Your feet are made up of 26 bones that work hard to support your every step. Whether you’re walking, running, or jumping, these small bones endure a surprising amount of stress—making foot fractures a common injury, especially in athletes and active individuals.
In this post, we’ll focus on one of the most frequently fractured foot bones: the 5th metatarsal. The 5th metatarsal is the long bone on the outside of your foot that connects to your little toe. It plays a key role in balance, stability, and the ability to push off during walking, running, or jumping. Despite its small size, this bone bears a surprising amount of stress during daily activities, and even more during sports.
Fractures of the 5th metatarsal are common, particularly in athletes and active individuals. Whether it’s from a sudden twist of the ankle, repetitive stress, or impact from a fall, this area is vulnerable to injury. Runners, dancers, soccer players, and basketball athletes are especially at risk.
In this article, we’ll break down the different types of 5th metatarsal fractures, what causes them and how they’re treated. Whether you’ve recently been diagnosed or are helping someone through recovery, understanding this injury is the first step toward healing.
What is the 5th Metatarsal?
The 5th metatarsal is one of the five long bones in the foot and is located along the outer edge, connecting to the base of the little toe. It plays a key role in foot mechanics, especially in weight-bearing and side-to-side movements.
Fractures of the 5th metatarsal are categorized based on where the break occurs along the bone. The three most common types include:
Avulsion Fracture (often called a “Dancer’s Fracture”): This occurs when a small piece of bone is pulled off by a tendon or ligament. It typically happens with a sudden twist of the foot or ankle and is located near the base of the bone.
Jones Fracture: Is usually caused by a forceful impact or repetitive stress and is located slightly further down the shaft than an avulsion fracture.
Stress Fracture: This type of fracture develops gradually due to repetitive overuse, often seen in runners, dancers, and athletes who place continuous strain on the outer foot.
Each type of fracture requires a different approach to healing, which is why proper diagnosis and treatment are so important.
Common Causes of 5th Metatarsal Fractures
Fractures of the 5th metatarsal can happen suddenly or develop gradually over time. Understanding the cause of the injury helps guide treatment and prevent future issues. Some of the most common causes include:
Twisting Injuries and Ankle Rolls
A sudden inward roll of the ankle (inversion injury) is one of the most frequent causes. As the foot twists, the tendon that attaches to the base of the 5th metatarsal can pull hard enough to fracture the bone, this is often how avulsion fractures occur.Direct Impact or Trauma
A heavy object falling on the foot or a direct blow during sports or a fall can cause an acute break in the 5th metatarsal.Overuse and Repetitive Stress
High-impact, repetitive activities like running, dancing, or jumping can gradually overload the bone. Without enough rest and recovery, small cracks, called stress fractures, can develop over time.Poor Foot Biomechanics
People with high arches or those who supinate (roll to the outside of their feet) when they walk or run place more strain on the outer edge of the foot, increasing the risk of 5th metatarsal injuries.Inadequate Footwear or Sudden Changes in Activity
Wearing unsupportive shoes or rapidly increasing training volume or intensity can contribute to both acute and stress fractures, especially in active individuals.
These fractures can happen to anyone but are especially common in athletes, dancers, and people who engage in sports that involve cutting, jumping, or quick changes in direction.
Diagnosis and Medical Management
A fracture of the 5th metatarsal can range from mild to severe, so an accurate diagnosis is essential for proper healing.
Clinical Presentation
Most people with a 5th metatarsal fracture will experience:
Pain and tenderness along the outside of the foot
Swelling and possible bruising
Difficulty bearing weight or walking
A feeling of instability, especially if the injury involved an ankle roll
Imaging
To confirm the diagnosis, your doctor will typically order an X-ray of the foot. This helps identify the location and type of fracture. If a stress fracture is suspected and isn’t visible on an X-ray, a bone scan may be needed for a more detailed view.
Treatment Options
Treatment depends on the type and severity of the fracture:
Conservative Management
Most fractures can be treated without surgery. This may include:Rest and activity modification
Ice and elevation to manage swelling
Immobilization using a walking boot, cast, or stiff-soled shoe to protect the foot
Crutches or other mobility aids to reduce weight-bearing if needed
Surgical Management
Surgery may be recommended for more serious injuries, such as:Displaced fractures where the bone ends are out of alignment, surgery usually involves the placement of screws or plates to stabilize the bone and promote healing.
Early Rehab – What to Expect
The early stages of rehabilitation for all foot fractures focus on promoting healing while minimizing the complications that can come with immobility. In the initial phase, your physiotherapy program will aim to:
Reduce pain and swelling through gentle movement, elevation, and modalities like ice.
Maintain mobility in the ankle, toes, and nearby joints to prevent stiffness.
