Patient Education

Fractures of the Fifth Metatarsal

Description

Shakespeare was a man of great intelligence and wit. But while he was well- versed in the affairs of the heart, he was not as familiar with (or perhaps simply not as interested in) the noble foot. If he were, we might have gotten such plays as A Midsummer Night’s Bunion, As You Like Your Arches, or possibly Much ado About Metatarsals. While the world may forever mourn the loss of these potential masterpieces, you can rest easy knowing that you can, because of modern science, (and the hard work of podiatric doctors), know more about your metatarsals than Shakespeare did.

Metatarsals are the elegant bones of the foot-world. They’re longer and more slender than most other foot bones (the poor tarsals, for instance, are quite dumpy in comparison, and the toe bones are kind of stumpy) and gracefully fill the gap between your toes and the midfoot. In fact, the ball of your foot is pretty much made up of metatarsals. (Surely Shakespeare could have penned at least one ode to these charming bones…)

Just as you have five toes on your foot (unless you’re one of the lucky people with an extra digit) you have five metatarsals, each of which connect to the base of a toe. Like your toes, metatarsals are numbered from one to five. The first metatarsal connects to your big toe, the second metatarsal connects to the next toe, and so on. Thus the fifth metatarsal connects to the bottom of your pinky toe. This bone is, unfortunately, prone to injury, although whether it’s because it’s on the outside of the foot or because it’s prone to starting fights in sorority houses, science has yet to answer.

Fractures of the fifth metatarsal tend to be one of a few different types. The first is an avulsion fracture, which usually occurs with an inversion (rolling) type of injury such as an ankle sprain. Basically, a tendon or ligament pulls away from the bone and takes a piece of bone with it. This fracture usually happens at the base of the metatarsal, on a prominent piece of the bone called the styloid process. Symptoms from an ankle sprain may mask the symptoms of an avulsion fracture.

Another type of fracture, and a more serious one, is known as a Jones fracture. This also occurs near the base of the fifth metatarsal, in an area known as the metaphyseal-diaphyseal junction. Unfortunately, this area has a rather poor blood supply, making healing rather difficult. Jones fractures are often due to repeated stress on the bone (i.e. stress fractures, or cracks in the bone), a complete fracture that has formed because of old stress fractures, or may be a result of trauma.

Spiral or oblique fractures usually occur on the shaft (middle) or neck (upper) part of the metatarsal. Such breaks may happen due to trauma (like dropping an anthology of Shakespeare plays on your foot) or mechanical stress.

Symptoms

You may be surprised to know that you may still be able to walk on a fracture of the fifth metatarsal. (Not that you should, necessarily, but you might be able to.) Avulsion fractures in particular, when they are part of an ankle sprain, may go unnoticed and untreated as you deal with the symptoms of an ankle injury.

Common symptoms of fractures in the fifth metatarsal include swelling, pain and some tenderness along the outside of the foot. You may notice some bruising in the area, and, although you may be able to walk, putting weight on the foot will likely not feel at all comfortable. If you experience any of these symptoms, you should probably get your foot checked out by a podiatrist. If you’re in doubt, just reflect that Shakespeare would almost certainly have visited a podiatrist at the first sign of foot pain. You know. If there were podiatrists back then.

Diagnosis

Your podiatrist may or may not be a fan of the Bard (particularly since Shakespeare did, in fact, neglect to mention athlete’s foot in pretty much all of his work), but he or she is certainly an expert in detecting and treating fractures of the foot. To determine if you’re suffering from a fracture of the fifth metatarsal, your doctor will likely examine your poor injured appendage (with or without murmurs of sympathy), and may press on the foot to determine where exactly the pain is coming from. So brace yourself beforehand. You’ll also likely need to relate a history of your symptoms.

Because your podiatrist will probably not have X-ray vision (unlike Shakespeare who, as we all know, could see through walls… or was that someone else?), he or she will almost certainly use some sort of imaging technology (X-rays are the most common) to get a good look at your bones and figure out if a fracture is present or not.

Treatment

If a fracture is currently disrupting the elegance of your fifth metatarsal, then your podiatrist will determine a healing plan for you. The type of treatment involved will really depend on the type of break you have and where it’s located.

If you have a stress fracture, or if the bone is not displaced (the pieces of bone are all where they’re supposed to be), your podiatrist may opt to treat your fracture conservatively, using the RICE method (Rest, Ice, Compression and Elevation) to reduce swelling in the area (and thus reduce pain) and give the injury a chance to heal.

Slightly more severe fractures may need a stiff-soled shoe, cast boot, or cast to immobilize the foot and allow the bits of bone to knit back together again. You may also need to get used to walking with crutches for a while.

Surgery may be necessary if your bones are displaced, or if there are multiple pieces of bone. Also, if you have a Jones fracture, surgical treatment often heals more quickly than conservative treatment. Screws, pins, and sometimes plates help secure bits of bone together so they can knit back up nicely. Eventually (usually after six to eight weeks, or possibly longer for more severe fractures), your bone will reunite into that elegant metatarsal you love so well. (A love you feel strongly enough enough, perhaps, to write a sonnet about it. Just like Shakespeare.)