Fractures of the fifth metatarsal

Abstract

Fractures of the fifth metatarsal are common injuries in athletes and active individuals. Overuse injuries and stress fractures of the metatarsals were first described in the nineteenth century military recruits and soldiers after intense training. Fifth metatarsal fractures in athletes have more recently been described in a wide variety of sports, running, and ballet. The anatomy of the fifth metatarsal and its soft tissue attachments lead to a variety of injury patterns based on different mechanisms of injury. Footwear selection, shoe-surface interface (cleats, turf), and foot type (cavovarus, adductus) may also play a role in acute and chronic injuries patterns. Diagnosis of fifth metatarsal fractures can generally be made after a complete history and physical exam along with three-view radiographs of the foot. For chronic overuse injuries and stress fractures not visible on plain radiographs, CT imaging may help confirm the diagnosis. Treatment recommendations range from conservative treatment, with limited weight bearing and immobilization, to surgery. The treatment of choice depends on the fracture pattern and location, and the goals and expectations of the patient. Competitive athletes have a unique set of demands and expectations, which often drive management decisions, with an emphasis on rapid recovery and return to sport. Operative versus non-operative treatment decisions directly affect rehabilitation, return to sport, union rates, and risk for re-injury. The purpose of this chapter is to review the literature related to fifth metatarsal fractures in athletes. The basic and surgical anatomy is reviewed along with various fracture classifications systems. Diagnosis and treatment options are discussed by fracture type, along with functional rehabilitation for athletes.