What is a Fifth Metatarsal Fracture?
A fifth metatarsal fracture is a break or crack in the long bone along the outside of your foot that connects to your little toe. This bone helps support your body weight and plays an important role in balance and movement, especially when walking, running, or changing direction.
It’s one of the most common foot injuries and can happen from twisting the foot, rolling the ankle, or a direct impact like dropping something heavy. Ensuring these injuries are properly diagnosed and treated is essential to ensure the bone heals correctly and to avoid long-term issues like pain or difficulty walking.
What are the Types of Fifth Metatarsal Fractures?
Fifth metatarsal fractures are classified into several distinct types, each with different implications for treatment, healing time, and likelihood of surgical intervention. Identifying the specific type of fracture is important for determining the best management plan.
Jones Fractures
A Jones fracture occurs near the base of the fifth metatarsal, in an area where the blood supply is limited. The poor blood supply makes healing more difficult and often slower than other types of fractures. Jones fractures typically result from twisting injuries or sudden changes in direction and may require immobilisation or surgical fixation.For more information, visit our Jones Fracture page
Avulsion Fractures
Avulsion fractures happen when a small piece of bone is pulled away from the base of the fifth metatarsal by a tendon or ligament, usually due to an ankle rolling inward. These are often caused by sudden traction from the peroneus brevis tendon during an inversion injury. Avulsion fractures are generally treated with rest, ice, a stiff-soled shoe or boot, and gradual return to activity.
Spiral or Shaft Fractures
Spiral or shaft fractures occur along the long portion (diaphysis) of the fifth metatarsal and are often the result of a twisting injury or high-impact trauma. These fractures can range from stable and non-displaced to unstable or displaced, which may require surgical intervention depending on alignment and functional demands.
Stress Fractures
Stress fractures are very small cracks/fractures in the bone that develop gradually due to repetitive strain, such as from running or overuse. They are common in athletes and individuals with sudden increases in activity. Symptoms may begin subtly but worsen over time. Early detection and activity modification are essential to avoid progression to a more severe injury.
Comminuted Fractures
Comminuted fractures are described when the bone is broken into multiple pieces. They are typically caused by high-energy trauma, for example when a heavy object falls on the foot or a crush injury. These fractures are more complex and may require surgical repair to realign the bone fragments and stabilise the foot.
At Access Ortho, our specialist orthopaedic team will use examination and x-rays to determine the type of fifth metatarsal fracture a patient has and guide treatment for optimal recovery.
How Common are Fifth Metatarsal Fractures?
Fifth metatarsal fractures are among the most common foot fractures, accounting for a large proportion of injuries seen in orthopaedic and urgent care settings. They occur across all age groups but are especially prevalent in active individuals, athletes, and those who frequently engage in running, jumping, or sports that involve sudden directional changes.
Some populations are more susceptible due to specific risk factors:
- Young adults and adolescents may experience these fractures due to high levels of sports participation, particularly in football, basketball, or dance.
- Middle-aged adults are prone to fractures related to sudden twisting injuries or falls, often combined with decreased bone density.
- People with biomechanical foot issues, such as high arches (pes cavus), are at increased risk due to the added stress placed on the outer edge of the foot.
- Individuals with osteoporosis may sustain these fractures from lower-impact mechanisms due to reduced bone strength.
Fifth metatarsal fractures are common due to the bone’s position along the outer edge of the foot and its key role in balance and weight transfer, which makes it especially prone to injury from trauma or overuse. Prompt diagnosis and early treatment are important to ensure proper healing and preventing complications like non-union or long-term foot pain.
Symptoms and Causes
What Are the Common Symptoms of a Fifth Metatarsal Fracture?