Prevent deconditioning by keeping the rest of your body active and engaged.
Preventing Muscle Loss with Blood Flow Restriction (BFR) Training
One of the biggest challenges during recovery is preventing muscle loss due to decreased activity. Blood Flow Restriction (BFR) training is a highly effective method to maintain and even build muscle during the early stages of rehab. It involves placing a cuff or band around the upper leg to reduce blood flow while performing light exercises. This creates a similar effect to heavy lifting by promoting muscle activation and growth—without placing stress on the healing foot. Benefits of BFR for fracture recovery include:
Prevents muscle loss during periods of immobilization or non-weight-bearing.
Maintains or improves strength using low-load exercises when traditional resistance training isn’t possible.
Effective during early rehab—can be started soon after injury or surgery.
Mimics effects of heavy lifting by creating a metabolic stress response with light loads.
Safe and well-tolerated when supervised by a trained physiotherapist.
Backed by research in populations recovering from surgeries and joint immobilization (e.g., knee, ankle, and ACL rehab).
Early Rehabilitation Exercises
While you may not be able to bear weight on the injured foot right away, that doesn’t mean you have to stop exercising altogether. In fact, keeping the rest of your leg strong is key to maintaining function, speeding up recovery, and preventing long-term weakness.
Here are some early rehab exercises that are safe to begin during the non-weight-bearing phase:
Straight Leg Raise (SLR): Strengthens the hip flexors and quadriceps without placing pressure on the foot.
Quad Over Roll (QOR): Activates the quadriceps, which can become weak after immobilization.
Bridge: Engages the glutes and core while keeping pressure off the injured foot.
Hip Abduction: Maintains strength in the outer hip muscles to support pelvic stability and gait.
Seated Leg Extension: Targets the quadriceps without needing to stand.
Stationary Bike (with the boot on): If cleared by your healthcare provider, using a stationary bike can help maintain cardiovascular fitness and lower body mobility while protecting the foot.
Managing Leg Length Difference When Wearing a Cast or Walking Boot
When you’re wearing a cast or walking boot, it effectively adds height to one leg, creating a temporary leg length difference. This unevenness can lead to a number of issues if not corrected, including altered walking mechanics, limping, low back pain, hip discomfort, and even knee or foot problems on the unaffected side.
To minimize these risks, it’s important to wear a shoe lift or an even-up device on the opposite foot. These simple tools help restore symmetry and promote a more natural gait. Without a lift, your body compensates for the height difference by tilting or hiking the hip on the shorter side, which puts stress on your spine and joints over time.
If you’re unsure what kind of lift to use or how much height you need, speak with a physiotherapist, they can assess your gait and recommend the most effective way to maintain balance and comfort.
Transitioning to Full Rehab
Once your healthcare provider confirms that the fracture has healed enough, typically through follow-up imaging, you’ll be cleared to begin partial or full weight-bearing. This marks a key turning point in your recovery.
From Protection to Progression
The shift from early rehab to more active rehabilitation involves gradually reintroducing weight through the foot and progressing functional movement. This phase focuses on:
Rebuilding strength in the foot, ankle, and lower leg muscles
Restoring balance and proprioception (your body’s sense of joint position), which can be impacted after weeks of immobilization
Improving walking mechanics, especially if you’ve been limping or compensating
Your physiotherapist will guide you through a progressive plan, which may include:
Resistance band or bodyweight strengthening
Balance exercises like single-leg stands or wobble board drills
Gait retraining and drills to correct abnormal walking patterns
Return-to-Activity Guidelines
For athletes or highly active individuals, this phase also includes sport-specific retraining:
Gradual return to impact activities like jogging, cutting, or jumping
Agility, coordination, and footwork drills tailored to your sport
Conditioning to safely rebuild cardiovascular fitness
Your physiotherapist will monitor for signs of overload, ensuring you’re progressing without risking re-injury. Return-to-play timelines vary depending on the type of fracture, but a structured rehab program can help you return stronger than before.
Conclusion
A fracture of the 5th metatarsal may be small in size, but without the right care, it can lead to long-term issues with mobility, strength, and confidence on your feet. Early diagnosis is key to identifying the type of fracture and guiding appropriate treatment from the start.
Physiotherapy plays a crucial role throughout the recovery process—from managing pain and swelling in the early stages, to restoring strength, balance, and function as you return to daily activities or sport. With the right rehab plan, most people can make a full recovery and get back to doing what they love.
If you’ve recently injured your foot or are recovering from a fracture, don’t wait. Book an assessment with a physiotherapist at Sheddon Physiotherapy and Sports Clinic to ensure you’re healing properly and on the right path to recovery. The sooner you start, the better your outcome will be.
