Feet Pics for When the Foot Tricks: A Discussion of Base of the 5th Metatarsal Fractures

 

Written by: Hannah Weisman, MD PGY-1; Edited by: Timothy Khowong, MD, MSEd

 

Teaching Goals:

  1. Define the 3 main types of base of the 5th metatarsal fractures 

  2. Learn how to recognize each fracture type 

  3. Understand the management of each type of fracture

Bony Anatomy of the Foot:

Classifying Base of the 5th Metatarsal Fractures: The Lawrence and Botte 3-Zone Classification

Physical Exam Features of Base of the 5th Metatarsal Fractures: 

  • Pain, swelling, and ecchymosis over lateral border of forefoot 

  • Point tenderness to palpation over the base of the 5th metatarsal 

  • Pain with weight bearing or inability to bear weight

Zone 1: Pseudo-Jones Fracture:

Mechanism: Inversion injury. Caused when bony fragment is detached by  ligament or other connective tissue 

  • On imaging the fracture line extends into metatarsocuboid joint 

Management:  

  • Weight bearing as tolerated  

  • Discharge home in a hard-soled shoe  

  • May require a walking boot for 1-2 weeks for comfort 

  • Likely to heal on its own due to good perfusion 

Pseudo-Jones Fractures

Zone 2: Jones Fracture

Mechanism: Forefoot adduction. Located at the Metaphyseal-diaphyseal junction (4th 5th metatarsal articulation)

The proximal 5th metatarsal has unique blood supply with a watershed area at the metaphyseal-diaphyseal junction. Fractures in this area are at a high risk for non-union due to the fracture interrupting the  already limited blood supply in this area

Management:  

  • Non-weight bearing for 6 weeks 

  • Short leg posterior splint, requires ortho follow up within 1 week

Left: Jones Fractures

Top: Watershed area at metaphyseal-diaphyseal junction.

Zone 3: Stress Fracture

Mechanism: Occurs from Repetitive microtrauma (stress fracture) 

  • Proximal diaphyseal fracture (distal to 4th-5th metatarsal articulation), instead of well-defined fracture lines, stress injuries may have widened fracture lines with surrounding  cortical thickening 

  • Stress fractures typically occur within 1.5 cm of the metadiaphyseal junction, slightly  distal to the site of a Jones fracture. 

  • Associated with cavovarus foot deformities or sensory neuropathies

Management: 

  • Non-weight bearing x6 weeks 

  • Short leg posterior splint, requires ortho follow up within 1 week

Stress fracture of 5th metatarsal

Take Home Points:  

  1. Location matters 

  2. These fractures are common with ankle sprains 

  3. Jones and stress fractures must be splinted with close ortho
    follow-up!!

Summary:

  • Zone 1: Heal very well, non-union is rare, can resume activities as tolerated

  • Zone 2/3: Despite immobilization non-union can develop 

    • High-caliber athletes are frequently treated with intra-medullary screw fixation

    • Non-union can lead to pain, difficulty ambulating, and possible need for surgery in the  future 

    • Given similar mechanism, have high index of suspicion for 5th metatarsal fractures in  typical ankle sprains

 
 

References: 

1.Fractures of the Base of the Fifth Metatarsal Bone: A Critical Analysis Review.

JBJS Reviews. 2021. Bušková K, Bartoníček J, Rammelt S.Review

2.Common Foot Fractures.

American Family Physician. 2024. Silver S, Williams E, Plunkett ML.Review

3.The Intraosseous and Extraosseous Vascular Supply of the Fifth Metatarsal: Implications for Fifth Metatarsal Osteotomy.

Foot & Ankle International. 2013. McKeon KE, Johnson JE, McCormick JJ, Klein SE.

4.Fractures of the Proximal Fifth Metatarsal: Selecting the Best Treatment Option.

The Journal of the American Academy of Orthopaedic Surgeons. 1995. Dameron TB.

5.Minimally displaced fracture involving the fifth metatarsal base.

Voio Radiology Database. VoioClinical Imaging

6.Fractures of the Proximal Fifth Metatarsal.

American Family Physician. 1999. Strayer SM, Reece SG, Petrizzi MJ.Review

7.National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in

Athletes.

Journal of Athletic Training. 2013. Kaminski TW, Hertel J, Amendola N, et al.Guideline

8.Bilateral Symptomatic Os Vesalianum Pedis: A Case Report.

The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons. 2011.

Dorrestijn O, Brouwer RW.Case

9.Lateral Foot Pain Due to Os Vesalianum Pedis in a Young Football Player; A Case Report and Review of the Current

Literature.

Skeletal Radiology. 2019. Aykanat F, Vincenten C, Cankus MC, Kose O, Sindel M.Review

10.Treatment Strategies for Acute Fractures and Nonunions of the Proximal Fifth Metatarsal.

The Journal of the American Academy of Orthopaedic Surgeons. 2000. Rosenberg GA, Sferra JJ.Review

11. Diagnosis and Management of Common Foot Fractures.

American Family Physician. 2016. Bica D, Sprouse RA, Armen J.Review

12. Return to Play and Fracture Union After the Surgical Management of Jones Fractures in Athletes: A Systematic Review

and Meta-Analysis.

The American Journal of Sports Medicine. 2021. Attia AK, Taha T, Kong G, et al.SR

13.Acute Fractures to the Proximal Fifth Metatarsal Bone: Development of Classification and Treatment Recommendations

Based on the Current Evidence.

Injury. 2012. Polzer H, Polzer S, Mutschler W, Prall WC.Review

14.Initial Assessment and Management of Select Musculoskeletal Injuries: A Team Physician Consensus Statement.

Medicine and Science in Sports and Exercise. 2024. Herring SA, Kibler WB, Putukian M, et al.Guideline

15. https://www.aafp.org/afp/2024/0200/common-foot-fractures (bony anatomy of foot)

16.Qureshi P, Dameron-Lawrence-Botte classification of proximal 5th metatarsal fractures. Reference article,

Radiopaedia.org (Accessed on 15 Jun 2026) https://doi.org/10.53347/rID-47848

17.https://coreem.net/core/jones-fractures/

18.Hanouneh S, Avulsion fracture of the 5th metatarsal tuberosity. Case study, Radiopaedia.org (Accessed on 15 Jun 2026)

https://doi.org/10.53347/rID-231106

19.https://radiologykey.com/lower-limb-iii-ankle-and-foot-2/

20.https://www.physio-pedia.com/Metatarsus_Adductus

21.Gaillard F, Dixon A, Stress fracture of the 5th metatarsal. Reference article, Radiopaedia.org (Accessed on 15 Jun 2026)

https://doi.org/10.53347/rID-7647

22.Mous A, Niknejad M, Jones fracture. Reference article, Radiopaedia.org (Accessed on 15 Jun 2026)

https://doi.org/10.53347/rID-1537

23.Yonso M, Jones fracture. Case study, Radiopaedia.org (Accessed on 15 Jun 2026) https://doi.org/10.53347/rID-99899

 
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