5th Metatarsal

Summary

The proximal (base) 5th metatarsal can be divided into 3 sections - the tuberosity, metaphysis and diaphysis. The tuberosity articulates with the cuboid while the metaphysis articulates with the base of the 4th metatarsal. The intermetatarsal joints are plane type synovial joints that allow slight gliding movements. The lateral band of the plantar fascia attaches the base of the 5th metatarsal tuberosity. The peroneus brevis muscle, which everts the foot, attaches to the lateral tuberosity.

Blood supply to the proximal 5th metatarsal is via the metaphyseal arteries and nutrient artery. The metaphyseal arteries supply the tuberosity while the metaphysis and proximal diaphysis receive blood supply from the nutrient artery. Fractures of the metaphyseal/diaphyseal junction are therefore more likely to have problems with non-union.

Fracture Type

Management

Follow-up

Tuberosity fracture

Walking boot for 4-6 weeks

Weight bear as tolerated

No running for 3 months

GP; 4-6 weeks post injury

Acute metaphyseal/diaphyseal fracture

Short leg backslab

Non weight bearing

Fracture clinic/orthopaedic follow-up within 7-10 days

Proximal diaphyseal stress fracture

Short leg backslab

Non weight bearing

Fracture clinic/orthopaedic follow-up within 7-10 days

Classification

Based on anatomical location.

Presentation

Mechanism of injury

  • Tuberosity fracture: inversion with foot in plantarflexion.
  • Acute metaphyseal/diaphyseal fracture: forefoot adduction.
  • Proximal diaphyseal stress fracture: repetitive microtrauma.

Assess

  • Onset, duration and quality of pain.
  • Palpate for area of tenderness.
  • Weight bearing status (usually possible but painful).
  • Neurovascular status.
  • Evaluate surrounding structures.

Imaging

X-ray: AP, lateral and oblique foot views.

ED Management Options

Tuberosity Fracture:

  • Walking boot (e.g. CAM boot) for 4-6 weeks as pain dictates, weight bear as tolerated.
  • No running for 3/12.

Acute metaphyseal/diaphyseal fracture

  • Short leg backslab (including toes), non-weight bearing.

Proximal diaphyseal stress fracture

  • Short leg backslab (including toes), non-weight bearing.

Referral and Follow Up Requirements

Fracture Type

Urgency

Follow-up

Tuberosity fracture

Non urgent

GP; 4-6 weeks post injury

Acute metaphyseal/diaphyseal fracture

Non urgent

Fracture clinic/orthopaedic follow-up within 7-10 days

Proximal diaphyseal stress fracture

Non urgent

Fracture clinic/orthopaedic follow-up within 7-10 days

Potential Complications

Non or delayed union: especially with acute metaphyseal/diaphyseal and proximal diaphyseal fractures.

Patient Advice

Pain from the fracture and restriction of movement is usual for 2-3 weeks and will require regular, then analgesia as required

ECI Pain Management Patient Factsheet

ECI Care of Paster Casts Patient Facthsheet

ECI Crutches Patient Factsheet

Further References and Resources

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