Case Report: 5th Metatarsal Fracture
Xray Series. Oblique, AP and lateral views of the patient with foot pain. On the oblique and AP views, there is an acute, non-displaced fracture of the base of the 5th metatarsal with intra-articular extension. (click images to enlarge).
Physical examination of the foot should start with inspection. In the case of 5th metatarsal fracture, you will often notice swelling and ecchymosis at the site. Evaluate for skin integrity as well. Palpation will reveal pain over the fracture site. It is important to pay specific attention to palpating the Lisfranc joint as well as the distal fibula and tibia due to possible associated injuries. Further physical exam will show pain with resisted foot eversion. A detailed neurovascular exam should be performed as well.Strayer SM, Reece SG, Petrizzi MJ. Fractures of the proximal fifth metatarsal. Am Fam Physician. 1999;59(9):2516-2522.
On exam, the patient had isolated pain and mild swelling with ecchymosis at the base of his left 5th metatarsal. He had no other tenderness to palpation in the remainder of his foot or ankle. Range of motion testing of his ankle was normal as was his neurovascular exam. Radiographs demonstrated an acute non-displaced fracture of the base of the 5th metatarsal with intra-articular extension. He was placed in a CAM boot, given crutches, and was made weight-bearing as tolerated. In follow up, the patient underwent an ORIF with orthopedics and did well in subsequent post op visits.
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