5th Metatarsal Shaft “Dancer’s” Fracture

Edited by David N. Garras, MD 

 

Summary

A twisting injury to the ankle and foot may cause a long fracture of the 5th metatarsal shaft — the bone that attaches the little toe to the midfoot (Figure 1). During this injury, the 5th metatarsal is twisted by a strong force resulting in a spiral fracture. This 5th metatarsal “Dancer’s” fracture causes localized pain, swelling, and difficulty walking. In most instances, this type of fracture can be treated non-operatively, with relative immobilization in a walking boot combined with limited weight-bearing. It typically takes about 6 weeks for adequate bone healing to occur, before patients can start to significantly increase their activity level. It often takes 12 or more weeks for a full recovery to occur.

**There is another fracture that may also be referred to as a dancer’s fracture. However, since this fracture was first described in ballet dancer’s, it has become known as a dancer’s fracture as well.

Figure 1:  5th Metatarsal Shaft “Dancer’s” Fracture

Clinical Presentation

A patient who suffers an acute rolling of their ankle while pointing the toes down can also fracture the shaft of the 5th metatarsal (See Figure 1). This will produce immediate pain over the outside aspect of the foot near the toes. It can be associated with significant swelling. Over time, the skin can turn black and blue. It will be associated with quite specific local tenderness over the bone near the base of the toes, on the outside of the foot (the 5th metatarsal). Patients who have suffered a 5th metatarsal shaft fracture will give a history of a twisting injury to their ankle and foot (inversion plantarflexion injury), similar to what occurs with an ankle or foot sprain (Figure 2).

Figure 2: Twisting mechanism causing injury

Physical Examination

When pressing on the outside of the foot, there will be marked tenderness over the 5th metatarsal. There may be tenderness over a large area of the outside of the foot. However, the main tenderness will be at the head and neck of the 5th metatarsal.

Imaging Studies

X-rays of the foot will reveal a long oblique fracture of the shaft of the 5th metatarsal. The size of the fractured fragment may vary considerably. There will be gapping at the fracture and there may be some shortening or rotation of the fracture (Figures 3A-3B). The usual fracture pattern is a spiral running from distal lateral (outside near the toes) to proximal medial (inside closer to the ankle).

Figure 3A: X-ray from the side (Lateral View)

Figure 3B: X-ray from the top (AP VIew)

Treatment

A 5th metatarsal shaft “Dancer’s” fracture is an injury that is usually treated non-operatively. The injury will likely heal with non-operative treatment. Treatment involves relative rest and time to allow the fracture to heal. Typically, patients are placed in a walking boot. For the first few weeks, they will have to significantly limit their walking and may need crutches. As the swelling settles and the fracture starts to heal, they can begin walking more extensively in the boot. Usually by 6 weeks, there is enough healing to allow them to transition to a stiff-soled shoe with lots of padding.  This is a frustrating injury because it takes a long time for healing to occur. Patients are often still symptomatic 6 to 8 weeks or more after this injury. They can usually resume dance activities by 10-12 weeks and return to performance level by 19 weeks.  It can be many months before the bone is completely healed and a full recovery has been achieved.

Surgery is rarely needed but may become necessary when there is complete displacement of the fracture fragments or failure to heal with non-operative treatment. In these cases, the bone fragments are repositioned and stabilized with screws and/or a plate.

It is important not to overlook other associated injuries to ligaments of the ankle and foot. Ankle or foot instability, when present should be addressed to avoid recurrence of ankle inversion injuries.

 

 

Edited November 10th 2018