- Discussion:
- the most common frx of the base of the 5th metatarsal (over 90%);
- may be due to pull of the lateral cord of the plantar aponeurosis
- most often this frx is extra-articular, w/ the frx lying proximal to the metatarsocuboid joint;
- commonly seen in dancers;
- frx may be associated w/ lateral malleolar frx;
- Radiographs:
- frx lines tend to be oriented more transversely to the joint;
- evidence of fracture healing lags behind radiographic union;
- Diff Dx:
- Jones fracture:
- Normal Apophysis:
- usually present between the ages of 9 to 14 years;
- apophyseal line runs parallel to shaft of metatarsal along its lateral-inferior margin of the tubercle;
- it does not extend proximally into the joint;
- Os peroneum:
- ossicle in peroneus longus tendon where it is seen at the tip of the fifth metatarsal base;
- is seen in 15% of population;
- Non Operative Treatment:
- short leg wt bearing cast for 4-6 wks;
- controversies:
- some authors advocate by a hard sole cast shoe and some (Wiener, et al (1997)) advocate a soft dressing;
- even if there is radiographic evidence of delayed union or non-union, the patient's symptoms are usually minimal;
- Operative Treatment:
- indicated only for displaced or very large avulsion frx, which extend into the cuboid-metatarsal joints
Fractures of the fifth metatarsal. Analysis of a fracture registry.
Treatment of fractures of the fifth metatarsal: a prospective study.