5th Metatarsal Fracture: Types, Symptoms & Treatment

A fifth metatarsal fracture is a common injury where the bone connecting your ankle to your little toe breaks. These fractures occur from injury, overuse or high arches. Providers can treat your broken bone with a cast, boot or shoe — or with surgery. Using ice, keeping weight off your foot and elevating your foot can help decrease recovery time.

What is a Fifth Metatarsal Fracture?

A fifth metatarsal fracture is a break on the outer edge of your foot and is among the most frequent foot injuries. This fracture affects the fifth metatarsal, the long bone on the outside of your foot that connects to the little toe.

Types of Fifth Metatarsal Fractures
Fifth metatarsal fractures are categorized into three zones:

• Zone 1 (Avulsion Fracture): Representing 93% of these fractures, an avulsion fracture occurs when a small bone fragment is pulled away by a tendon or ligament. This often happens when the ankle rolls, sometimes overlooked if paired with an ankle sprain.
• Zone 2 (Jones Fracture): Occurring in a limited blood-supply area, a Jones fracture may be a stress fracture (developing over time) or a sudden break. These fractures are often caused by overuse, stress, or trauma and can be challenging to heal.
• Zone 3 (Mid-Shaft or Dancer’s Fracture): Mid-shaft fractures are generally due to trauma or twisting, occurring at the metatarsal head and neck.

Who is at Risk?

Metatarsal fractures account for 5%-6% of fractures seen by U.S. healthcare providers. Though anyone can experience this injury, it’s most common among men in their 30s and women in their 70s, with women showing higher rates of avulsion and mid-shaft fractures.

Symptoms and Causes

Causes of a Fifth Metatarsal Fracture
A fifth metatarsal fracture can result from:

• A direct blow to the foot
• High arches causing excess outer foot pressure
• Repetitive stress or overuse
• Inward ankle rolling (inversion injury)
• Foot twisting or rotating, often from sports or accidents

Symptoms
Common signs of a fifth metatarsal fracture include:

• Pain or discomfort on the foot's outer edge
• Bruising and swelling
• Tenderness
• Difficulty walking

Diagnosis and Tests

How is a Fifth Metatarsal Fracture Diagnosed?
Your healthcare provider will evaluate pain onset and location, then examine the foot. Imaging tests may include:

• X-rays to locate the fracture, though Jones fractures may not always appear.
• CT or MRI scans for a clearer view if a Jones fracture is suspected.

Management and Treatment

Treatment Options
Treatment depends on the bone’s alignment, your activity level, age, and health:

• Immobilization: For aligned bones, immobilization is generally enough, especially for avulsion fractures. Immobilization can involve a cast, boot, or stiff-soled shoe, often combined with crutches, lasting six to eight weeks.

• Surgery: Misaligned bones or high-activity needs (e.g., athletes) may require surgery. Jones fractures or unresponsive cases also frequently undergo surgery, which involves using pins, screws, or plates to stabilize the bone.

Complications of Treatment
Possible complications include:

• Blood clots, infections, or excessive bleeding
• Muscle atrophy
• Nonunion or malunion
• Persistent pain

Self-Care and Symptom Management
To aid recovery:

• Elevate and ice the foot as advised.
• Avoid weight-bearing until approved.
• Manage pain with suitable medications, following provider advice.

Prevention

Reducing Your Risk
Maintaining a healthy weight and managing conditions like diabetes can help reduce the risk of metatarsal fractures.

Outlook / Prognosis

Recovery Expectations
Healing takes approximately six to eight weeks with immobilization, and up to seven weeks after surgery. Physical therapy may be recommended to restore foot mobility.

When to See Your Healthcare Provider
Seek medical attention if you develop symptoms such as increased pain, swelling, numbness, or skin discoloration in the foot or leg.

A Note from Cleveland Clinic
Fifth metatarsal fractures are common but manageable. With proper treatment and self-care, you can generally resume activities in a few months. Rest, elevation, and following recovery guidelines can help you return to regular routines.