Symptoms of a fifth metatarsal fracture can vary depending on the type and severity of the break, but commonly include:
- Pain on the outside edge of the foot. This may be particularly near the base of the little toe
- Swelling on the outside of the foot
- Bruising or discolouration around the injury site
- Tenderness to touch along the fifth metatarsal
- Difficulty walking or bearing weight, particularly in more severe fractures
- A popping sound or sensation at the time of injury (in cases of acute trauma)
- Gradual onset of pain with stress fractures, often worsening with activity and improving with rest
If you’re experiencing any of these symptoms, it’s important to seek assessment. An X-ray is typically needed to confirm the diagnosis, and radiology and a physical examination will be used to determine the most appropriate treatment.
Access Ortho has acute injury fracture clinics in Brisbane and Ipswich, offering rapid appointments.
What Causes Fifth Metatarsal Fractures?
Fifth metatarsal fractures occur through various mechanisms. The most common causes include:
Sudden Twisting of the Ankle or Foot
One of the most frequent causes of fifth metatarsal fractures is an inversion injury, where the ankle rolls inward. This inward motion places sudden tension on the peroneus brevis tendon. This tendon attaches to the base of the fifth metatarsal. This can potentially pull off a piece of bone (avulsion fracture) or create a break near the base (such as a Jones fracture).
Direct Trauma or Impact
A heavy object dropping onto the outside of the foot or a forceful blow during an accident can directly fracture the fifth metatarsal. Depending on the nature of the impact, this mechanism often results in comminuted or transverse fractures.
Repetitive Stress on the Bone
Overuse or repetitive loading, such as from long-distance running, jumping, or wearing unsupportive footwear, can gradually lead to a stress fracture in the shaft of the fifth metatarsal. These injuries often develop over time and may go unnoticed until the pain becomes persistent.
Falls from Height
Landing awkwardly from a height can create significant force through the foot, particularly if weight is transferred laterally. This can cause the fifth metatarsal to fracture, especially if the foot twists or the impact is concentrated on the outer edge.
Sports Injuries
Sports and activities involving movements such as cutting, pivoting, or sudden directional changes, like football, basketball, and tennis, place considerable stress on the outer side of the foot. These movements can cause acute fractures through twisting forces or lead to stress fractures with repeated strain over time.
Identifying the cause of injury is crucial for choosing the right treatment and assessing the risk of reinjury. At Access Ortho, our team helps assess the mechanism of injury and guides your recovery with targeted orthopaedic care.
What Are Fifth Metatarsal Fracture Risk Factors?
Several factors can increase your risk of a fifth metatarsal fracture:
High-Impact Sports Participation
Activities like football, basketball, and running place repeated stress on the outer foot, raising the risk of injury.
Inadequate Footwear
Wearing shoes without proper support or protection can lead to increased strain and poor shock absorption.
Poor Foot Mechanics
High arches or abnormal gait patterns can shift more pressure to the fifth metatarsal during walking or exercise.
Previous Foot Injuries
A history of sprains or fractures may weaken the bone or surrounding structures, making reinjury more likely.
Bone Density Issues
Conditions like osteoporosis reduce bone strength, making fractures more likely, even with lower-impact activity.
What Are the Complications of Fifth Metatarsal Fractures?
Untreated or improperly managed fifth metatarsal fractures can lead to several complications, some of which may cause long-term issues with foot function and mobility:
Delayed or Non-Union of the Bone
Due to limited blood supply in parts of the fifth metatarsal, particularly where Jones fractures occur, healing can be slow. If the fracture doesn’t heal properly (non-union), further treatment or surgery may be required.
Chronic Pain and Discomfort
Improper alignment or incomplete healing can result in ongoing pain, especially when walking, running, or standing for long periods.
Reduced Mobility
Persistent stiffness or instability in the foot can affect your ability to walk normally, participate in sports, or perform daily activities comfortably.
Secondary Arthritis
If the fracture involves a joint or isn’t properly aligned during healing, it may lead to post-traumatic arthritis in the surrounding joints over time.
Altered Gait Mechanics
To compensate for pain or instability, you may unconsciously change how you walk, which can strain other joints, potentially leading to knee, hip, or lower back issues.
