Metatarsal fracture
A break in one of the five long bones in the middle of the foot. Most metatarsal fractures heal well without surgery, but certain patterns - particularly fifth metatarsal base fractures - have specific treatment considerations.
📊 Metatarsal fractures are common, accounting for around 5-6% of all fractures seen in primary care. The fifth metatarsal is the most frequently affected bone. Stress fractures (small cracks from repetitive loading) are also common in runners and military recruits.
What is a metatarsal fracture?
The metatarsals are the five long bones in the middle of the foot, running from the midfoot to the toes. They are numbered from 1 (under the big toe) to 5 (under the little toe). Metatarsal fractures can occur in any of these bones and result from a wide variety of mechanisms - from a direct blow (something dropped on the foot) to twisting injuries, repetitive stress, or stubbed toes.
The most clinically important metatarsal fracture is at the base of the fifth metatarsal - the prominent bone on the outside edge of the foot. There are three distinct fracture patterns at this site, each with different treatment implications. Avulsion fractures (Zone 1) heal well without surgery; Jones fractures (Zone 2, at the junction of the bone shaft and base) have a poor blood supply and often need surgery in active patients; and stress fractures (Zone 3) in long-distance runners frequently need surgery to heal reliably.
Stress fractures are a separate category - small cracks in the bone caused by repetitive loading rather than a single injury. They typically present with gradually worsening pain in a runner or person who has rapidly increased activity. The second and third metatarsals are most commonly affected. Stress fractures usually heal with rest and a boot, but those at the base of the fifth or in the navicular bone need particular care.
Common mechanisms
- Direct trauma - object dropped on the foot, kick injury
- Twisting injury with the foot fixed (common in fifth metatarsal injuries)
- Inversion sprain - tightening of the peroneus brevis tendon avulses the fifth metatarsal base
- Repetitive overload - stress fractures in runners or military recruits
- Sudden increase in training volume or intensity
- Underlying osteoporosis - low-energy fractures in older adults
Who is at risk? Risk factors include high-impact sports (running, dancing, football), rapid increase in training volume, female sex (particularly the female athlete triad), vitamin D deficiency, smoking, and osteoporosis. The fifth metatarsal base is particularly vulnerable to inversion injuries.
Symptoms
Symptoms typically begin at the time of injury and can vary depending on the severity:
- Pain over the affected bone, usually worse with weight-bearing
- Swelling and bruising over the top or side of the foot
- Tenderness on direct pressure over the broken bone
- Pain with attempts to spread the toes
- Sudden onset with traumatic fractures, gradual onset with stress fractures
- Limp or inability to weight-bear, depending on severity
When to seek help: Attend A&E or your GP if you have significant pain after a foot injury, particularly if you cannot weight-bear. For gradually worsening pain in a runner, see your GP or a sports doctor - delayed diagnosis of a stress fracture means delayed treatment and prolonged disability.
How is it diagnosed?
Your foot and ankle specialist will take a detailed history and examine the foot. The following investigations may be arranged to confirm the diagnosis:
- X-rays - AP, lateral, and oblique views of the foot. Most metatarsal fractures are visible
- Stress fractures - may not show on early X-rays. Repeat imaging at 2-3 weeks often reveals the fracture as it begins to heal
- MRI - the imaging of choice for suspected stress fractures and for assessing fifth metatarsal base injuries
- CT scan - occasionally used for complex fracture patterns, particularly involving the metatarsal base joints
Fifth metatarsal base fractures are commonly confused. An "avulsion fracture" (Zone 1) at the tip of the bone heals well without surgery. A "Jones fracture" (Zone 2) at the junction of base and shaft has a poor blood supply and may need surgery. Getting this right matters because treatment differs significantly.
Treatment pathway
Treatment depends on the severity of the injury, your age, and your activity demands. Many injuries can be managed without surgery; others require surgical fixation.
Walking boot and weight-bearing as tolerated
Most metatarsal fractures - including avulsion fractures of the fifth base, isolated lesser metatarsal shaft fractures, and stress fractures - heal well with 4-6 weeks in a walking boot, with weight-bearing as comfort allows.
