Pain in 5th Metatarsal When Walking: Tips!

Are there different types of fifth metatarsal fractures?

First, be reassured by the fact that we are quite familiar with fifth metatarsal fractures: they are the most common foot fractures! And this is one of the bones that people tend to break the most.

There are many different ways to name and categorize fractures of this bone. None of them have a universal consensus, but here is one of the most commonly used.

You may encounter these terms in your X-ray report: Zone 1, 2, or 3 fractures.

Most often (in 90% of cases), when one fractures the fifth metacarpal, there is a small bone fragment avulsion from the metatarsal due to the fascia and tendon that inserts onto it, causing a pulling force. It’s a 5th metatarsal avulsion fracture.

These fractures can involve the joint or solely affect the bone. Fractures that only affect the bone generally recover more quickly.

They can also be non-displaced, where the bone fragments on either side of the fracture line are still in contact, or displaced, where the bone fragments are separated.

Non-displaced fractures that do not affect the joint typically heal faster. However, for fifth metatarsal fractures, you have an equally good chance of recovering well and resuming sports and other activities, whether you have a displaced or joint-affecting fracture or not (Herterich 2021).

One can also experience stress fractures of the 5th metatarsal, not as a result of a fall or repeated impact, but due to repetitive trauma from insufficiently gradual sport intensity increase or because of medical conditions or genetic predispositions.

In the following sections of the article, I will discuss the general healing time for fifth metatarsal fractures, regardless of the specific type.

Source: Chloros 2022.

How long does it take for the 5th metatarsal to heal when it’s broken?

In the majority of cases, a broken fifth metatarsal typically takes 6 to 8 weeks to fully consolidate.

Fractures in zones 2 and 3 have a higher rate of non-union: 15 to 30% of people do not fully consolidate after this type of fracture (though it doesn’t necessarily prevent them from resuming their daily life).

Stress fractures of the fifth metatarsal may take longer to consolidate, potentially up to 20 weeks (4 and a half months).

Source: Smidt 2023.

How long does the pain last with a fifth metatarsal fracture?

Pain is something that is often experienced in the days (and sometimes weeks) following a fifth metatarsal fracture.

Pain results from several physiological mechanisms involved in the bone healing and repair process.

When the bone fractures, there is typically an inflammatory response in the fracture area. This inflammation is a natural body response to mobilize the necessary resources for your healing. This can lead to a sensation of pain, heat, redness, and swelling around the fracture.

Pressing on it may also temporarily increase the pain, without necessarily indicating a problem!

Pain may only last a few days after a fifth metatarsal fracture in some cases. However, more often, it will take several weeks for the pain to completely disappear.

Fifth metatarsal pain when walking

When walking with a fracture in the 5th metatarsal, pain can occur due to various physiological mechanisms, such as:

1. Inflammation: It can cause pain, swelling, and tenderness around the fracture site.
2. Stress on the fracture site: When you put weight on the foot during walking, the mechanical stress on the fractured bone can lead to discomfort and pain.
3. Healing process: As the bone heals, there can be pain associated with the formation of callus tissue or remodeling of the bone.

The duration of pain when walking with a 5th metatarsal fracture typically persists for several weeks to a few months, gradually decreasing as the bone heals and the inflammatory response subsides.

Just because you have some pain or discomfort doesn’t mean you shouldn’t walk. It’s not a sign of complications; you just need to find the right balance to gradually resume walking based on what your body can tolerate.

How long does it take to walk normally after a 5th metatarsal fracture?

You are probably in one of these two situations after your fifth metatarsal foot fracture:

1. You are allowed to put weight on the fractured foot from the first days following the fracture, without special precautions (or with crutches).
2. You are not allowed to put weight on the fractured foot (or only with a walking boot) for 3 to 6 weeks.

In any case, it will likely take a few weeks to walk normally as before, without crutches or limping. Often, it can take between 3 weeks and 2 months.

When you are able to walk without crutches, with little to no limping, over several kilometers, you can then consider gradually resuming more demanding foot-related activities, such as running.

How long until you can drive?

In France, like in many countries, the law does not strictly prohibit you from driving with a foot fracture.

You simply need to be ‘in a state and position to execute all maneuvers that are incumbent on you comfortably and promptly,’ according to the Highway Code. In essence, it is up to you to determine if you are fit to drive or not.

However, in case of an accident, this may be held against you. You can test, while stationary, if putting pressure on the pedals with the fractured foot is painful or not, and if you feel sufficiently reactive.

Driving with a walking boot is generally complicated or even impossible, depending on which foot is fractured and the type of car you have (automatic or not).

Can you speed up the healing time of a fifth metatarsal fracture?

What is the best treatment to ‘accelerate’ consolidation and healing? Or at the very least, not hinder it?

Here is what a Greco-British research team found when summarizing studies on the treatment of a fifth metatarsal fracture:

There are numerous non-surgical treatment modalities, including elastic bandage support, non-weight-bearing immobilization, hard-soled shoes, short walking boots, or a locking walking boot.

Various surgical techniques are available, including intramedullary screw fixation with or without bone graft, tension band systems, and plates.

Chloros 2022

Depending on the medical and surgical team you encounter, you may receive different recommendations, depending on the type of fracture you have and your overall condition.

For example, surgery is not recommended for individuals at risk of complications, especially those with diabetic neuropathy (Chloros 2022).

There are no studies indicating that using a walking boot is more effective than not using one.

Most fifth metatarsal fractures (zone 1 and zone 2 fractures) require simple conservative/functional treatment without surgery or immobilization/discharge.

Should you avoid putting weight on the fractured foot?

Here’s what a German research team has to say about this:

[Zone 1] Immobilization or surgery were superior to conservative functional management only in terms of the time required for radiological consolidation.

According to available studies, early functional therapy is recommended for zone 1 fractures. This also applies to displaced, intra-articular, and comminuted fractures.

[Zone 2] Early functional treatment produces very good functional results for zone 2 fractures. In comparison with studies that used surgical management, functional therapy appears to result in a quicker return to full function and at least equivalent functional outcomes.

Herterich 2021

Conclusion: For the majority of fractures, it is recommended to resume your daily activities as soon as possible, including walking with weight on the fractured foot.

You can place your foot on the ground and apply pressure. If it is too painful, you can use crutches for a few days (See here in pictures and videos how to walk with crutches after a fracture.).

However, you can quickly stop using crutches.

It often happens that you are recommended to walk without weight on the foot or with a walking boot for 3 to 6 weeks, and then gradually resume weight-bearing.

If you find this too restrictive, you can discuss it with the professionals who made these recommendations, so they can explain why it seems suitable in your case.

Do you need physical therapy, and for how long?

Physical therapy sessions are sometimes prescribed after a fifth metatarsal fracture, but not always.

Why? Because quite often, you can regain all your pre-injury activities by yourself!

If you have persistent walking difficulties or significant pain while walking for several weeks, or if you cannot resume your sport, having an evaluation with a physical therapist can likely be beneficial!

There is no specific rehabilitation protocol to follow. Your physical therapist assesses your capabilities and difficulties, along with your desires/priorities, and works with you to determine what is possible.