Fractures (breaks) are common in the fifth metatarsal -- the long bone on the outside of the foot that connects to the little toe. With an increase in public interest in physical fitness, clinical practitioners are diagnosing metatarsal fractures with greater frequency. Fifth metatarsal fractures are fairly common, especially in older women who may be in menopause.
There are two types of fractures that can happen in the metatarsals -- acute fractures due to an acute (sudden) injury to the foot, which are commonly due to dropping a heavy object onto the foot, a fall or a sporting injury, and stress fractures due to overuse or repetitive injury to a normal metatarsal bone. The type of acute fractures in the metatarsal is based on where it is located.
Avulsion fracture
In an avulsion fracture, a small piece of bone is pulled off the main portion of the bone by a tendon or ligament. This type of fracture is the result of an injury in which the ankle rolls. Avulsion fractures are often overlooked when they occur with an ankle sprain.
Jones fracture
Jones fractures occur in a small area of the fifth metatarsal that receives less blood and is therefore more prone to difficulties in healing. A Jones fracture can be either a stress fracture (a tiny hairline break that occurs over time) or an acute (sudden) break. Jones fractures are caused by overuse, repetitive stress or trauma. They are less common and more difficult to treat than avulsion fractures.
Other types of fractures can occur in the fifth metatarsal. Examples include mid-shaft fractures, which usually result from trauma or twisting and fractures of the metatarsal head and neck.
Causes
Acute metatarsal fractures can be caused by direct injury to the foot, for example, someone stepping on or kicking your foot. Twisting of the foot or the ankle can typically cause fractures of the base of the fifth metatarsal. In this injury, the twisting mechanism pulls on a strong ligament that attaches to the base of the fifth metatarsal that then pulls off a fragment of bone. The shaft of the metatarsal is commonly injured because of twisting of the foot on landing from a jump. This is a common problem in ballet dancers.
Metatarsal stress fractures generally occur due to overuse. They most commonly affect the second and third metatarsal bones, as these bones have the most amount of stress placed on them when you are moving. They tend to occur in people who have recently increased the intensity, duration or frequency of their exercise. They can occur after new footwear, insufficient rest or continuing to exercise despite the presence of foot pain. Sometimes metatarsal stress fractures can occur in someone who has an underlying problem affecting the bones, such as rheumatoid arthritis, osteoporosis or diabetes.
Symptoms
Avulsion and Jones fractures have the same signs and symptoms -- pain, swelling and tenderness on the outside of the foot. Difficulty walking and bruising may occur.
Diagnosis
Anyone who has symptoms of a fifth metatarsal fracture should see a podiatrist as soon as possible for proper diagnosis and treatment. To arrive at a diagnosis, the podiatrist will ask how the injury occurred or when the pain started. The foot will be examined with the doctor gently pressing on different areas of the foot to determine where there is pain.
The podiatrist will also order x-rays. Because a Jones fracture sometimes does not show up on initial x-rays, additional imaging studies may be needed.
Non-surgical treatment
Until you are able to see a foot and ankle surgeon, the "R.I.C.E." method of care should be performed:
Rest: Stay off the injured foot. Walking may cause further injury.
Ice: Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
Compression: An elastic wrap or brace should be used to control swelling.
Elevation: The foot should be raised slightly above the level of your heart to reduce swelling.
The foot and ankle surgeon may use one of two non-surgical options for treatment of a fifth metatarsal fracture - immobilization or bone stimulation.
Depending on the severity of the injury, the foot is kept immobile with a cast, cast boot or stiff-soled shoe. Crutches may also be needed to avoid placing weight on the injured foot.
Bone stimulation is a pain-free external device used to speed the healing of some fractures. Bone stimulation, most commonly used for Jones fractures, may be used as part of the treatment or following an inadequate response to immobilization.
When surgery is needed
If the injury involves a displaced bone, multiple breaks or has failed to adequately heal, surgery may be required. The foot and ankle surgeon will determine the type of procedure that is best suited to the individual patient.
o For more information email us at foothealth242@hotmail.com or visit www.apma.org. To see a podiatrist visit Bahamas Foot Centre, Rosetta Street, telephone 325-2996 or visit Bahamas Surgical Associates, Albury Lane, telephone 394-5820 for an appointment.

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