Rehabilitation and Management of 5th Metatarsal Fractures: From Diagnosis to Full Recovery
Rehabilitation and Management of 5th Metatarsal Fractures: From Diagnosis to Full Recovery
Recently we’ve been seeing a big influx of foot fractures in the clinic, whether from an acute injury or bone stress injuries from overload or other underlying ffactors. Today we are going to talk about 5th metatarsal fractures in the foot. This is a common injury that can be painful and disruptive to daily life, and even then can sometimes be completely missed! Proper management is essential to ensure a full recovery and a return to pre-injury activity levels so let’s work through the identification, rehabilitation, and even discuss the potential surgical interventions for 5th metatarsal fractures.
What is the 5th Metatarsal
Let’s start with the anatomy of the 5th metatarsal. If you look at the image below you’ll see that the metatarsals are the long bones in the midfoot, numbered from 1 to 5 (with the 1st metatarsal being the bone connected to the big toe on the far right of the image). The 5th metatarsal is the bone that runs along the outside of the foot on the left of the image below and is particularly susceptible to fractures due to its position and the forces it encounters during walking, running, jumping etc.
Types of 5th Metatarsal Fractures
The above image has listed the 3 key fractures likely to be encounter and there general position of occurrence on bone. The severity and location of the fracture will determine the management approach we take. Lets discuss these 3 common fracture types:
Avulsion Fractures: The most common of the three, these occur when a small piece of bone chips away from the main metatarsal bone. This can be seen in the mage below. This is often the result of an ankle or foot roll where the peroneal muscle (attaching to the apophysis) of the lateral ankle pulls a small fragment of the bone off when put on stretch rapidly.
Jones Fractures: A Jones fracture is more severe than the avulsion and its location is further along the shaft in the green area shown above. The image below shoes the location of the Jones fracture across the body of the bone. It’s usually due to direct trauma or a significant force applied to the foot. These fractures will often take longer and are more likely to require surgical intervention.
Stress Fractures: Overload to areas of the body where repetitive stress on the bone over time causes a fracture is very common. Athletes and individuals engaging in high-impact activities like running and jumping are more susceptible to stress fractures. We are seeing too many of these at the moment! Not only are they sometimes tricky to identify but if not picked up quick can turn into more severe fractures if load management strategies are not addressed asap.
Identification and Diagnosis
In order to have the right management we first need to ensure we have correctly diagnosed the type of fracture. Let’s start with the common signs and symptoms you will likely feel if you have one of these types of fractures listed above:
· Pain along the outside of the foot, particularly while doing weight-bearing activities.
· Swelling and tenderness around the fractured area.
· Bruising or discoloration of the foot.
· Difficulty walking or weight bearing on the affected foot.
If this is you then its time to get it assessed by your physio and sent for an immediate scan starting with an Xray then progressing to MRI if more detail is required. This will help confirm the type and severity of the fracture so that the right plan can be put in place quickly.
Non-Surgical Management
While the treatment will vary depending on the degree and location of the fracture, conservative management is usually the first point of call. This is including avulsion and some stress fractures. Here’s what this management entails:
Immobilization: The critical step: BOOT IT! This restricts movement and allows the bone to heal properly. The duration of boot wear will vary depending on the severity of the fracture but your likely looking at somewhere between 4-6 weeks.
Rest and Elevation: The next classic step: DELOAD! You have a fracture, so rest is crucial for the healing process. Elevate the foot to help with swelling, and most importantly minimise weightbearing on the affected foot during the initial healing phase. No coastal walks please!
Pain Management: If your pain is bad in those early weeks it’s always good to speak to your GP to discuss appropriate pain relievers or prescription medications which can help manage pain and discomfort without disrupting healing processes of the body
Physiotherapy: After you’ve been correctly diagnosed and put in the boot you wont see us again until that boot is getting ready to come off. After diagnosis, our job is to then help you restore strength, stability, mobility, and normal function to the foot. We will guide you through a range of treatment starting with hands on manual therapy then a progressive exercise and strength program to improve range of motion and muscle strength and power.
Gradual Weight Bearing: We will also guide you through progressively loading your foot back up again safely. Once that boot comes off you aren’t running a marathon, there are many steps in between. This process should be gradual and done progressively, no short cuts!
Surgical Intervention
While conservative management is the first point of call there will be cases where surgery is required. Jones fractures, in particular, often require surgery due to their location and the limited blood supply to the area. Surgical options may include:
Internal Fixation: The most common surgical approach which utilises screws, wires, or plates to stabilise the segment that is fractured. This approach helps provide stability and align the bone for optimal healing.
Bone Grafting: We won’t see this as often, but there will be more advanced cases where the bone fragment hasn’t healed together even with fixation or is slow in its process (delayed union or non-union). This will help stimulate bone heeling more effectively.
Recovery and Rehabilitation
Rehabbing after a 5th Met fracture is a gradual process. The timeline for returning to pre-injury activity levels will vary for each individual and be dictated by the type of fracture and how there healing process goes based on individual factors. The rough timeline we often see recommended by orthopaedic surgeons will be 4-6 weeks booted followed by up to 12-16 weeks of Physio. In general here are the things you need to ensure you adhere to when making your way through the recovery process:
Follow Medical Advice: Its important to adhering to your healthcare provider’s instructions. To many times have we seen a fracture worsen or go from conservative management to requiring surgical intervention due to rushing through the steps and doing too much on your feet to quickly. This includes wearing the boot properly for the right amount of time, taking medications as they’ve been directed, and attending follow-up appointments to keep track of the healing along the way.
Physiotherapy: Physio is an integral part of recovery as there are steps that need to happen once you’re out of the boot. Your therapist will design an individualised program to help you regain strength, mobility and stability to get you back to your pre-injury activity levels without risk of reinjury. As always when it comes to physio and exercises, consistency is key!
Progressive Weight Bearing: Your physio in conjunction with your doctor or specialist will guide you through the gradual process of increasing weight bearing on the injured foot in an appropriate way that is specific to you so you don’t reinjure . Remember, we don’t skip steps!
Return to Activity: Returning to pre-injury activity levels is going to vary between individuals but as discussed above this decision will be made with your healthcare team. Factors such as the type of fracture, healing progress, and individual capacity play a role in this decision.
Prevention and Support: It’s always good to take into consideration reducing the risk of future fractures in the future. As such we need to look at addressing any underlying factors which may have contributed to your initial injury in the first place. This may involve gait analysis, shoe modifications, and maybe even orthotic support to prevent further injury.
Conclusion
So, what have we learnt? 5th metatarsal fractures are not only painful and limiting, but frustrating! BUT, with proper identification, treatment, and rehabilitation, you will fully recovery and return to your pre-injury activity levels. Remember that your road to recovery may be longer than expected, but with patience, consistency and not trying to skip the steps, you can get back on your feet and back to your active lifestyle.
References
Title: 5th Metatarsal Fracture Website: https://motusspt.com/5th-metatarsal-fracture/ Publisher: Motus Physical Therapy Accessed on: 30/10/23
Title: Metatarsal Foot Fractures – Emergency Department Website: https://www.rch.org.au/clinicalguide/guideline_index/fractures/Metatarsal_Foot_Fractures_-_Emergency_Department/ Publisher: Royal Children’s Hospital Melbourne Accessed on: 30/10/23
