What is a fifth metatarsal fracture?
A fifth metatarsal fracture is a break in the long bone on the outside of the foot that connects to the little toe. It is one of the most common foot fractures we see, typically caused by a twisting injury, a rolled ankle, or a direct blow to the outside of the foot. Because the fifth metatarsal sits along the foot's outer edge, it takes on significant stress whenever the ankle rolls or the foot is planted awkwardly during sports or a misstep on uneven ground.
There are two main types of fifth metatarsal fracture, and telling them apart matters because they heal differently:
- Avulsion fracture — a small piece of bone is pulled off the main portion of the bone by a tendon or ligament, most often from an ankle-rolling injury. These generally heal well with conservative care.
- Jones fracture — occurs in an area of the bone with reduced blood supply, near the base of the fifth metatarsal. Jones fractures are less common and more difficult to treat than avulsion fractures, and they carry a higher risk of delayed or incomplete healing.
If your pain is centered more around the ankle joint itself rather than the outside of the midfoot, it may be worth comparing symptoms with our ankle fractures guide, since the two injuries can happen together and are sometimes confused for one another.
What are the symptoms of a fifth metatarsal fracture?
Symptoms typically appear right after the injury and include:
- Pain, swelling, and tenderness on the outside of the foot
- Difficulty walking or bearing weight on the affected foot
- Bruising around the injured area
- Pain that intensifies when the outside of the foot is pressed or when trying to stand
Because these symptoms overlap with a sprained ankle, it is easy to mistake a fifth metatarsal fracture for a simple sprain. If pain and swelling are significant or you cannot put weight on the foot, it is worth having it evaluated rather than assuming it is "just a sprain."
What causes a fifth metatarsal fracture?
Most fifth metatarsal fractures result from an acute injury — an ankle that rolls or twists suddenly, a hard landing after a jump, or a direct impact to the outer foot. Avulsion fractures are especially common alongside ankle sprains, since the same twisting motion that stretches or tears ankle ligaments can also pull a fragment of bone away from the fifth metatarsal. Jones fractures can result from a single traumatic injury or can develop gradually from repetitive stress on the bone, particularly in athletes.
How do we diagnose a fifth metatarsal fracture?
Diagnosis starts with a physical examination of the foot, checking for tenderness, swelling, and areas of point pain along the outside of the foot. Your podiatrist will also ask about how the injury happened, since the mechanism of injury helps distinguish an avulsion fracture from a Jones fracture. X-rays confirm the diagnosis, show the exact location and pattern of the break, and help determine whether the bone fragments are aligned or displaced. In some cases, additional imaging such as a CT scan or MRI may be used to get a clearer picture of a Jones fracture or to check for a stress fracture that is not yet visible on X-ray.
How is a fifth metatarsal fracture treated?
Treatment depends on which type of fracture you have, whether the bone is displaced, and how active you are. Initial first aid follows the R.I.C.E. method — Rest, Ice, Compression, and Elevation — to control swelling and pain right after the injury.
Non-surgical treatment
- Immobilization in a walking boot, cast, or stiff-soled shoe to protect the bone while it heals
- Activity modification and limited weight-bearing, especially for Jones fractures, which heal more slowly
- Bone stimulation devices, which use gentle electrical or ultrasound signals to support healing in cases where bone repair is slow
- Custom orthotics or supportive footwear during the return-to-activity phase — see our custom orthotics options
Surgery
Surgery may be needed when the bone fragments are displaced, when there are multiple fractures, or when a fracture — particularly a Jones fracture — fails to heal with conservative treatment. Surgical fixation, typically with a screw placed down the length of the bone, can also be recommended for competitive athletes who need a faster, more predictable return to activity. Your podiatrist will walk you through the risks and benefits of surgical versus nonsurgical care based on your specific fracture pattern.
What is recovery from a fifth metatarsal fracture like?
Recovery time varies with fracture type and treatment. Avulsion fractures generally heal within several weeks in a boot or supportive shoe, with a gradual return to normal footwear and activity. Jones fractures take longer to heal because of the bone's limited blood supply in that area, and they require closer follow-up to confirm the bone is knitting together properly before returning to full activity. Following your weight-bearing restrictions closely is one of the most important factors in avoiding a delayed union or re-fracture.
When should you see a podiatrist for a foot injury?
See a podiatrist any time you have significant pain, swelling, or bruising on the outside of your foot after a twisting injury, or if you are unable to bear weight comfortably. Even if you suspect "just a sprain," an evaluation with an X-ray is the only reliable way to rule out a fracture and make sure it is treated correctly from the start. When you are ready, you can request an appointment at either of our Northern Utah offices.
Why choose Wasatch Foot & Ankle Institute?
Wasatch Foot & Ankle Institute is a locally rooted podiatry practice serving Farmington, South Ogden, and the surrounding Davis and Weber County communities. Our board-certified, fellowship-trained physicians focus exclusively on the foot and ankle, from acute injuries like fifth metatarsal fractures to complex reconstructive care.
That focus lets us offer on-site X-rays, casting and bracing, and — when needed — surgical fixation under one roof, so your care can move forward without unnecessary delays or referrals. We treat patients from both of our clinics; learn more about our Farmington and South Ogden locations or call the office nearest you.
Medically reviewed by the physicians at Wasatch Foot & Ankle Institute. Our board-certified, fellowship-trained podiatrists provide foot and ankle care in Farmington and South Ogden, Utah. This page is for general education and is not a substitute for an in-person evaluation.