Avulsion Fracture of the Fifth Metatarsal

What is Dancer's Fracture?

Ballerina dancing in beautiful rehearsal room
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An avulsion fracture of the fifth metatarsal, also called a "Pseudo-Jones fracture," is the most common type of fifth metatarsal fracture. The fifth metatarsal is the bone that runs from the midfoot to the base of the small toe on the outside of the foot. An avulsion fracture of the fifth metatarsal occurs where a tendon attaches to the bone at this point (the peroneus brevis tendon). When an avulsion fracture occurs, the tendon pulls off a tiny fragment of bone.

These fractures are usually not badly out of place. 

How does an avulsion fracture of the fifth metatarsal occur?

Causes of an avulsion fracture in this area include any forced inversion of the foot or ankle - rolling inward. The force causes the tendon to yank a bit of bone off of the fifth metatarsal at the base of the pinkie toe.

This can happen to dancers, which is where it gets its nickname of dancer's fracture. You don't have to be a dancer to get this injury, as any time you manage to get the foot and ankle rolling inward it can occur. 

Also Known As: Dancer's fracture, Pseudo-Jones fracture

What are the symptoms of an avulsion fracture?

You will have pain at the base of the bone and probably have swelling and bruising in the area.

How is the diagnosis of avulsion fracture of the fifth metatarsal made?

Avulsion fractures can be confused with other types of fractures to the fifth metatarsal bone.

The most common problem is distinguishing this injury from a Jones fracture. The distinction is important because treatment of these injuries is different.

After you injure your foot, you will likely go to your primary care doctor or an urgent care clinic or even an emergency room. The doctor will do a physical examination of the foot and listen to your history of how you sustained the injury.

You'll probably be sent for an X-ray to use to diagnose whether it is an avulsion fracture or a Jones fracture. You may also have blood tests to screen your general health and any other contributing factors to the accident. For example, if you were faint or uncoordinated this might indicate a silent medical problem such as diabetes or high blood pressure.

What is the treatment of an avulsion fracture?

Treatment of avulsion fractures is usually accomplished with a walking cast or a walking boot. These protect the fracture site, but allow you to walk and place weight on the foot. The walking cast or boot is worn for about four to six weeks. Crutches are not usually needed for this injury, and surgery is seldom necessary. But, needless to say, you won't be doing much dancing for the next month or two as you make a recovery. Resting and icing the area are also in the cards for you during recovery.

Surgery might be needed if the avulsion fracture is displaced. The doctor may recommend an open reduction with internal fixation or a closed reduction with pinning.


Dameron, TB "Fractures of the Proximal Fifth Metatarsal: Selecting the Best Treatment Option" J. Am. Acad. Ortho. Surg., Mar 1995; 3: 110 - 114.

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