avulsion_5th_proximal_metatarsal

Foot fractures are one of the most common conditions treated in my office, with metatarsal fractures in women among the most frequent, especially of the fifth metatarsal (the bone on the side of the foot just behind the 5th toe). Several recent studies reported fifth metatarsal fractures account for between 56% and 68% of all metatarsal fractures.

Fifth metatarsal fractures are most often associated with an ankle sprain or twisting motion, resulting in what is typically referred to as an avulsion or Jones fracture, respectively. A spiral or twisting fracture at the middle of the bone, known as a “dancer’s fracture”, is not uncommon.

Studies show that there is an age-related rise in frequency of fifth metatarsal fractures in women. This may be linked to a steady decrease in bone mineral density resulting in osteoporosis as women age, typically not seen in men. As women age, they are more likely to develop issues related to osteoporosis, which weakens the bones, making them more susceptible to fracture. Osteoporosis related fractures are more commonly in the spine (vertebral), femur (upper leg, especially near the hip), wrist and foot. A woman experiencing any of these fractures has an 86% increased risk of having another. Studies suggest however that osteoporosis related metatarsal fractures tend to occur in younger women suggesting that these fractures may be an important indicator or early warning sign of osteoporosis which has yet to be diagnosed.

Many physicians, including myself, and hospitals have implemented a program to identify a patient with an osteoporosis related fracture and refer her (or him) for bone density testing in order to evaluate for osteoporosis and begin a prevention and treatment program. A woman who thinks she might have suffered an osteoporosis related foot fracture should discuss this issue with her Podiatrist or Orthopedist.