© Ali Abbasian
Website Designed ByIt is a spiral break in the shaft of the fifth metatarsal, the long bone on the outside of the foot. It usually happens by twisting the foot, often in sport, or in a fall. It was first described in ballet dancers, hence the name.
Usually not. In our study every patient healed without an operation, including those whose fracture had moved more than 5 mm out of place. What matters is whether the little toe looks twisted and whether the ends of the metatarsals still line up in a smooth curve. If they do, the fracture can be treated without surgery.
About 1 in 5 patients had another injury as well, such as an ankle sprain or a fourth metatarsal fracture, so the whole foot and ankle should be checked.
We compared 33 patients treated in a stiff-soled post-operative shoe or a walking boot.
| Stiff-soled shoe | Walking boot | |
|---|---|---|
| Back to pain-free walking | 4.6 weeks | 8.4 weeks |
| Back to normal shoes | 6 weeks | 7.3 weeks |
| How restrictive it felt | 78% said only slightly | 75% said moderately or severely |
Patients in boots told us they struggled on stairs, public transport and at work. On average the bone had healed on X-ray by 8 weeks. Three fractures were slow to heal but all had united by 6 months.
Walk on the foot as normal in a stiff-soled shoe for 6 weeks, and keep the ankle moving from the start.
Reference: Morgan C, Abbasian A. Management of spiral diaphyseal fractures of the fifth metatarsal: a case series and a review of literature. The Foot 2020;43:101654. doi:10.1016/j.foot.2019.101654
Mr Abbasian sees patients at Guy’s Hospital and in private practice in London. Book a consultation.