4 Types of Fifth Metatarsal Fracture

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

Metatarsal bones are in the midfoot, just behind the phalanges (toes). The fifth metatarsal bone lies on the outer edge of your foot and connects to your little toe. The metatarsals curve upward and give your foot its arch.

The fifth metatarsal is unique in that it also curves outward. Additionally, it's the only metatarsal bone that has two points of contact with the ground, one at either end.

Causes

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

Rolling your foot and ankle toward the outside, called an inversion injury, is the most common cause of fifth metatarsal fractures (and also a common cause of ankle fractures.)

That's because a powerful tendon, called the peroneus Brevis tendon, attaches to the base of the metatarsal. When twisted, it can transmit a strong enough force to break the bone.

The four common types of fifth metatarsal fracture are:

• Head or neck fractures
• Dancer's fracture
• Jones fracture
• Avulsion fractures

Head or Neck Fracture

Head or neck fractures occur at the forward end of the bone, which is called the head and/or neck. They're most common with lower-force injuries or direct blunt trauma, like stubbing your little toe.

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.

These fractures tend to be unstable and may require surgery. 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

In most of the medical community, "dancer's fracture" has become a universal term for any fifth metatarsal fracture, but foot surgeons generally reserve it for fractures of a specific orientation.

A true dancer's fracture occurs mostly in the middle portion of the long metatarsal bone and is oriented diagonally along the shaft. The fracture line may even spiral and rotate throughout the bone. Sometimes it'll cause the bone to chip into smaller pieces (called comminution).

Jones Fracture

The Jones fracture is the most notorious fifth metatarsal fracture because it is very difficult to heal. It occurs near the back 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, which makes it slow to heal. This is especially true if the fracture further impedes circulation.

Jones fractures can be treated with or without surgery, although most surgeons will recommend surgery if you're physically active, and especially 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, a cast is required for six to 12 weeks.

Avulsion Fractures

The avulsion fracture is by far the most common fifth metatarsal fracture. It occurs in the rear-most portion of the bone, closest to the ankle. It's frequently confused with a Jones fracture and often referred to as a pseudo-Jones fracture.

Avulsion fractures are so-named because a small portion of bone attached to a tendon or ligament has pulled off (avulsed) from the primary part of the bone. It 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 break into many tiny pieces.

Most avulsion fractures of the fifth metatarsal don't require surgery. They're more often treated with protective immobilization, such as a fracture boot.

Surgery may be needed if the bones are unacceptably separated, angulated, or displaced.