Fractures of the 5th Metatarsal
Until you are able to see a doctor or surgeon, follow the “P.R.I.C.E.” rules:
- Protect your injured foot from further injury.
- Rest: Stay off the injured foot. Walking may cause further injury.
- Ice: Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
- Compression: An elastic wrap should be used to control swelling.
- Elevation: The foot should be raised slightly above the level of your heart to reduce swelling.
You can take simple over the counter pain-killers like panadol. In general, it's recommended you try to avoid using anti-inflammatories (like nurofen) in the early recovery period.
Simple stress fractures affecting the middle of the bone will often heal with basic care, including staying off your foot as much as possible, and wearing protective insoles or just thick shoes. The pain will then tend to gradually improve over weeks to months.
In breaks affecting the end and tip of the bone (Jones & avulsion fractures), the bone will often heal without needing surgery. You may however need to see a physiotherapist, who may suggest one or more of the following:
- Immobilization - keeping the foot and ankle still. Depending on the severity of the injury, the foot is kept in position with a cast, cast boot (sometimes called a 'moon boot'), or stiff-soled shoe. Crutches may also be needed to avoid placing weight on the injured foot (see non-weight-bearing).
- Progressive exercises. Exercises to strengthen the muscles and maintain the flexibility of the joints are very important. If you need to stay off your foot for long periods of time you may also need balance or 'proprioception' exercises.
- Manual therapy. The physiotherapist may feel you need specific massages or movements in the foot to keep muscles and joints felxible and supple.
- Bone stimulation. A machine applied for a short time to the outside of the foot is used to speed the healing of the bones - this is pain free. Bone stimulation, most commonly used for Jones fractures, may be used as part of the treatment or following an inadequate response to immobilization.
When is Surgery Needed?
Generally, surgery is only required when the break is severe or complicated. This may be due to:
- Poorly aligned bone fragments (displaced bone)
- Multiple breaks through or around the bone,
- When the break has failed to heal with a cast or shoe.
There are a number of different surgical options, and the appropriate choice will depend on your injury and individual wishes. This can be discussed with your surgeon at the time.
For more information on one type of surgery, see Surgery for Jones Fractures.