Slideshow
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Figure 1. Anteroposterior view of fifth metatarsal fracture.
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Figure 2. Oblique view of the fifth metatarsal.
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Figure 3. Lateral view of the left foot.
A 35-year-old man presents with left foot pain after tripping up the stairs 2 days ago. He developed pain and swelling over the lateral aspect of his foot and is having trouble bearing weight on the left foot. On physical examination, tenderness to palpation over the fifth metatarsal and moderate lateral foot swelling is noted. Radiographic views are shown in Figures 1, 2, and 3.
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Metatarsal fractures are among the most common orthopedic injuries seen in the urgent care setting. Injury mechanism varies from overuse type (stress related), low impact from twisting of the foot (most common), or a traumatic high energy impact (less common). The second metatarsal is the most common site of stress fractures whereas the fifth metatarsal is the most common for all other types of fractures.1,2
Most metatarsal fractures can be treated nonoperatively with a weight-bearing cast or boot with no difference in outcomes between the two.1 Surgical indications for first metatarsal fractures include angulation greater than 10°, greater than 3 to 4 mm of displacement, articular involvement, and the presence of rotational deformity or shortening.1 Normal length and alignment of the first metatarsal are critical to prevent weight transfer to the other metatarsals during ambulation.
Central metatarsal (2-4) fractures have more stability because of the surrounding soft tissue attachments.1 Indications for surgery for central fractures include significant sagittal plane deformity (>10°), greater than 4 mm of translation, and multiple bones involved.1
Fractures of the proximal fifth metatarsal are broken into Zone 1 (metatarsal base avulsion fractures), Zone 2 (metaphyseal-diaphyseal junction or Jones fractures), and Zone 3 (proximal diaphyseal fractures).1 Zone 1 fractures account for 93% of proximal fifth metatarsal fractures. A spiral fracture of the distal fifth metatarsal diaphysis is often called a Dancer’s fracture.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopedics for Physician Assistants.
References
1. Sarpong NO, Swindell HW, Trupia EP, Vosseller JT. Metatarsal fractures. Foot Ankle Orthop. 2018;3(3):2473011418775094. doi:10.1177/247301141877
2. O’Malley MJ, Hamilton WG, Munyak J. Fractures of the distal shaft of the fifth metatarsal: “dancer’s fracture.” Am J Sports Med. 1996;24(2):240-243. doi:10.1177/036354659602400223.
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