At Access Ortho, we offer rapid appointments at our fracture clinics in Brisbane and Ipswich, providing prompt assessment, referral for X-rays, and treatment by experienced orthopaedic clinicians. Early diagnosis and specialist care can significantly decrease the chance of complications and help ensure a full recovery.
Diagnosis and Tests
How Are Fifth Metatarsal Fractures Diagnosed?
Orthopaedic specialists diagnose fifth metatarsal fractures through clinical evaluation and imaging studies to determine the fracture’s type, location, and severity. Key steps include:
Clinical Examination
The clinician will inspect the foot for swelling, bruising, and deformity, and palpate along the fifth metatarsal to identify areas of tenderness or instability.
Patient History Assessment
A detailed medical history helps determine if there are underlying risk factors such as previous injuries, bone health conditions, or recent changes in activity level.
Evaluation of Mechanism of Injury
Understanding how the injury occurred, whether from a twist, fall, or repetitive stress, helps guide diagnosis and suggests the likely type of fracture.
Pain Location and Severity Analysis
The precise location and intensity of pain can indicate whether the fracture is near the base (as in a Jones or avulsion fracture) or along the shaft, and whether soft tissue involvement is likely.
Which Tests Do Providers Use to Diagnose Fifth Metatarsal Fractures?
X-rays from Multiple Angles
Standard X-rays are the first-line imaging tool and are usually taken from several views to confirm the presence and alignment of a fracture.
MRI for Detailed Soft Tissue Evaluation
MRI scans may be used to assess for associated injuries to ligaments or tendons, or when pain persists despite normal X-ray findings, especially in stress-related cases.
CT Scans for Complex Fracture Patterns
CT imaging offers a more detailed look at complex or comminuted fractures and is helpful in surgical planning when multiple fragments or joint involvement are suspected.
Bone Scans for Stress Fractures
If stress fractures are suspected but not visible on X-ray, a bone scan may detect subtle changes in bone metabolism that indicate early injury.
Access Ortho has clinics in Brisbane and Ipswich, offering rapid appointments for quick and accurate diagnosis of fifth metatarsal fractures without needing a hospital visit.
Specific Considerations for Fifth Metatarsal Fractures
Jones Fracture vs. Avulsion Fracture
Understanding the difference between these common fracture types is crucial, as they have distinct healing profiles and treatment pathways:
- Jones Fracture: This fracture occurs in a zone of the fifth metatarsal with poor blood supply, approximately 1.5 to 3 cm from the base of the bone. It is often caused by repetitive stress or sudden trauma, such as twisting the foot while the heel is off the ground. Because of the limited vascularity, Jones fractures carry an increased risk of delayed healing or non-union and may require longer periods of non-weight-bearing or even surgical fixation.
- Avulsion Fracture: They are often referred to as a “dancer’s fracture.” This occurs when a tendon or ligament is overstretched and pulls off a small fragment of bone during an acute inversion injury (e.g., rolling the ankle). These fractures typically occur at the very base of the fifth metatarsal, an area with better blood flow, and usually heal well with conservative management, such as immobilisation in a moon boot and gradual return to activity.
Recognising which type of fracture is present helps guide decisions around imaging, immobilisation, surgery, and return to sport or daily activities.
Blood Supply Considerations
The fifth metatarsal has zones with variable blood flow, which can directly affect healing:
- The tuberosity (base) has relatively good vascularity, aiding the healing of avulsion fractures.
- The metaphyseal-diaphyseal junction, where Jones fractures occur, has a watershed area with limited blood supply, making it more vulnerable to complications like delayed union or non-union.
- This is why Jones fractures are treated more cautiously, and early identification is essential to avoid chronic problems.
Advanced imaging (such as MRI or CT) may be used to assess fracture complexity and healing progress, particularly for fractures in poorly perfused areas.
Weight-Bearing Implications
Weight-bearing protocols must be tailored to the fracture type and healing stage:
- Avulsion Fractures: Patients are usually allowed to weight-bear as tolerated in a moon boot, often progressing quickly to full activity within a few weeks if pain and swelling allow.
