5th Metatarsal Avulsion Fracture

What Is A 5th Metatarsal Avulsion Fracture?

A 5th metatarsal avulsion fracture is a common foot injury. This type of fracture occurs when there is enough force a small piece of bone is pulled from the base of the 5th metatarsal in the foot. This type of injury is often seen in sports activities such as dancing, running, basketball, or soccer. Sports where jumping and landing as well as sudden directional changes are common.

Types of 5th Metatarsal Fractures

The 5th metatarsal is one of the most common fractures in the foot, and it is particularly vulnerable to avulsion injuries. In the case of the 5th metatarsal, here are a few different types of fractures.

• Dancer’s Fracture: The most common type of avulsion fracture of the 5th metatarsal is known as a “Dancer’s Fracture.” This injury occurs at the base of the 5th metatarsal where the peroneus brevis tendon attaches. It typically happens when a sudden twisting motion or forceful supination of the foot pulls the tendon, causing a small fragment of bone to break off.
• Avulsion fracture of the 5th metatarsal styloid: Less common type of avulsion fracture involving the 5th metatarsal styloid. The small bony prominence on the outer side of the foot near the base of the little toe. This fracture is caused by an injury to the peroneus brevis tendon, similar to the dancer’s fracture but located more proximally on the bone. This type of fracture generally heals well with non-surgical treatments. However, frequently still requires the use of a moon boot to protect the bone during the early healing phase.

Other Non-Avulsion 5th Metatarsal Fractures

• Jones Fracture: A Jones fracture refers to a specific type of fracture located at the base of the 5th metatarsal, at the junction between the shaft and the metaphysis (the area near the middle of the bone). Unlike a dancer’s fracture, which is an avulsion injury, the Jones fracture involves a break at a different location. It can be more difficult to heal due to its location in an area with limited blood supply meaning healing may take longer, and surgical intervention is sometimes required. 
• A stress fracture of the 5th metatarsal is another type of fracture seen in this part of the foot. An overuse injury rather than traumatic like the above mentioned fractures. Occurring due to repetitive loading often seen in athletes and individuals engaging in high-impact activities particularly in runners, dancers. 

Treating an Avulsion Fracture of the 5th Metatarsal?

Treatment for a 5th metatarsal avulsion fracture as with any injury generally depends on the severity. In most cases, the injury can be treated conservatively. Starting with rest, ice, compression, and elevation. Given many of these fractures can occur in area where healing is challenging immobilization via a CAM walker is frequently prescribed. In an attempt to protect the healing bone and avoid non-union. 

If the fracture is severe, surgical intervention may be deemed necessary to reattach the bone fragment to achieve optimal healing. 

Is an Avulsion Fracture a Real Fracture?

Yes, an avulsion fracture is a real fracture. Although it might seem less severe than a ‘classic break’ to the shaft of the bone. It still involves the separation of bone from the main structure. And is therefore a “real fracture” requiring appropriate care to promote healing, prevent complications and achieve a full recovery. 

Physio Rehabilitation for a 5th Metatarsal Avulsion Fracture

Recovery from a 5th metatarsal avulsion fracture varies depending on the severity of injury. For mild cases, physiotherapy can begin as soon as the initial swelling and pain subside. Looking to encourage early weight bearing and controlled exercise. Physios work with their patients to regain range of motion, strength, and balance control in the foot and ankle. All while protecting the healing bone. In more severe cases, patients may need to wait longer until cleared by their specialist for ‘active therapy’.

Physiotherapy looks to help patients restore their function through;

• Gait re-education as needed
• Range of motion exercises
• Strengthening exercises for the foot and ankle
• Proprioception and balance exercises 
• functional and sport specific re-training 
• Education regarding appropriate prophylactic taping, brace and support use on return to sport

As you progress through the rehabilitation process, your physiotherapist will work with you to gradually increase the intensity of your exercises. The goal is always to return to pre-injury activity levels as timely and safely as possible. All prescribed exercise programs are primary concerned with protecting the healing bone and appropriate safe progression. 

Preventing Future Injuries

Incorporating balance and proprioception training into your routine can improve overall foot and lower limb stability. In doing so helping prevent future ankle sprains or fractures. This aspect of rehabilitation is particularly important following a 5th metatarsal avulsion fracture. At Sydney Physio Clinic we would like to consider that following proper rehabilitation protocols. As well as using appropriate return to sport prophylatic supports most patients can return to their normal activities and prevent further injury.