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Proximal fifth metatarsal fractures

John Alsobrook, MD
Robert L Hatch, MD, MPH
Section Editor
Patrice Eiff, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Fractures of the proximal fifth metatarsal pose an important diagnostic challenge. A difference of millimeters in location can lead to a vastly different prognosis and treatment plan; a suboptimal treatment regimen can cause delayed union, reinjury, and chronic disability. Confusion surrounding fracture terminology often compounds the problem of appropriate diagnosis and management.

This topic review will discuss the diagnosis and management of the three major types of proximal fifth metatarsal fractures. Discussions of other metatarsal, foot, and ankle injuries are found elsewhere. (See "Stress fractures of the metatarsal shaft" and "Metatarsal shaft fractures".)


The fifth metatarsal is located on the lateral side of the foot (figure 1A-C). Its proximal portion is divided into three parts: the tuberosity, metaphysis, and proximal diaphysis (figure 2). The base, or proximal portion, of the fifth metatarsal articulates medially with the fourth metatarsal, while the tuberosity articulates proximally with the cuboid. Strong ligaments attach the fifth metatarsal to these two bones. Thus, range of motion is minimal. The lateral band of the plantar fascia (PF) attaches to the plantar aspect of the tuberosity. The peroneus brevis tendon (PB) attaches to the lateral aspect of the tuberosity. Tuberosity avulsion fractures are thought to result from traction by these structures during inversion injuries. (See 'Tuberosity (styloid) avulsion fractures' below.)

Variations in the blood supply to the fifth metatarsal help explain the pathophysiology of fracture healing. The tuberosity receives blood from multiple metaphyseal vessels and branches of the nutrient artery; the proximal diaphysis receives its blood supply solely from the nutrient artery (figure 3). A fracture to the proximal diaphysis is therefore more likely to disrupt the blood supply, thereby inhibiting healing and increasing the risk of nonunion [1].


In 1902, Sir Robert Jones described a series of acute fractures of the proximal fifth metatarsal diaphysis [2]. Confusion over terminology has clouded the management of these fractures ever since. Some clinicians use the term "Jones Fracture" to refer specifically to acute diaphyseal fractures. Others use it indiscriminately to describe all proximal fifth metatarsal fractures. To add to the confusion, some authors separate these fractures into two groups [3], while others refer to three groups [4-7].


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Literature review current through: Oct 2015. | This topic last updated: Jun 16, 2014.
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  1. Smith JW, Arnoczky SP, Hersh A. The intraosseous blood supply of the fifth metatarsal: implications for proximal fracture healing. Foot Ankle 1992; 13:143.
  2. Jones R. I. Fracture of the Base of the Fifth Metatarsal Bone by Indirect Violence. Ann Surg 1902; 35:697.
  3. Torg JS. Fractures of the base of the fifth metatarsal distal to the tuberosity. Orthopedics 1990; 13:731.
  4. Quill GE Jr. Fractures of the proximal fifth metatarsal. Orthop Clin North Am 1995; 26:353.
  5. Rosenberg GA, Sferra JJ. Treatment strategies for acute fractures and nonunions of the proximal fifth metatarsal. J Am Acad Orthop Surg 2000; 8:332.
  6. Nunley JA. Fractures of the base of the fifth metatarsal: the Jones fracture. Orthop Clin North Am 2001; 32:171.
  7. Eiff, MP, Hatch, RL, Calmbach, W. Fracture Management for Primary Care, 2nd, WB Saunders, Philadelphia 2002. p.345.
  8. Lawrence SJ, Botte MJ. Jones' fractures and related fractures of the proximal fifth metatarsal. Foot Ankle 1993; 14:358.
  9. Richli WR, Rosenthal DI. Avulsion fracture of the fifth metatarsal: experimental study of pathomechanics. AJR Am J Roentgenol 1984; 143:889.
  10. Theodorou DJ, Theodorou SJ, Kakitsubata Y, et al. Fractures of proximal portion of fifth metatarsal bone: anatomic and imaging evidence of a pathogenesis of avulsion of the plantar aponeurosis and the short peroneal muscle tendon. Radiology 2003; 226:857.
  11. Stiell IG, Greenberg GH, McKnight RD, et al. Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation. JAMA 1993; 269:1127.
  12. Pao DG, Keats TE, Dussault RG. Avulsion fracture of the base of the fifth metatarsal not seen on conventional radiography of the foot: the need for an additional projection. AJR Am J Roentgenol 2000; 175:549.
  13. Strayer SM, Reece SG, Petrizzi MJ. Fractures of the proximal fifth metatarsal. Am Fam Physician 1999; 59:2516.
  14. Mehlhorn AT, Zwingmann J, Hirschmüller A, et al. Radiographic classification for fractures of the fifth metatarsal base. Skeletal Radiol 2014; 43:467.
  15. Wiener BD, Linder JF, Giattini JF. Treatment of fractures of the fifth metatarsal: a prospective study. Foot Ankle Int 1997; 18:267.
  16. Kavanaugh, JH, Brower, TD, Mann, RV. The Jones fracture revisited. J Bone Joint Surg 1978; 60A:776.
  17. Fernández Fairen M, Guillen J, Busto JM, Roura J. Fractures of the fifth metatarsal in basketball players. Knee Surg Sports Traumatol Arthrosc 1999; 7:373.
  18. Mologne TS, Lundeen JM, Clapper MF, O'Brien TJ. Early screw fixation versus casting in the treatment of acute Jones fractures. Am J Sports Med 2005; 33:970.
  19. Dameron TB Jr. Fractures of the Proximal Fifth Metatarsal: Selecting the Best Treatment Option. J Am Acad Orthop Surg 1995; 3:110.
  20. Furia JP, Juliano PJ, Wade AM, et al. Shock wave therapy compared with intramedullary screw fixation for nonunion of proximal fifth metatarsal metaphyseal-diaphyseal fractures. J Bone Joint Surg Am 2010; 92:846.
  21. Torg JS, Balduini FC, Zelko RR, et al. Fractures of the base of the fifth metatarsal distal to the tuberosity. Classification and guidelines for non-surgical and surgical management. J Bone Joint Surg Am 1984; 66:209.
  22. Holubec KD, Karlin JM, Scurran BL. Retrospective study of fifth metatarsal fractures. J Am Podiatr Med Assoc 1993; 83:215.
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