Metatarsal fractures are referred to as long bone fractures. As a long bone, treatment for these types of fractures varies depending on the location of the fracture and the extent of the damage both to the bone and to the neurovascular supply to that bone.
Treatment of these fractures should be individualized, based on the patients health status, ambulatory needs, and clinical presentation.
Fractures of the fifth metatarsal usually are treated similarly to other metatarsal fractures. Due to the increased weight bearing load of the first and fifth metatarsal bones, extra care should be taken to ensure adequate alignment, compression of the fracture fragment (s) and immobilization to allow proper bone healing.
There are basically four (4) types of 5th metatarsal fractures. Head & Neck fractures, Midshaft, Avulsion, and a unique type of fracture known as a “Jones Fracture”.
A Jones Fracture is a break in the fifth metatarsal that occurs in-between the mid shaft portion of the bone and the posterior or base of the metatarsal. This is not to be confused with an “Avulsion Fracture”, where a small piece of bone breaks off due to the pull of a ligament or tendon. This type of injury usually is caused by “inversion” or rolling in of the ankle.
The Torg classification system is commonly used by physicians to determine proper treatment based on radiographic findings. Due to the high rate of nonunions in these type of fractures (caused by the disruption of the blood supply to the metatarsal fracture site), this classification system allows proper treatment based on the severity of the fracture line.
The Torg system is divided into 3 types of fractures. Type I and II usually are treated conservatively with a non-weightbearing cam walker or cast for 6-8 weeks. This is followed up with gradual weight bearing in a tall or short walking boot. Some Type II fractures may require surgery depending on the patient and activity level (athlete). Type III fractures usually are displaced fractures (separated) and should be treated surgically with fixation devices to hold the two bones together. This is followed up with a non-weight bearing cast or cam walker.
Follow up x-rays are usually taken after the fracture to determine the healing stage of the fracture site.
Whatever treatment options are indicated by your physician, it is important that the patient follow instructions to the letter. Non-unions are very common with this type of fracture and may result in months or years of pain, swelling and disability.