Broken 5th Metatarsal

joeycarson1,

The only way to know for sure, if the metatarsal is fractured, is to have it x-rayed.

The shaft of the 5th metatarsal does not heal as readily as the base. In the base of the 5th metatarsal, there is a lot of cancellous bone, which makes healing much easier. That is not to say that the fracture will not heal, almost all do with a little immobilization and time. But, in the statistical analysis of 5th metatarsal fractures, there more cases of nonunion in the shaft, than in the base.

(Make sure we are on the same page, the head of the metatarsal is towards the toes and the base in back towards the ankle.)

If the fracture is in the head of the metatarsal, it is necessary to make sure that the fracture line does not involve the metatarsalphalangeal joint (MTPJ). If it is intraarticular, then surgery may be necessary.


So, if you have a well aligned fracture, without undue angulation or rotation, then a short period of immobilization is usually all that is necessary. The type of immobilization depends upon how tender the patient is. Some patients are so tender that a short leg cast with a toe plate is required. While others can get by with stiff soled shoes or boots.

It usually takes about 4 to 6 weeks for a metatarsal to unite. But, this time does not include the time for rehabilitation. If a patient is out of activity for a few days to weeks, muscle atrophy and cardiac deconditioning occurs. That will all have to be rehabbed.


In rare cases, if the fracture cannot be reduced and is stable, then surgery may be needed. In these cases, either an intramedullary screw or a plate/screws is placed on the metatarsal.


So, if you are concerned that this is a fracture, you should probably have it x-rayed. If it is broken, treatment depends upon where the fracture is located, if it is displaced, and the patient's pain level.

Good luck.

Gaelic-

I would like to ask a quick question. I fractured my 5th metatorsol at the base on October 8, 2012. I was in an air cast with no crutches for 2 weeks. This x-ray showed cacification(healing??). The doctor was pleased so then told me I could wear a post op shoe. 2 1/2 wweks later(today) I had another x-ray but this time showed little healing. I am being referred to a surgeon-yikes! I have no swelling and very little pain. I am back to a boot. I almost feel I should have never been taken out of the air cast boot! Is this type of injury a hard one to heal? Maybe giving more time in the air cast would start the healing again? I would like to avoid a surgery if at all possible.

Thanks for any advice!

CRD3

CRD3,

There are actually several different fracture patterns in the base of the fifth metatarsal. Not all base of the fifth fractures are the same.

So, the first thing that needs to be determined is what type of fracture you actually have. Some fractures in the base of the fifth heal readily and can basically be treated like a sprained ankle.

But, the reverse is also true, a certain fracture pattern in the base is notorious for difficulty in healing. This pattern can often go on to a nonunion. Thus, this pattern is commonly treated surgically.


Sometimes, if the fracture is slow in healing, going to more immobilization (either with a fracture brace or a short leg cast) and maybe limiting weight bearing, will help the fracture heal. However, it is known that a little stress across a fracture will stimulate the body to heal it a little quicker. This is known as Wolff's Law - bone will respond to the stresses applied to it. But, it is a fine line. You want just the right amount of stress; not too much, not too little.


When you see the orthopedic surgeon, discuss the fracture pattern and what the usual treatment is for it. Tell the surgeon that you would prefer to avoid surgery if possible. The surgeon should take your wishes into account when developing a treatment plan. You never have to have surgery, if you do not want to. It is the surgeon's job to advise you of the options available to you, to give you the risks versus benefits, and then it is basically up to you to decide what you want to do.


Good luck.