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 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 with an associated twisting motion.
Physical Examination
Physical exam 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 against the skin on top or the 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 recover of function often takes many months.
If the fracture is significantly displaced, a closed reduction may be required. This is essentially a manipulation of the fracture back 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. In rare instances, it may necessary to open up the fracture and put a small plate on the fracture in order to stabilize it into 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 to allow for appropriate healing. The total recovery time is often 6 or more months.
Revised 12.31.2011
