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What is a fifth metatarsal fracture?

The fifth metatarsal is the long bone on the outside of the foot leading to the little toe.

Fractures near its base are common following twisting injuries, falls or ankle sprains.

The exact location of the fracture is important because different areas have different blood supplies and therefore different healing potential.

What symptoms and signs might I experience?

• Pain on the outside of the foot.
• Swelling.
• Bruising.
• Difficulty putting weight through the foot.
• Tenderness around the base of the fifth metatarsal.

How is it diagnosed?

X-rays are usually sufficient to identify the fracture.

Additional imaging may occasionally be required if the fracture is difficult to see or if there is concern about delayed healing or another associated injury.

How is it treated without surgery?

Many fifth metatarsal fractures heal successfully without surgery.

Treatment may include:

• A supportive shoe or walking boot.
• Weight-bearing according to the fracture type and      pain.
• Activity modification.
• Elevation.
• Pain relief.
• Gradual return to activity.
• Follow-up X-rays where required.

When might surgery be considered?

The decision depends on the location, displacement and type of fracture.

Jones fractures occur in an area with a relatively poorer blood supply and can have a higher risk of delayed healing or non-union.

Surgery may be considered for:

• Significantly displaced fractures.
• Fractures that fail to heal.
• Symptomatic non-union.
• Selected athletes or highly active patients where      early return to activity is particularly important.

What might surgery involve?

Surgery commonly involves screw fixation. Plate and screw fixation or bone grafting may be required in selected cases, particularly for delayed healing or non-union.

What is recovery like?

Recovery varies according to the type and location of the fracture.

Some fractures heal within several weeks, whereas Jones fractures can take longer. Return to sport should generally be guided by clinical and radiological evidence of healing.

When Should I Seek Further Medical Advice?

You should seek medical assessment if you have:

• Severe or worsening pain.
• Inability to put weight through the foot or ankle.
• Significant swelling or deformity.
• Increasing redness or warmth.
• New numbness or weakness.
• A wound or exposed bone.
• Symptoms following significant trauma.
• Persistent pain despite appropriate treatment.
• Recurrent ankle instability or giving way.
• Increasing difficulty with normal activities.
• New or rapidly developing foot drop.

What happens at a foot and ankle assessment?

Your assessment will usually include a detailed discussion about your symptoms, how they affect your activities and what treatments you have already tried.

Your foot and ankle will then be examined, including your:

• Alignment.
• Walking pattern.
• Joint movement.
• Strength.
• Tendons and ligaments.
• Foot and ankle stability.
• Neurovascular function.

Where appropriate, investigations may include weight-bearing X-rays, ultrasound, MRI or CT.

Importantly, an abnormal scan or X-ray does not necessarily mean that you need surgery. Imaging findings are considered alongside your symptoms and examination findings.

Your treatment plan

Treatment should be tailored to you.

Depending on your condition, this may include:

• Advice about footwear.
• Activity modification.
• Physiotherapy and rehabilitation.
• Orthotics or braces.
• Medication.
• Injections.
• Further investigations.
• Surgical treatment where appropriate.

The aim is to find the least invasive treatment that is likely to give you a meaningful improvement in pain and function.

Where surgery is recommended, we will discuss the expected benefits, potential risks, alternatives and recovery period so that you can make an informed decision about your treatment.