Proximal fifth metatarsal fractures

NewsBot · Jan 18, 2026

Gait changes in daily life during the healing process of fifth metatarsal fracture: a case report
Shota Suzuki et al
J Med Case Rep. 2026 Jan 17.

Background: The fifth metatarsal is a major component of the lateral longitudinal arch of the foot. Damage to this area reduces foot function and impairs gait. Furthermore, immobilization used to treat fractures causes muscle weakness and contracture of the ankle joint, which impedes walking. Most studies on gait after fractures have been conducted in controlled laboratory environments, and the limitations of gait on patients' daily lives remain unclear. This case report aimed to quantitatively demonstrate the decline in gait function in daily life after a fifth metatarsal fracture and to report its duration and recovery over time.

Case presentation: This report describes a 39-year-old Japanese man who sustained a tuberosity avulsion fracture of the fifth metatarsal after slipping and falling on stairs. The fracture was immobilized with a splint, and the patient was instructed to use crutches for ambulation. The splint was removed 4 weeks post-injury, and crutches were discontinued. Daily walking was measured using inertial sensors embedded in insole devices worn on both feet. Walking speed and stride length decreased after the fracture and then gradually improved, reaching prefracture values 16 weeks postfracture. A significant decrease in the left push-off angle was observed, which decreased from approximately 77° before fracture to 54°. However, it improved weekly and reached prefracture values at 16 weeks. A decrease in the contact angle of the right foot was also observed, which took approximately 16 weeks to improve.

Conclusion: This is a case report on the temporal changes in gait pattern pre- and postfracture in a patient treated conservatively for a fifth metatarsal fracture. The fifth metatarsal fracture and subsequent immobilization strongly suggest a decrease in push-off force on the injured side during walking. This also affects the movement of the right lower limb. Decreased push-off on the fractured side reduces propulsion and limits the walking performance in daily life. Walking speed improved after 16 weeks, and this improvement was consistent with an improvement in the push-off angle. As this report measured gait in daily life, the patient's real-life mobility was affected for 15 weeks after the fracture.
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NewsBot · Jan 27, 2026

A Novel Classification System for Fifth Metatarsal Base Fractures Is Reliable and Clinically Validated
Randall E Marcus et al
Clin Orthop Relat Res. 2026 Jan 22.

Background: One goal of classifying fractures at the base of the fifth metatarsal is to reliably identify which fracture patterns have an increased risk of delayed union and nonunion and therefore merit consideration for operative fixation. The most common classification system of proximal fifth metatarsal fractures is the three-part Lawrence and Botte scheme, which has been shown to have poor interobserver and intraobserver reliability and can be ambiguous in terms of clinical treatment and prognosis. In particular, the assignment of the middle classification (Type II) has unclear implications for treatment and prognosis.

Questions/purposes: We developed a two-part classification system based on prior anatomic and biomechanical studies that we performed, and we asked: (1) What is the interobserver and intraobserver reliability of the system? (2) What association does it have with the risk of delayed union or nonunion?

Methods: This novel classification system was based on previous work on the effect of the peroneus brevis insertion on fracture stability. The fractures were divided into two categories, avulsion or indirect, based on their location with regard to the peroneus brevis footprint and with regard to the mechanism of injury. Fractures were considered avulsion if they occurred as the result of a direct avulsive force as ascertained by whether they were located within the peroneus brevis footprint. Fractures were considered indirect if they occurred as a result of a bending moment applied to the fifth metatarsal and were located outside of the peroneus brevis footprint. In that previous study, we used 10 cadaver specimens, and we simulated two loading conditions on the peroneus brevis tendon: (1) fractures within the peroneus brevis insertion (avulsion) were found to be stable and (2) fractures distal to the peroneus brevis footprint (indirect) were found to be unstable. The mean length of the peroneus brevis footprint on those specimens was 15 mm. This corresponded regardless of foot size to anatomic and radiographic features of the base of the fifth metatarsal. The most distal lateral extent of the avulsion fracture was 15 mm from the tuberosity. The most distal medial extent was proximal to the point where the curve of the articular surface of the base of the fifth metatarsal changes direction (inflection point). The most proximal lateral extent of the indirect fracture was distal to 15 mm from the tuberosity. The most proximal medial extent was distal to the inflection point of the curve of the base of the fifth metatarsal. To evaluate the reliability of this classification system, 30 sets of initial presentation radiographs composed of 10 fractures previously clinically diagnosed as representing each of the three zones in the Lawrence and Botte system were used. These radiographs represented a diverse pool of fractures chosen without knowledge of the patients' clinical outcome and without knowledge of the care provided. The 30 sets of radiographs were evaluated and classified by nine orthopaedic surgeons and three orthopaedic foot and ankle fellows to determine interobserver reliability for the proposed two-part system. Four weeks later, the same set of radiographs was reevaluated in random order to determine intraobserver reliability for the two-part classification system. Kappa and intraclass correlation values for interobserver and intraobserver reliability were calculated. For clinical validation, 23 of 30 patients were followed to complete healing as determined by symptomatology and radiography. The groups were too small for us to perform statistics, so we evaluated outcomes qualitatively.