- Jones Fractures: These may require a period of non-weight-bearing to reduce the risk of delayed healing. In athletes or those with poor healing potential, surgical intervention may allow earlier mobilisation but still involves a careful return-to-load program.
Premature weight-bearing can compromise healing and increase the chance of re-fracture, so medical supervision is essential.
Management and Treatment of Fifth Metatarsal Fractures
How are Fifth Metatarsal Fractures Treated?
Treatment varies depending on the type, location, and severity of the fracture, as well as the patient’s activity level and overall health. Management typically falls into two broad categories:
Non-Surgical Management
Most fifth metatarsal fractures, especially avulsion fractures, can be treated without surgery. Key components of conservative care include:
- Immobilisation with a cast or moon boot protects the injured area and allows the bone to heal properly by preventing unnecessary movement. Depending on the fracture type and healing response, the duration of immobilisation typically ranges from 4 to 8 weeks.
- Protected weight-bearing: Patients may initially be advised not to put full weight on the affected foot. Based on pain levels and healing progress, a gradual increase in weight-bearing is introduced.
- Crutch or walking aid use: Assists in mobility while reducing stress on the healing bone. Use is typically reduced as recovery progresses.
- Physiotherapy: Once healing is established, physiotherapy helps restore strength, flexibility, and balance and supports a safe return to activity.
Surgical Fixation Techniques
Surgery is generally recommended for displaced fractures, Jones fractures with poor healing potential, or in high-demand patients such as athletes. Surgical options include:
- Internal fixation with screws: A common technique for Jones fractures. A metal screw is inserted along the shaft of the bone to provide compression and stability for healing.
- Plate fixation: Involves placing a metal plate and screws along the outside of the bone. This is typically used for more complex or comminuted fractures.
- Bone grafting procedures: Used when there is a risk of non-union or delayed healing, particularly in chronic or re-fracture cases. Bone grafts help stimulate healing in areas with compromised blood flow.
- Minimally invasive techniques: Some surgical procedures can be performed through small incisions to reduce soft tissue disruption, minimise scarring, and speed up recovery.
If surgery is required, the Orthopaedic team at Access Ortho will help arrange this for you.
Rehabilitation Protocols
Effective rehabilitation may be required for a full recovery, whether the fracture is managed surgically or conservatively. Key components typically include:
- Gradual weight-bearing and mobility progression: Under the guidance of your healthcare provider, you’ll move from restricted weight-bearing to walking normally as healing allows.
- Targeted strength training: Exercises are prescribed to rebuild strength in the foot and ankle, support stability, and reduce the risk of reinjury.
- Balance and proprioception work: This is especially important for athletes or those with previous ankle injuries, as it helps restore coordination and joint control.
- Return-to-sport planning: A tailored program ensures a safe, confident return to activity, with sport-specific demands considered.
Prevention
How Can I Prevent Fifth Metatarsal Fractures?
Preventative strategies focus on reducing stress on the foot and improving overall biomechanics:
- Proper footwear selection
Supportive, well-fitted shoes with appropriate cushioning help absorb impact and stabilise the foot during activity.
- Gradual activity progression
Increase intensity and duration of exercise slowly to allow bones and soft tissues to adapt and strengthen over time.
- Strengthening exercises
Building strength in the lower limb muscles help support the metatarsals and reduce injury risk.
- Balance training
Improves ankle stability and control, especially important for athletes and individuals with previous foot or ankle injuries.
- Technique modification in sports
Correcting faulty movement patterns, such as poor landing mechanics or uneven loading, helps minimise strain on the fifth metatarsal.
Outlook / Prognosis
What Can I Expect If I Have a Fifth Metatarsal Fracture?
Recovery typically involves:
- Pain management phases
Initial pain improves with rest, ice, and immobilisation; discomfort reduces as healing progresses.
