5^th Metatarsal Stress Fracture

A stress fracture to the 5^th MT (metatarsal) is commonly known as a 'Jones fracture' and strikes along the bone coming off the little toe into the body of the foot. It is less common than many sports injuries but can be problematic where it does occur. This injury is distinct from a 5^th MT avulsion fracture, which is provoked by force from a foot ligament and mostly connected to trauma or ankle twisting (see our article for further details).

Symptoms of Metatarsal Stress Fracture

Pain will be present midway along the outside of the foot, which can be a sharp pain or a chronic ache depending on the severity of the stress fracture. The pain is worsened during physical activity, especially weight bearing, and walking can become very difficult as a result. The injured party will often report some pain in the foot before the fracture is sustained; this is due to the gradual deterioration that leads to the injury. Most of the time it is easy to identify the moment of the fracture, and sometimes the symptoms arise on both feet.

Causes of MT Stress Fracture

A 5^th Metatarsal stress fracture is caused due to repetitive motions involving the outside of the foot, especially weight bearing or other movements characterised by high pressure to the mid foot. This happens over time, and is linked to overuse failures such as training with weakened muscles, lack of warm ups, and exercising for longer than you can feasibly sustain. However the final incident that leads to the fracture usually involves a heavy landing, such as in a fall or high impact sport like basketball, football or rugby. Other fairly demanding yet ordinary motions can also be the final movement before the fracture. Track athletes including sprinters and jumpers can be at risk. High arches on the feet are another common shared factor among those with the fracture, meaning that excess pressure is placed upon the outside of the foot. Worn and ineffectual shoes are also frequently reported.

Medical Treatment for Metatarsal Stress Fracture

These fractures can often be treated conservatively without any surgery, but they are regularly recurring due to the repetitive pattern of pressure on the foot remaining unchanged. This is exacerbated by the inadequate blood supply to the area, which can slow healing time. Conservative treatment usually utilises a cast or protective boot to restrict the amount of weight bearing for around 2 months, with the patient required to rest and to use crutches to get around. Anti-inflammatory pain medication can help to reduce some of the symptoms. The doctor will then assess the injury and inform you when you are ready to bear weight again and move on to gradual physical rehabilitation, stretching and strengthening the surrounding muscles before a full return to activity.

Surgery for Metatarsal Stress Fracture

Approximately 25% of cases result in operative treatment, particularly repeated fractures. The site of the fracture will be stabilised using a method such as fitting a metal screw, and after surgery the physical rehabilitation will follow a comparable program to that described above.

Prevention of Metatarsal Stress Fracture

The best method of prevention is to modify your sporting activities to consciously apply less pressure to the outside of the foot, and to use stretches to build strength in the feet.