Results: The novel two-part classification of proximal fifth metatarsal fractures demonstrated high interobserver reliability of κ = 0.92 and intraobserver reliability of κ = 0.85 to 1.00. All four indirect fractures treated with closed management went on to nonunion. Two of the remaining 11 indirect fractures, all treated with internal fixation, experienced healing complications, including one nonunion and one refracture, possibly as a result of incomplete healing. Seven of eight avulsion fractures treated with internal fixation healed primarily. One displaced avulsion fracture was treated with excision.

Conclusion: This novel two-part radiographic classification system of proximal fifth metatarsal fractures based on the anatomy and biomechanical effect on fracture stability of the peroneus brevis tendon insertion demonstrated high interobserver and intraobserver reliability. It substantially outperformed the Lawrence and Botte three-part scheme as well as other recently studied two-part classification schemes. This two-part classification system distinguishes fractures resulting from avulsion or indirect injury, providing surgeons with guidance in determining treatment and prognosis. It therefore warrants consideration for use in both clinical and research applications.
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NewsBot · Mar 26, 2026

Risk Factors for Union Deformities in Fifth Metatarsal Fractures: A Scoping Review
Date Van der Meij et al
Source

Background
Union deformities are relatively common in proximal fifth metatarsal (5MT) fractures following both conservative and surgical treatment. Several risk factors have been identified to guide risk prediction and management. This review aimed to summarize factors contributing to delayed or nonunion in 5MT fractures.
Methods
A literature search for studies reporting risk factors for 5MT fractures was performed using PubMed/Medline, EMBASE, ScienceDirect, Web of Science, and CINAHL databases. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Data on bone healing rates, complications, fracture zones, treatment approach, and healing outcomes were collected and summarized.
Results
The initial search identified 668 articles, of which 13 met inclusion criteria, including over 1000 cases. Multiple risk factors were significantly associated with impaired union in 5MT fractures. Fracture zone (particularly zone 2), a plantar gap >1 mm, small screw diameter, and early return to activity before radiographic healing were the most consistent predictors of delayed or nonunion. Surgical treatment led to faster union but higher rates of delayed union and refracture. Bone grafting and larger screw diameters significantly improved union outcomes.
Conclusion
Healing outcomes in 5MT fractures are influenced by multiple risk factors, with fracture zone, fracture chronicity, and fixation strategy being the most significant contributors to union deformities. Identifying high-risk patients and tailoring treatment may reduce nonunion and improve recovery. Further high-quality studies are warranted to establish standardized definitions, treatment protocols and risk stratification models.
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NewsBot · Apr 6, 2026

Clinical and Biomechanical Determinants of Fixation Failure in Fifth Metatarsal Fractures: Implications for Surgical Decision-Making
Robert Daniel Dobrotă et al
J. Clin. Med. 2026, 15(5), 1680; https://doi.org/10.3390/jcm15051680

Objectives: To provide a mechanism-oriented integration of clinical and biomechanical evidence regarding fixation failure in fifth metatarsal fractures, with particular emphasis on Jones and diaphyseal stress fractures, and to clarify the mechanical determinants that influence construct performance under physiologic gait-related loading. Methods: A narrative, concept-driven review was conducted focusing on experimental biomechanical investigations and clinically relevant outcome studies addressing cyclic shear, bending, torsion, interfragmentary gap behavior, and loading direction. Special attention was given to studies employing advanced experimental models, including three-dimensional printed anatomical constructs combined with digital image correlation (DIC), to evaluate fixation strategies under simulated gait-phase loading conditions. Literature selection was guided by thematic relevance to construct mechanics and clinical fixation outcomes rather than systematic retrieval criteria. Results: Available evidence indicates that fixation constructs relying predominantly on interfragmentary compression demonstrate increased sensitivity to imperfect reduction, interfragmentary gaps, and multidirectional cyclic shear forces, particularly during midstance loading. Experimental models suggest that loading angle and gap size significantly influence stress concentration and failure patterns. Plate-based and hybrid constructs may provide improved resistance to cyclic bending and shear in specific experimental conditions, maintain stability in the presence of small fracture gaps, and distribute mechanical loads more uniformly across the fracture site. These biomechanical characteristics may help explain reported clinical patterns of delayed union, refracture, and hardware failure in high-demand patients or in cases with cortical compromise. Conclusions: Fixation failure in fifth metatarsal fractures appears to result from the interaction between fracture morphology, patient-specific loading demands, and construct biomechanics. Mechanism-based integration of biomechanical findings with clinical context may support individualized surgical decision-making. However, given the heterogeneity of available clinical data and the inherent limitations of experimental models, biomechanical insights should be interpreted as hypothesis-generating and complementary to clinical judgment rather than prescriptive guidance.
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NewsBot · Jun 19, 2026

