Steve HowardThe fifth metatarsal fracture is the most common that affects the bones of the foot, according to the foot and ankle podiatrist at Clinica Cemtro in Madrid. As he describes, “this injury usually occurs between the second and fifth decades of life and is closely related to sports practice.”
To get closer to it, first determine the exact location of the lesion: “Fractures of the fifth metatarsal bone with fractures of the base, fractures of the metaphysis (Jones fracture) or fractures of the diaphysis”
This is important because each of these fractures happens in a different way. According to the expert, “those from the base are produced by an inversion / abduction mechanism of the foot, in which the action of the short lateral peroneal tendon (and the structure of the plantar fascia) causes excessive stretching and ends up removing a splinter of bone. »
However, in the metaphyseal zone, better known as stress fracture, “it is caused by repeated micro-trauma from bad shoes, poor spike adaptation, football boots, etc.”
For all of this, as Navarro points out, “there is an increased risk in patients with physical exertion.” Likewise, in the case of football, the expert “considers it necessary to devote to the selection of the boot well, the positional adjustment of the studs and the adaptation of the shoe type to the surface of the field, as well as to tactical and positional characteristics. athlete “.
What are your symptoms?
The patient knows that this injury can be caused by symptoms such as “pain in the side of the foot, with swelling or swelling and inability to continue playing sports,” he recalls. These are the main symptoms of an acute fracture.
However, prior to this type of fracture or injury, it is important to see a specialist for a differential diagnosis of acute ankle sprain “, which means that the fracture may go unnoticed unless it is a Suspected, well-studied, or involving the base of the fifth metatarsal in an emergency. X-ray examination.
In the case of stress fractures, it is common to feel “chronic pain in the lateral face, which is not very intense, but limits exercise,” he describes. In these cases, if simple x-rays are unsuccessful and stress trauma is suspected, “additional tests such as magnetic resonance imaging or computed tomography (CAT) should be requested.”
Should we immobilize?
If you suspect an acute fracture or sprain of the ankle at high energies, the first thing to do is contact the emergency services for the first diagnosis and initial treatment. ” reminds Navarro. After that, the ideal option would be to “conduct close observation for definitive treatment in the foot and ankle unit.”
After diagnosis in the case of base and shaft fractures, “conservative treatment will be chosen in most cases if the fragment displacement does not exceed 2 mm,” point.
Regarding the immobilization of the area, Navarro points out that today there is a certain controversy regarding the time of immobilization. In these cases, your device chooses a shortened splinting time and progressive partial load and boot protection associated with early physiotherapy of the remaining intact structures.
For stress fractures (metaphysis) “surgical treatment is recommended because although there is no displacement in this region, there is a greater risk of delayed consolidation,” he notes. For this injury, the technique used at their center is an intramedullary compression screw for the focus of the fracture.
With regard to treatment, Navarro recalls that it is fundamental, since “the main problem of not treating this type of fracture is delayed consolidation (pseudoarthrosis).” For this reason, he insists that “it is important to be vigilant, especially with metaphysis fractures during initial treatment.”
Prevention
To prevent this injury, Navarro says, the key is to influence proprioceptive ankle training “which consists of training in internal stability to avoid episodes of entorsis (closed joint injury due to twisting) suddenly) in patients with repeated sprains “.
Another important problem in primary prevention is the use of plantar orthoses in athletes with axial disabilities. Also, remember, “Athletic footwear is a key factor, especially in football.”