Fifth Metatarsal Fracture

Metatarsal fractures are common injuries of the foot which are the long bones in the mid foot.

• Some report a popping sound.

• Swelling and later bruising is common.

• Palpation of the fifth metatarsal is painful.

• Walking is normally possible with varying degrees of pain.

If you think you’ve broken the 5^th metatarsal seek medical help as soon as possible. NHS advise you call 111 or go to an urgent care centre. Click here for more information.

The team assessing a suspected fracture may take an X-ray – to determine whether a fracture is displaced or not displaced.  A displaced fracture is less common and may need to be properly lined up and stabilised. This may involve an anaesthetic and potentially metal pinning or plating of the bones.

Fifth metatarsal fracture usually presents with history of acute trauma or repetitive trauma to the forefoot. This may be due to sudden injury (an acute fracture), or due to repeated stress (stress fracture – link to stress fractures section). With acute fractures the most common mechanism of injury is an inversion injury where the forefoot is supinated (twisted round) and plantar flexed (pointing forwards). This results in pull from the lateral band of the plantar fascia (connective tissue) and Peroneus Brevis (muscles).

In adults, metatarsal fractures peak in the second to fifth decades of life. The most frequent fracture seen is the fifth metatarsal, accounting for 68% of metatarsal fracture.

At Pure, your Physiotherapist will ask for a detailed history of your symptoms, proceeded with a clinical examination to help provide an accurate and timely diagnosis. Obtaining a fast diagnosis will allow the most effective treatment to begin straight away, maximising the chances of achieving favourable outcomes.

Your clinician at Pure Physiotherapy will help guide you through the most appropriate treatment and management. The Physiotherapist may help work out a specific plan to modify activities which you may be struggling with due to your pain. The Physiotherapist can also answer any questions you may have about your pain, such as what is causing the pain and the likely recovery time with your rehabilitation programme.

Each fracture will require individual assessment and guidance it is likely, however, a walker boot and crutches are issued to help with walking.  Normally patients are permitted to put as much weight on your foot as comfort allows.  It is common if a boot or plaster shoe is issued, the individual can decide themselves when it is comfortable to wear normal shoes. To help reduce swelling and supporting the healing process, your Physiotherapist will recommend elevating your leg and applying cold packs on your foot.

Commonly after a foot injury, the strength in the leg and back muscles is reduced. Also our biomechanics (the way you walk/alignment of the feet/lower limbs) can change. Therefore, it is vital to ensure a phased/graded return to sport/activity to reduce to risk of re-injury and other subsequent conditions such as back and knee pain. Appropriate strength and conditioning is required for rehabilitation. Your Physiotherapist will use their expertise to devise a personalised and progressive exercise programme for you and with regular re-assessment, will make any necessary changes in your plan to help achieve optimal outcomes.

Your Physiotherapist will use hands on treatment techniques to help mitigate any joint stiffness that may develop from wearing a boot and will help normalise biomechanics and reduce pain. You will also be provided with ongoing advice so that you can continue to manage your symptoms and minimise the likelihood or re-injury.

Bowes, J. & Buckley, R. (2016). Fifth metatarsal fractures and current treatment. World journal of orthopedics, 7(12), 793.