The size of the fractured fragment may vary considerably. X-ray of the foot will reveal an avulsion (“pulling off”) fracture of the base of the 5th metatarsal. However, they usually are able to perform the action though with decreased strength compared with the opposite side. Doing this usually creates some discomfort for the patient. This assesses for continuity of the tendons that evert the foot. This is done by placing the foot in an everted position and asking them to maintain that position against some resistance. On exam, it is determined if the patient can still move their foot to the outside (eversion of the foot). However, the main tenderness will be at the base of the 5th metatarsal. There may be tenderness over a large area of the outside of the foot. When pressing on the outside of the foot, there will be marked tenderness at the base of 5th metatarsal.
Figure 2: Twisting mechanism causing injury Patients who have suffered a 5th metatarsal base avulsion fracture will give a history of a twisting injury to their ankle and foot (inversion plantarflexion injury), similar to what occurs with an ankle or foot sprain (Figure 2). It will be associated with quite specific local tenderness over the base of the bone, on the outside of the foot (the 5th metatarsal).
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Over time, the skin can turn black and blue. Difficulty with balance due to weakness of the peroneus brevis also occurs. It can be associated with significant swelling. This will produce immediate pain over the outside aspect of the foot. Figure 1: 5th Metatarsal Avulsion FractureĪ patient who suffers an acute rolling of their ankle can also injure the base of the 5th metatarsal (See Figure 1). Some clinicians refer to this type of fracture as a “Dancer’s Fracture.” However, more commonly a “Dancer’s fracture” is considered a spiral fracture of the 5th metatarsal shaft that was originally described in Dancer’s. This type of injury needs to be differentiated from a “ Jones fracture“, which occurs slightly further towards the center of the 5th metatarsal. Impact activity, such as running or sports can take up to 6 months for complete bone healing.
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It often takes 12 or more weeks for a full recovery to occur. It typically takes about 6 weeks for adequate bone healing to occur, before patients can start to significantly increase their activity level. In most instances, this type of fracture can be treated non-operatively, with relative immobilization in a walking boot combined with limited weight-bearing.
The major muscle that controls lateral foot balance, the peroneus brevis, also attaches at the base of the 5 th metatarsal and can be a source of increasing pain if not allowed to rest. A Dancer’s fracture causes localized pain, swelling, and difficulty walking. During an avulsion injury, a variable size fragment of bone at the base of the 5th metatarsal is pulled off by a strong plantar ligament that is attached to this part of the bone. Summary 5th Metatarsal Avulsion Fracture HandoutĪ twisting injury to the ankle and foot may cause an avulsion (pulling off) fracture of the base of the 5th metatarsal – the bone that attaches the little toe to the midfoot (Figure 1).
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