walkers are used in
the treatment of foot injuries or ankle
injuries such as a ankle fracture and Metatarsal
High profile players such
as Wayne Rooney, David Beckham and Steven
Gerrard have all used Aircast Walkers successfully
following a foot or ankle injury.
What are they?
The Aircast Walker features a lightweight
removable plastic cast with a durable, semi-rigid
shell which provides far greater protection
compared to a conventional plaster cast.
The aircast shell is lined with four air
cells for pneumatic support and increased
comfort. These air cells can be custom inflated
using the hand bulb for a 'total contact'
fit. This unique method of compression supports
the swollen ankle or foot, which helps to
reduce swelling. For this reason, they are
commonly used in the treatment of Metatarsal
fractures and other conditions
such as a broken ankle.
One of the main benefits of the Aircast
Walker is that it is much lighter
than a plaster cast and allows a greater
level of mobility, making it much more comfortable
and convenient to wear. This allows
the patient to be active and back to work
(depending on your profession).
The walkers rocker sole reduces pressures
through the sole of the foot which allows
earlier partial weight bearing. Controlled
weight bearing as instructed by your doctor
also greatly enhances healing and reduces
rehabilitation time, allowing you to get
back to your sport.
The other advantage of uses the Airast
Walker compared to the plaster cast is that
the patient can take the cast off and undergo
physiotherapy and exercise to prevent stiffness
and reduce healing times. You can also wash
your feet which makes it a much
more hygienic and convenient method of
immobilization following a metatarsal fracture.
Who uses them?
Many elite athletes such as such as Wayne
Rooney and David Beckham have used the Aircast
Walkers following a foot or ankle injury
but they can be used by anybody who has
suffered from a metatarsal fracture or ankle
it like Beckham! - Significantly improve
your recovery time and your quality of life
following a metatarsal fracture.
here to view the Aircast Walker