Clinical Outcomes and Complications of Surgical and Conservative Treatment for Jones Fractures: A Systematic Review
Rodrigo Encinas , Sarah Hall Kiriluk, Stuart DePaolo, J Benjamin Jackson 3rd, M Kareem Shaath, Tyler Gonzalez
J Am Acad Orthop Surg. 2026 Jun 22.

Background: Forefoot fractures are among some of the most common orthopaedic injuries. Treatment of zone 2 fifth metatarsal or Jones fractures is controversial and many times dependent on surgeon preference. Management of these injuries remains without clear guidelines. Accordingly, the goal of the current systematic review is to compare the clinical outcomes and complications for both surgical fixation and conservative treatment.

Methods: Two independent authors completed a systematic review using the PubMed, EMBASE, and Cochrane Library databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol and Cochrane Handbook guidelines were followed. In addition, the Methodological Index for Non-Randomized Studies score was used to evaluate the quality and bias of the nonrandomized controlled trials. Our criteria included only studies that reported on both conservative and surgical treatment of Jones fractures.

Results: Ten studies including 998 patients met our criteria for inclusion. A total of 787 patients underwent conservative management while 211 patients underwent surgical fixation. The surgical cohort had a significantly lower rate of total complications (18/211 (8.5%)) in comparison with the conservative cohort (123/787 (15.6%; P = 0.02). Similarly, those who underwent surgery had a lower rate of nonunion (7/211 (3.3%) versus 91/787 (11.6%; P = 0.04)). Patient-reported outcome scores, including American Orthopaedic Foot and Ankle Society scores were significantly better at final follow-up in the surgical group (96.5) in comparison with the conservative group (84.1; P = 0.005).

Conclusion: This systematic review found markedly fewer total complications, a lower nonunion rate, and higher mean American Orthopaedic Foot and Ankle Society scores in patients who underwent surgical management for Jones fractures in comparison with those who were treated nonoperatively. Although, conservative treatment is also a successful method of treatment, our findings support surgical treatment of Jones fractures.
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NewsBot · Jul 2, 2026

Metatarsus Adductus Association With Fifth Metatarsal Fractures: Radiographic Analysis
Caitlin Curtis Crocker et al
Foot Ankle Orthop. 2026 Jun 28;11(2):24730114261453078.

Background: Metatarsus adductus is a congenital forefoot deformity associated with pathologies including proximal fifth metatarsal fractures. The aim of this study is to assess the presence of metatarsus adductus and alignment in patients with proximal fifth metatarsal fractures. We hypothesize that there is an increased incidence of metatarsus adductus in patients with proximal fifth metatarsal fractures.

Methods: A retrospective analysis was performed of patients who were treated for fifth metatarsal fractures from 2022 to 2024. Radiographic measurements including metatarsus adductus angle (MAA), lateral Meary angle, fracture zone, and foot alignment were recorded for each fracture.

Results: Forty-nine patients were included. Patients with a zone 1 fracture had an average MAA of 14.2°. Of these patients, 10% had a cavus and 18% had a planus midfoot. Patients with a zone 2 fracture had an average MAA of 19.9°. Of these patients, none were cavus and 4% were planus. Patients with a zone 3 fracture had an average MAA of 26.8°. Four percent of patients had a cavus midfoot, whereas 4% had planus. Patients with a dancer's fracture had an average MAA of 15°. Of these patients, 8% were cavus and 4% were planus. A significant difference (P < .001) was detected between the average MAA of zone 1 vs zone 3 fractures and between zone 3 and dancer's fractures, suggesting an association between increasing metatarsus adductus severity and more proximal diaphyseal fracture location.

