Peroneus Brevis attaches at the lateral side of the tuberosity (red area in figure 1), with peroneus tertius attaching at the dorsal side of the most proximal compartment of the metaphysis. Taking the example of avulsion fractures at the 5th metatarsal It is divided into 3 parts: the tuberosity, the metaphysis, and the head. It can occur at numerous sites in the body, but some areas are more sensitive to these types of fractures than others, such as at the ankle which mostly occurs at the lateral aspect of the medial malleolus or in the foot where avulsion fractures are common at the base of the fifth metatarsal, but also at the talus and calcaneus.Ĭlinically Relevant Anatomy: This occurs as tendons can bear more load than the bone. It can be caused by traumatic traction (repetitive long-term or a single high impact traumatic traction) of the ligament or tendon.

4 Characteristics/Clinical Presentationĭefinition/Description: Īn avulsion fracture is where a fragment of bone is pulled away at the ligamentous or tendinous attachment.Early surgical fixation reduces time to healing and time to return to sports. Nondisplaced avulsion fractures of the fifth metatarsal tuberosity require symptomatic therapy only (elastic or soft bandage followed by firm shoe when tolerated).įractures of the proximal fifth metatarsal diaphysis require more aggressive treatment, such as early surgical fixation or prolonged casting with no weight bearing. Stress fractures of the metatarsal shaft usually heal well without immobilization and typically respond well to cessation of the causative activity for four to eight weeks. Most nondisplaced metatarsal shaft fractures require only a soft elastic dressing or firm, supportive shoe and progressive weight bearing. If there is more than 3 to 4 mm displacement in a dorsal or plantar direction, or if dorsal/plantar angulation exceeds 10 degrees, reduction is usually required. If radiography reveals a normal position seven to 10 days after injury, progressive weight bearing may be started, and the cast may be removed three to four weeks later.įractures of a single metatarsal with lateral or medial displacement usually heal well without correction and may be managed like nondisplaced fractures. Nondisplaced fractures of the proximal portion of metatarsals 1 through 4 can be managed acutely with a posterior splint followed by a molded, non–weight-bearing, short leg cast. Treatment of fractures distal to the tuberosity should be individualized based on the characteristics of the fracture and patient preference. Radiographs should be carefully examined to distinguish these fractures from tuberosity fractures. Proximal fifth metatarsal fractures that are distal to the tuberosity have a poorer prognosis. Avulsion fractures of the proximal fifth metatarsal tuberosity can usually be managed with a soft dressing. Stress fractures of the first to fourth metatarsal shafts typically heal well with rest alone and usually do not require immobilization. Nondisplaced fractures of the metatarsal shaft usually require only a soft dressing followed by a firm, supportive shoe and progressive weight bearing. Injuries to this ligament require referral or specific treatment based on severity. If the midfoot is injured, care should be taken to evaluate the Lisfranc ligament. Referral is generally indicated for intra-articular or displaced metatarsal fractures, as well as most fractures that involve the first metatarsal or multiple metatarsals. The fracture should then be characterized and treatment initiated. Initial evaluation should focus on identifying any conditions that require emergent referral, such as neurovascular compromise and open fractures. Patients with metatarsal fractures often present to primary care settings.

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