What is a fifth metatarsal fracture?
The fifth metatarsal is one of the long bones of the midfoot. It is positioned on the outside of the foot and connects to the little toe. A fracture of this bone is referred to as a fifth metatarsal fracture.
There are several different types of fifth metatarsal fracture, including avulsion fractures and the Jones fracture. In an avulsion fracture, a small piece of bone is pulled off from the end of the fifth metatarsal by a tendon that inserts at that point, usually resulting from an ankle sprain. Jones fractures occur in a small area in the middle of the fifth metatarsal and are caused by either overuse or trauma. They are less common and more difficult to treat than avulsion fractures.
How can it occur?
Avulsion fractures of the fifth metatarsal are often the result of landing awkwardly from a jump. Jones fractures, in contrast, are overuse injuries from intense ballet training and most often relate to impaired foot and ankle stabilization. Muscle dysfunction can seriously affect foot and ankle stabilization and is an important contributing factor to these fractures. The psoas muscle is probably the most important muscle involved with dance injuries and overuse issues. Psoas dysfunction leads to tightness of the rectus femoris muscle (a part of the quadriceps) and deactivation of the piriformis (one of the smaller pelvic muscles inserting on the sacrum). This causes pelvic torsion and functional leg length discrepancy. The increased amount of stabilization work needed to compensate for leg length discrepancy will overcharge different groups of muscles. The peroneals – a group of two active foot stabilizers on the lower leg – are often affected. Active foot stabilization thus can be seriously affected and the risk of overuse in the foot will rise. Poor bone quality due to osteoporosis is another important contributing factor. It is referred to as bone insufficiency and is often related to eating disorders in dancers. With reduced bone density, the risk of a stress fracture is immensely elevated.
What are the typical symptoms of a fifth metatarsal fracture?
Avulsion fractures as well as Jones fractures have similar symptoms. They include pain and swelling on the outside of the foot. Most probably, you will have difficulty to walk and bare weight on your foot.
How can a fifth metatarsal fracture be diagnosed?
Your doctor will examine your foot and review your symptoms as well as your current training activities. Given that a fifth metatarsal fracture can be an overuse injury, correct diagnosis demands a thorough functional clinical examination, including specific tests to identify joint and muscle dysfunction. Finding out the underlying causes of stress fractures is often challenging and your doctor may ask a specialist in manual medicine for his opinion. To fully evaluate the condition, he will order X-rays to secure the diagnosis and determine the type of fracture.
This X-ray of the forefoot shows the typical aspect of a fracture on the base of the fifth metatarsal bone.
What treatment options are there?
Metatarsal fractures demand instant medical care and sometimes need surgical treatment if the injury involves a displaced bone, multiple breaks, or has failed to heal adequately. If you had a severe ankle sprain or suspect a metatarsal fracture, stop your ballet training immediately! Ignoring the pain can have serious consequences.
This fracture will need time and rest to heal. You should not attend ballet training for at least 6-8 weeks, depending on the severity of the problem. Immobilization of the foot will often be necessary. You may be given a cast, a special cast boot or a stiff-soled shoe and sometimes crutches.
The RICE concept (rest, ice, compression and elevation) is an easy guideline that can be used to initially treat acute as well as overuse injuries. Please read my “First Aid” post to obtain some background information that you will need to adapt this concept successfully and learn about the use of painkillers.
In order to handle a given overuse situation successfully, its underlying causes – namely muscle dysfunction and muscle dysbalance – have to be addressed specifically in the rehabilitation process. Muscle dysfunction can appear as muscle tightness (contraction) or weakness (inhibition) and the muscles affected have to be treated accordingly in the rehabilitation process. Some muscles will have to be stretched whereas others will rather have to be strengthened. A well-suited training program including corrective exercises as well as a general strengthening and endurance routine is the most effective way to deal with most overuse situations. Manual medicine and especially deep myofascial release treatment is recommended to address present joint and myofascial dysfunction. Restriction of the fascia plays a key role in all overuse issues and can be addressed effectively with manual medicine.
Ensure that you follow your specific training routine after the rehabilitation is finished. Myofascial rollers (Blackroll, Triggerpoint Roll, etc.) as well as Lacrosse balls and resistance bands are easy to use in the studio and will help you remain balanced in the long run.
Did you have a severe ankle sprain or suspect a metatarsal fracture and want to have it sorted out? These are the next steps:
- See a doctor
Dancers seek help from various different kinds of therapists, many of whom may employ treatments that are outside of mainstream medicine. Before considering the use of such alternative medicine, you should see a doctor for an evaluation and diagnosis.
Finding a doctor who is familiar with the specific medical issues faced by dancers is often challenging and you may need to see several different specialists in order to get a full picture of your diagnosis. A good place to start is to ask your friends and fellow dancers for the names of their favorite doctors.
- Find a specialist in manual medicine
Doctors who specialize in manual medicine practice a whole-body approach. They will try to identify and specifically treat the underlying causes of your problem, rather than just the localized symptoms. This approach is important in addressing all aspects of the often very complex overuse problems that dancers experience. A specialist in manual medicine will perform a functional examination on every part of your body and will treat you according to these thorough findings.
To find a physician who specializes in this field, search for “Manual Medicine”, “Osteopathic Manipulative Medicine” or “Osteopathic Physician” on the internet.
- Start working on your problem
There is a lot that you can do to work on your problem after a proper diagnosis has been set. Ultimately, it often comes down to addressing the same fundamental issues. Here are some useful exercises that I recommend to my patients:
Strength training: Compex “DISUSE ATROPHY” program (peroneal muscles), “The clamshell” – Piriformis training,
Please refer to your doctor to confirm that the exercises you choose to do are suited to your individual problem, and obtain supervision from a professional trainer to ensure that you are performing them correctly.
- Talk to your ballet master or dance teacher
Technical issues and faulty dance technique are important predisposing factors of overuse and injury in dancers. Amending dance techniques often plays a crucial role in the treatment and prevention of overuse and injury and you should not hesitate to address any issues, if necessary.