Dr. Bigas Bonamusa is a renowned specialist in Sports Medicine and Traumatology in Barcelona. With more than 20 years of experience, he is an expert in knee and shoulder pathology. He currently directs the Padel Clinic and the Runner and Cyclist Clinic, both in Barcelona.
How does a fracture of the 5th metatarsal of the foot occur?
It is a very common injury among athletes (soccer, tennis, …). Lately it has become famous for having been suffered by the PSG soccer player: Neymar.
The fifth metatarsal located in the lateral area of the foot, connects to the little toe. It has a small size, but it is very important in the biomechanics of the foot. The fracture usually occurs due to a bad jump, especially on uneven surfaces. There are two types of fracture of the fifth metatarsal:
- Avulsion fractures: This is a tearing of the base of the bone by a ligament or tendon. It is usually the result of an ankle or foot (tarsal) sprain. It often goes undiagnosed after an ankle sprain.
- Jones fracture: It is the most complex and frequent. It is located in an area of the fifth metatarsal with poor blood supply. It has a slower healing time. It also usually occurs after ankle or foot sprain (tarsus). Although they can be caused by microtrauma or repetitive stress in the metatarsal area.
Many of the patients who have suffered a Jones fracture have a varus-supinator foot, and this can be a predisposing factor for the development of the fracture, due to the increased stress to which the fifth metatarsal is subjected. Few people know that Leo Messi suffered this same injury when he was young.
The most frequent symptom is immediate pain in the lateral area of the foot, after a sprain, accompanied by swelling. Pain is characteristic when resting the foot on the ground.
How to treat a fracture of the 5th metatarsal of the foot?
It is necessary to perform X-rays or X-rays for an accurate diagnosis of the injury. It is important to place an ice pack on the foot and to start immobilization of the foot (compressive bandage) as soon as possible. It is also necessary to try to maintain the foot elevated, without support.
Depending on the severity of the fracture, a plaster boot, 3-4 weeks (avulsion fracture) and a posterior ankle brace may be sufficient.
In the case of complex fractures of the 5th metatarsal (Jones fracture), they are more difficult to treat due to a possible delay in bone healing of the fracture. This is because the middle zone of the bone (5th metatarsal diaphysis) is poorly irrigated.
All this leads to two possibilities for treatment:
- Surgical intervention, placing a screw or nail. In 4 weeks, rehabilitation can begin. It is usually the treatment of choice for athletes, allowing an early support of the foot, with a rate of consolidation of the fracture of 100%. Thus, recovery is accelerated.
- You can opt for plaster boot. Healing with a cast will be slower than the surgical process and requires immobilization for 6 to 8 weeks. The support of the foot is delayed. It is recommended in non-athletic patients.
In all the cases (surgical or Botina plaster), a later rehabilitating treatment (4 weeks) in addition to a sport readaptation is necessary, in case of sportsmen.
In all cases, a gait study by a podiatrist is recommended. The use of plantar orthoses (insoles varus foot), help to a faster recovery as well as to the prevention of a new fracture.