- Activity modification
Temporary limits on walking, sports, or high-impact activities are common during early recovery.
- Return to function
Most patients regain normal foot function with appropriate treatment and rehab.
What is the Recovery Time from a Fifth Metatarsal Fracture?
Healing time depends on several factors:
- Fracture type and location
Jones fractures often take longer to heal than avulsion fractures.
- Treatment method
Surgical patients may resume weight-bearing sooner under guidance, while non-surgical recovery is typically more gradual.
- Patient factors
Age, bone health, and overall fitness can influence recovery speed.
- Compliance
Following medical advice closely improves healing outcomes and reduces complication risks.
When Should I See a Specialist?
When Should I Go to a Fracture Clinic?
You should seek specialised care from a fracture clinic like Access Ortho if you experience:
- Persistent pain
Pain that doesn’t get better with rest or over-the-counter measures may indicate a more serious injury.
- Visible deformity
Any unusual shape or angle in the foot after an injury requires urgent assessment.
- Inability to bear weight
If walking is extremely painful or not possible, prompt evaluation is recommended.
- Significant swelling or bruising
Excessive swelling or bruising over the outer foot can signal a fracture.
- Snap or crack at the time of injury.
Hearing or feeling a “pop” may indicate a bone break and should be investigated quickly.
What is a Fracture Clinic?
A fracture clinic is a medical service that diagnoses and manages bone, joint, and soft tissue injuries. At Access Ortho, we provide:
- Rapid access to orthopaedic specialists
Skip long emergency department waits with same-day or next-day appointments.
- Referral for imaging
X-rays and other diagnostic tests are arranged for immediate evaluation.
- Expert treatment plans
Our team tailors care to your specific injury, whether it requires a boot, physiotherapy, or surgical referral.
- Coordinated rehabilitation
We help streamline your recovery through guided rehab and return-to-activity programs.Whether you have a minor fracture or a more complex injury, Access Ortho offers expert, efficient care. It has fracture clinics in Brisbane and Ipswich.
Frequently Asked Questions About Fifth Metatarsal Fractures
Can I walk on a broken fifth metatarsal?
It depends on the fracture type. Some minor fractures allow weight-bearing in a boot, while others (like a Jones fracture) may require strict non-weight-bearing.
How long will I need to wear a boot for a fifth metatarsal fracture?
Typically 4–8 weeks, depending on the severity and healing progress.
Will I need surgery for my Jones fracture?
Not always, but surgery is often recommended due to poor blood supply and a higher risk of non-union.
What’s the difference between a fifth metatarsal fracture and a sprained ankle?
A fracture is when there is a break or crack in the bone, while a sprain affects ligaments. Both can cause swelling and pain and require structured treatment.
How soon can I return to sports after a fifth metatarsal fracture?
Most people return to sports within 8–12 weeks, but high-level athletes or surgical patients may take longer.
Can I drive with a broken fifth metatarsal?
Driving isn’t recommended until you can safely bear weight and control the pedals without pain, typically after the boot is removed.
Will my fifth metatarsal fracture heal completely?
With proper treatment and follow-up, most fractures heal well, though Jones fractures have a higher risk of delayed healing.
Do I need crutches for a fifth metatarsal fracture?
Crutches may be needed early on, especially if weight-bearing is restricted. Use will decrease as healing progresses.
What shoes should I wear during recovery?
Supportive, cushioned footwear is key. Avoid unsupportive shoes like thongs, flats, or high heels during recovery.
How can I tell if my fifth metatarsal fracture isn’t healing properly?
Signs include persistent pain, swelling beyond 6–8 weeks, or difficulty weight-bearing. Follow-up imaging may be needed.
Are fifth metatarsal stress fractures common in runners?
Yes, especially in those with increased training loads, poor footwear, or biomechanical issues like high arches.
What exercises help strengthen the foot after a fifth metatarsal fracture?
Exercises may include toe curls, marble pickups, resistance band work, and balance drills, ideally guided by a physiotherapist.