Metatarsal Fracture
5th Metatarsal Fracture X-rays picture album X-rays of 5th metatarsal fractures including identification of zone 1, zone 2, and zone 3 fractures of the 5th metatarsal base.
5th Metatarsal Fractures picture album Several pictures illustrating avulsion, Jonesí, proximal diaphyseal stress, and dancerís fractures.
The long bones of the foot are called the metatarsals.  There are 5 metatarsals -- one for each  toe.  An injury to the foot can break one or more of the metatarsals.  This is known as a  metatarsal fracture. Metatarsal fractures often occur as the result of “rolling” or twisting the foot.  They may also  occur with a traumatic blow, such as dropping a heavy object on the foot.  Some metatarsal  fractures are stress fractures.  This means that the fracture does not occur as the result of one  specific injury.  Instead, repetitive blows to the metatarsal, such as the foot pounding the  ground while running, gradually overload the bone and cause it to crack.  Metatarsal fractures  may involve the head, neck, shaft, or base of the metatarsal. Metatarsal fractures are diagnosed based on a history, physical exam, and x-rays.  Patients  usually report twisting the foot or sustaining a traumatic blow.  If they have a stress fracture,  they may report gradually worsening pain, especially with running or strenuous activity. Upon physical exam, the foot may be bruised and swollen.  The broken bone will, of course, be  tender to push on. X-rays are important not only to confirm that the foot is broken, but to evaluate the fracture.   Fractures may be non-displaced (just a crack) or displaced.  They may involve the cartilage in  the joints (intra-articular).  They may be angulated (bent at the fracture site).  Certain locations  in the metatarsals are known to have an unreliable blood supply, and may not heal as well. Non-displaced metatarsal fractures can be treated without surgery.  A cast, boot, or hard-soled  shoe is applied for 4-6 weeks.  Depending on the location of the fracture, weightbearing may or  may not be permitted.  Follow-up x- rays are obtained to evaluate healing.   If the metatarsal fracture is displaced or angulated, it may require surgery.  Fractures with a  little bit of angulation to the side may not need surgery, but fractures with angulation in the  plantar or dorsal direction (up and down) need to be corrected.   Stress fractures may or may not be visible on x-rays.  If a stress fracture is suspected by not  visualized on an x-ray, an MRI or bone scan may be obtained.   Fractures at the base of the 5th metatarsal (the bone on the outer side of the foot) are a special  case.  The blood flow to the 5th metatarsal base is unusual.  Good blood supply is important for  fracture healing.  Some 5th metatarsal fractures do not heal as well.  These fractures may be  treated more aggressively with casting and non- weightbearing or surgery. If surgery is needed, the fracture is reduced (the bone fragments are pushed back into place)  and then pins, screws, or plates are used to hold the fragments in place while the fracture  heals.  Sometimes the fracture can be pushed back into place without making an incision.  A  pin can then be pushed through the skin and drilled into the bone.  This is known as  percutaneous pin fixation or closed reduction-internal fixation (CRIF).  Pins are often removed  in the office a few weeks later.  Sometimes the fracture cannot be successfully reduced without  making an incision and exposing the bone.  This is known as open reduction-internal fixation  (ORIF).  Screws or plates may be used to fix the fragments in place.  These are generally not  removed.