5th Metatarsal Neck Fracture

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Summary

5th metatarsal neck fractures result in pain and swelling in the outside part of the forefoot. They occur following an acute injury, often from jamming and twisting the foot against a solid object. The fracture occurs at the weak area of the bone. Treatment is usually non-operative in a walker boot, with limited mobilization through the heel. Occasionally the fracture will need to be repositioned so that it heals in an appropriate position.

Clinical Presentation

An acute injury to the outside part of the front of the foot (base of the little toe) may lead to a 5th metatarsal neck fracture. Symptoms will include pain, swelling, and great difficulty walking. Typically the injury will occur from a direct blow, such as dropping an object on the foot, or from jamming the outside of the foot against a solid object, often with an associated twisting motion.

Physical Examination

Physical examination will identify swelling in the outside part of the forefoot. The area will be painful to touch. If the fracture is displaced, the bone (5th Metatarsal head) may be prominently positioned, creating a lump against the skin either on top of the foot or in sole of the foot. There may be some sensation of numbness or tingling in the 5th toe. Very rarely will the blood supply to the 5th toe be affected.

Imaging Studies

X-ray of the foot will reveal the fracture. This will allow the physician to determine if the fracture is displaced, and whether the fracture position is acceptable to allow non-surgical treatment.

Treatment

Non-Operative Treatment

Treatment of 5th metatarsal neck fractures is usually non-operative. If the fracture is not displaced, or only minimally displaced, it will be treated with rest and immobilization to allow healing. Relative immobilization in a stiff sole shoe or walker boot for 6-8 weeks to allow for appropriate healing is usually adequate.  However, full recovery of function often takes many months.

If the bone is sufficiently out of position, it will need to be manipulated into a better position. Whether there is excessive displacement of the fracture is usually determined by the surgeon, based on the clinical examination and the x-ray findings.  If the bone is going to heal in a flexed position, or if allowing it to heal in its present position will cause a permanent lump on the bottom or side of the foot, then manipulating it back into a better position is indicated.  A manipulation involves moving the bone into an improved position, and may be done under local anesthetic. Once this has been done, typical non-operative treatment of relative immobilization and time to allow healing is instituted.

Surgical Treatment

Occasionally the fracture will be markedly displaced and surgery will be required. In this instance, the fracture may be manipulated back into place and stabilized with a wire (pin). In rare instances, it maybe necessary to open up the fracture and put a small plate on the fracture in order to stabilize it in an improved position. Once this has been done, the typical recovery again involves a period of immobilization in a stiff sole shoe or walker boot for 6 or more weeks, allowing for appropriate healing. The total recovery time before complete unrestricted activities may be resumed is often 6 months or more.


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