Foot Case 2 History/Physical Exam

The “avulsion” fracture within 1.5cm of the styloid process of the 5th metatarsal is more common (over 90%) and typically more benign. It is usually caused by sudden inversion of a plantar flexed foot with avulsion of the lateral band of the plantar aponeurosis from the metatarsal. It often presents as a twisting injury similar to an ankle sprain.

The “diaphyseal or metatarsal” fracture beyond 1.5cm of the styloid process is less common and potentially more severe. It usually occurs when a load is applied to the lateral forefoot in the absence of inversion in running and jumping activities and pivot-shifting in football, basketball, or soccer with the heel off the ground.

Patients complain of pain and variable ability to bear weight.  Swelling and/or ecchymosis is likely to be observed. Pain is often diffuse but can be localized on exam since the lateral tuberosity is easily palpable.  There also may be ankle swelling from a coexisting ankle injury that occurred at the same time.  The fifth metatarsal should be carefully examined in any twisting ankle injury so a fracture at the base of the 5th metatarsal is not mistaken for an ankle sprain.