Conclusion: Cavovarus deformity was infrequent in our cohort, whereas most patients had some degree of metatarsus adductus. Twenty-two percent in zone 1 and 6% in zone 2 were mild metatarsus adductus. Six percent in zone 2 and zone 3 were moderate, whereas 10% in zone 3 were severe. The authors recommend assessing for the presence of metatarsus adductus in patients with fifth metatarsal fractures, particularly zone 2 and 3, although further study in larger cohorts is needed to confirm these findings.
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NewsBot · Jul 11, 2026

Effect of the dorsiflexion and plantarflexion angles of the foot on the fifth metatarsal bone: finite element analysis
Luis Ángel Ortiz-Lango et al
Quant Imaging Med Surg. 2026 Jul 1;16(7):586.

Background: Fractures of the fifth metatarsal bone are frequent in athletes, yet the mechanical conditions that increase stress in this region are not fully understood. Understanding how foot positioning influences local stress may help clarify potential risk factors related to sports activities. The aim of this study was to evaluate how different foot loading directions and ankle positions affect the stress, strain, and deformation of the fifth metatarsal bone using a three-dimensional (3D) computational model.

Methods: A 3D model of the human foot was created from computed tomography (CT) imaging and included cortical bone, trabecular bone, and cartilage structures. Six loading conditions representing different ankle positions between forty and ninety degrees were simulated. A load equivalent to approximately three times body weight was applied to replicate impact during unilateral landing. Stress, strain, and deformation of the fifth metatarsal bone were quantified for each loading condition.

Results: The highest stress value in the fifth metatarsal bone occurred at 60° of dorsiflexion, with a stress magnitude of 3.18 MPa, a deformation of 0.071 mm, and a strain of 1.46×10-4. The lowest stress value occurred when the load was applied vertically at 90°, with a stress of 0.66 MPa, a deformation of 0.009 mm, and a strain of 2.72×10-5. The first and fifth metatarsal bones consistently showed the greatest concentration of mechanical stress across all load conditions.

Conclusions: Changes in foot position substantially influence the mechanical response of the fifth metatarsal bone. Dorsiflexion at sixty degrees generated the highest stress values and may represent a potentially critical condition for this region during high-impact sports movements.
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NewsBot · Jul 19, 2026

Predictors of Pain Recovery and Functional Outcomes After Conservative Management of Fifth Metatarsal Fractures: A Retrospective Cohort Study
Ahmet Taha Yakıt et al
Source

Background
Patient-related predictors of pain and functional recovery after conservative fifth metatarsal fracture management remain unclear.
Purpose
To evaluate clinical outcomes and identify factors associated with pain reduction.
Study Design
Retrospective Cohort Study.
Methods
Ninety-nine patients with conservatively managed fractures were evaluated (minimum 12-month follow-up). The primary outcome was pain reduction (ΔNRS%), with absolute NRS change reported alongside. Secondary outcomes included time to union (bridging callus), return to daily activities, clinical recovery, and functional scores (FAAM, AOFAS). Multivariable regression evaluated independent associations.
Results
The cohort (41 women, 58 men; mean age 43.2 years, BMI 26.5 kg/m²) predominantly sustained zone 1 fractures. All achieved early radiographic healing (bridging callus; mean 4.0 weeks), and complete union without complications. Mean NRS decreased from 6.79 to 0.68 (mean absolute reduction, 6.11 ± 0.79 points). Mean FAAM and AOFAS scores were 98.37 and 97.68. Most returned to daily activities within 5 weeks (n=65) and recovered within 8 weeks (n=74). Within this cohort, BMI was the only variable independently associated with ΔNRS%, with higher BMI associated with less pain improvement.
Conclusion
Conservative management yielded favorable outcomes in this predominantly zone 1, minimally displaced cohort (mean initial displacement 0.53 ± 0.79 mm; median 0 mm). BMI was the only variable independently associated with the magnitude of pain recovery; however, because metabolic, nutritional, occupational, and adherence-related variables were unavailable, BMI is best regarded as a pragmatic clinical marker of slower symptomatic recovery rather than a demonstrated causal determinant. Zone-specific findings require caution given limited zone 3 cases
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Proximal fifth metatarsal fractures

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Proximal fifth metatarsal fractures

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Transverse fracture proximal to the fifth metatarsal

'MoAkin' biplanar proximal phalanx closing wedge osteotomy

Proximal influences on plantar pressures

Extensor Digitorum Longus Tendon Insertion in the Proximal Nail Matrix

Proximal Plantar Intrinsic Tendinopathy

Proximal tibial bone graft

Does ‘proximal control’ need a new definition or a paradigm shift in exercise prescription?

Share This Page

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