The Commonly Fractured 5th Metatarsal
The Thunder reported that Kevin Durant, the NBA’s reigning Most Valuable Player, will be reevaluated in six weeks after undergoing surgery on 10/16/14 for a Jones fracture. Unfortunately, he is more likely to be sidelined for 10 to 12 weeks. Dr. Lowell Scott Weil, the team Podiatrist for the Chicago White Sox, remarked “Because the fracture forms over time, and Durant is unsure of when it occurred specifically, there’s really no telling how severe it is and how long it will take to heal. There’s a good chance he has been playing on a fractured foot for a few weeks, which could significantly lengthen his recovery. The worst thing he could do is return too soon.”
The 5th metatarsal is the one of the most common bones fractured in the foot. Situated just below the pinky toe, the anatomy of this bone influences the type of fracture that develops. The metatarsal itself is comprised of a base, tuberosity, shaft, and head. A Jones fracture is located slightly anterior to the tuberosity (1 cm from the joint, closer to the toes than the tuberosity fracture). The Jones fracture takes a longer time to heal because of the poor blood supply at this particular location in the bone. Treatment can be either conservative or surgical, depending on the patient’s age, health, and activity level. Conservative treatment involves 6-8 weeks of strict non-weightbearing cast immobilization, followed by a few additional weeks of weightbearing boot or cast immobilization. Surgical treatment, which consists of exposing the metatarsal and placing plates and / or screws across the fracture, is generally recommended for athletes and more active individuals and allows shorter periods of immobilization with faster healing times.
The tuberosity, which is the posterior-most aspect of the bone near the midfoot, is clinically evident as it protrudes laterally (some people complain that this rubs in their shoes). Tuberosity fractures, also known as avulsion fractures, can be displaced or non-displaced. The position of the fracture will determine the type of treatment. For non-displaced fractures, the treatment is conservative and focuses mainly on symptoms. This includes protected weightbearing in a hard-soled walking boot or a short-leg walking cast. Pain usually resolves after a few weeks, and healing of the fracture fragment itself is evident on x-ray after approximately 6-8 weeks post-injury. These types of fracture generally heal well with no long-term complications. Larger, displaced fragments are commonly treated surgically, which varies from percutaneous pinning (making a small cut in the skin and inserting a screw without having to expose the entire metatarsal) to open reduction with internal fixation site, similar to that described for Jones fractures.
Common to both types of fractures are soft tissue attachments found at the base of the 5th metatarsal. A tendon (peroneus brevis) from the lateral leg compartment courses down into the foot and attaches at the base of the metatarsal. The lateral band of the plantar aponeurosis (which can occasionally be the culprit of the infamous heel pain known as “plantar fasciitis“) also attaches here. These two soft tissue structures have the potential to pull at the fracture fragment, thus causing possible displacement and may complicate fracture healing. This is why it is extremely important to seek treatment at Tooele Medical Group Foot & Ankle Clinic if you suspect that you have sustained a 5th metatarsal fractures.