The fifth metatarsal is the long bone on the outer edge of the foot that connects to your smallest toe, sometimes called the pinky toe.
You have five metatarsals in your foot. Each metatarsal connects one of the five toes to the bones of your ankles (the tarsals). The metatarsals help with arch support and balance.
A fracture of the fifth metatarsal may be a result of a trauma, injury, or from repeatedly putting stress on the bone. When it comes to foot injuries, fractures (breaks) in the fifth metatarsal are fairly common.
Fractures of the fifth metatarsal can be divided into types called “zones.” The zone is related to the location of the break. Treatment and recovery time often depend on the zone.
Fractures of the fifth metatarsal can happen to anyone, but they’re more common in athletes and dancers.
Sometimes they’re a result of trauma or injury. In some cases, the fracture happens more slowly over time as stress on the foot builds up from repeated use.
A fifth metatarsal fracture can be caused by an injury. Examples include:
- dropping something heavy on the foot
- getting the foot crushed in a football tackle
- rolling the ankle
- landing awkwardly on the foot while jumping
- suddenly changing direction while running, walking, or dancing
- injuring the foot in a car collision
- falling or slipping
Overuse and stress
Repetitive stress from activities such as running, dancing, or sports such as soccer and basketball can lead to an eventual break in the fifth metatarsal over time. This is called a stress or hairline fracture. It’s the result of overuse or repetitive actions, especially when you don’t allow yourself time to heal between activities.
People who have obesity or who experience sudden extreme weight gain may also be at risk of a stress fracture in the fifth metatarsal because the excess weight puts stress on the foot.
Researchers have developed a classification system to help define the different types of fifth metatarsal fractures according to their location. A system known as the Lawrence and Botte classification is most frequently used today.
This system classifies fractures into three zones:
- Zone 1: avulsion fractures
- Zone 2: fractures at the metaphyseal-diaphyseal junction, or Jones fracture
- Zone 3: proximal diaphyseal fractures, also called dancer’s fracture
Zone 1 (avulsion fracture of the 5th metatarsal)
Zone 1 fractures, or avulsion fractures, involve the part of the fifth metatarsal that’s closest to your ankle. Avulsion means “pulling or tearing away.” In an avulsion fracture, the bone is pulled off the fifth metatarsal bone by a tendon or ligament.
Avulsion fractures are often caused by an injury during an athletic activity. For example, if you land awkwardly after a jump or if you roll your ankle. They’re sometimes called pseudo-Jones fractures.
Zone 2 (Jones fracture of the 5th metatarsal)
Zone 2 fractures are also called Jones fractures. These fractures occur at the part of your fifth metatarsal close to the joint that meets the fourth metatarsal. This is called the metaphyseal-diaphyseal junction.
Jones fractures are caused by repetitive stress (stress fracture) or trauma, such as dropping something heavy on the foot.
A stress fracture is a tiny hairline fracture that occurs slowly over time. Pain in the foot might increase over many months before the bone breaks.
Zone 3: (mid-shaft fracture or dancer’s fracture)
Zone 3 fractures occur in the middle section (shaft) of the metatarsal. They’re usually the result of trauma or twisting. They’re sometimes called dancer’s fractures.
A zone 3 fracture can also occur at the ‘head and neck’ of the metatarsal. This is the part closest to the pinky toe.
These fractures can also be caused by repetitive stress (stress fracture).
The most common symptom of a fifth metatarsal stress fracture is pain on the outside of the foot. The pain worsens when weight is placed on the foot. The pain may build up in intensity over time.
Other symptoms of a stress fracture of the fifth metatarsal include:
- bruising on the outside of the foot or near the pinky toe
- difficulty walking
Contact a doctor or healthcare professional if you’re experiencing pain, swelling, or tenderness on the outside of the foot that makes it difficult to walk.
You should get medical help right away if you’ve had a sudden injury or trauma.
While you wait to see a doctor, keep your weight off your foot and follow the RICE method:
If a doctor finds out that you have a fracture in one of the bones of your foot, they may refer you to an orthopedic surgeon for treatment.
A doctor will ask you questions about your symptoms such as when the pain started and if it began after a trauma or injury.
They might also feel around the foot and put pressure on the foot to find out where the pain is coming from.
Imaging tests can help a doctor see if there are any fractures in the bones of your feet. A doctor may order one or more of the following:
Treatment depends on the location of the fracture, but most fractures of the fifth metatarsal can be treated conservatively without surgery.
Immobilization and rest
You should stay off your injured foot as much as possible. A doctor might also recommend that you elevate the foot slightly above the level of your heart to reduce swelling.
You may need surgery to fix a fracture of the fifth metatarsal if there are multiple breaks, if the bone is displaced too far to heal on its own, or if the fracture fails to heal after a period of rest and immobilization.
Zone 2 and 3 fractures are prone to not healing properly and might need surgery more often than zone 1 fractures.
Some surgical options include:
- placing a screw to stabilize the bone and hold it in place while healing occurs (most common)
- using special plates, wires, pins, or bands to stabilize the bone
- using bone marrow aspirated stem cells or bone grafts to speed up healing
Most fractures of the fifth metatarsal fracture heal in
In some cases, especially with zone 2 or 3 fractures, the bone won’t heal properly.
If you’re an athlete, a doctor might recommend surgery for a zone 2 or 3 fracture right away to minimize the risk of nonunion (failure of the bone to stay together). Surgery might also help shorten the amount of time you’ll have to be away from competing in your sport.
You’ll only be allowed to return to sports if your symptoms are completely gone and an X-ray confirms that the fracture has healed. It’s possible to refracture the bone if you return to vigorous physical activity too early, so it’s important to listen to your surgeon’s advice.
Many fractures of the fifth metatarsal happen when athletes land incorrectly after a jump. You can’t always prevent a fifth metatarsal fracture. But if you’re a dancer or athlete, you might be able to do exercises that help you stabilize the ankle and foot while running or jumping.
It’s important to make foot stretching and strengthening exercises part of your routine. If you feel pain on the outside of your foot after high intensity training, you might be able to prevent a stress fracture by taking a break from training. Wearing proper shoes with support for your ankle and foot can also help prevent injuries.
A fifth metatarsal fracture is a common type of foot injury. Here are the answers to some frequently asked questions:
Can you walk on a 5th metatarsal fracture?
Walking will be painful if you have a fifth metatarsal fracture. To allow the bone to heal, you shouldn’t walk without a cast or a boot and crutches to keep weight off the foot. Walking on a fifth metatarsal fracture could delay or disrupt healing of the bone.
How long does it take for a 5th metatarsal fracture to heal?
A fifth metatarsal fracture typically heals in about 6 to 8 weeks after wearing a cast or a boot.
Two weeks after surgery, you’ll likely be able to do light physical activity that keeps weight off the foot, such as swimming, and gradually progress to putting weight on the foot after 6 weeks. In most cases, the fracture will heal more quickly the more you rest and immobilize the foot after your injury. It may take a few months before you’re able to return to sports or vigorous physical activity.
Fractures that occur in the outer bones of the foot are called fifth metatarsal fractures. They’re common injuries in athletes or dancers but can happen to anyone. A doctor might refer to the fracture as an avulsion fracture, Jones fracture, or dancer’s fracture, depending on which part of the bone is broken.
Fractures of the fifth metatarsal can usually be treated with rest and immobilization of the foot over the course of a few weeks. In some cases, surgery is needed to help the bones heal properly. Always speak with a doctor before returning to physical activity or sports.