Reduction and fixation
Significantly displaced or angulated metatarsal shaft fractures - particularly of the first metatarsal, or multiple metatarsals - may need surgical fixation with wires, plates, or screws. The first metatarsal is the most important for weight-bearing and lower tolerance for displacement.
Screw fixation for Zone 2 fifth metatarsal
A true Jones fracture at the junction of the fifth metatarsal base and shaft has a high non-union rate (10-30%) when treated non-surgically. In athletes or active patients, primary screw fixation gives faster, more reliable healing and is the preferred approach.
Activity modification and gradual return to load
Most stress fractures heal with 6-8 weeks of reduced activity and a boot. Underlying factors (training error, vitamin D deficiency, low bone density) should be addressed to prevent recurrence. High-risk stress fractures (Jones, navicular) often need surgery.
Recovery
Recovery depends on the fracture pattern. Most simple metatarsal fractures heal within 6-8 weeks. Jones fractures and stress fractures take longer - typically 3-4 months even with surgery. Return to running is staged: walking comfortably first, then easy jogging, then full running. Rushed return to running is the most common cause of re-injury.
- Initial pain control and elevation: 1-2 weeks
- Walking in boot: 2-6 weeks
- Out of boot, into supportive shoes: 6-8 weeks
- Walking comfortably: 8-12 weeks
- Return to running (most fractures): 3-4 months
- Return to running (high-risk stress fractures): 4-6 months
What results can I expect?
Outcomes are generally excellent for simple metatarsal fractures - over 95% heal without long-term issues. Jones fractures have a higher non-union rate without surgery. Long-term ankle/foot function is preserved in most cases. Recurrent stress fractures may indicate an underlying bone health issue worth investigating.
In numbers
When can I…?
Typical activity timelines for this condition. These are approximate and vary considerably between patients. Always follow the specific guidance given by your surgeon and physiotherapist.
| Activity | Typical timeline | Notes |
|---|---|---|
| Wear a supportive shoe or boot | 4-6 weeks | Most metatarsal fractures are managed in a stiff-soled shoe or walking boot rather than a cast.[2] |
| Bear weight | As tolerated | Weight-bearing in the boot/shoe is usually safe and recommended for most patterns.[2] |
| Drive | When comfortable out of the boot | When you can perform an emergency stop without pain or the boot. Often 4-6 weeks. Inform your insurer.[3] |
| Return to running | 8-12 weeks | Gradual return once the bone has healed and walking is pain-free. Jones fractures and stress fractures may take longer.[1] |
| Return to sport | 3-4 months (most) | Simple metatarsal fractures: 3-4 months. Jones fractures or surgically fixed fractures: 4-6 months.[1] |
Is this normal?
Common concerns from patients with this condition or recovering from treatment, and whether they are expected or worth mentioning to your team.
Related injuries & conditions
Your questions, answered
Plain-English answers to the things people most often ask, grounded in published guidance. Tap a question to open it.
About thisWhich bone have I broken?
A metatarsal fracture is a break in one of the long bones in the middle of the foot. Many heal well without surgery.
Fractures of the fifth metatarsal on the outer border are especially common.
Your choiceWill I need surgery?
Most undisplaced metatarsal fractures heal in a stiff-soled shoe or boot. Displaced fractures, or certain fractures at the base of the fifth metatarsal known as Jones fractures, may need surgery.
Your X-ray and the exact location guide this.
Getting backHow long to heal?
Commonly around six to eight weeks. Jones fractures can be slower to unite and are watched more closely.
Follow-up confirms the bone is healing.
Getting backCan I walk on it?
Many metatarsal fractures allow weight-bearing as comfortable in a supportive shoe or boot, guided by your team.
Comfort is a reasonable guide once you have been told it is safe.
About thisHow is a stress fracture different?
A stress fracture is an overuse injury from repetitive load rather than a single event. It needs a period of reduced loading and a gradual, planned return.
Reviewing training or footwear helps prevent it returning.
UrgentWhat should prompt review?
Cold or numb toes, severe or increasing swelling, or pain that is not settling as expected should be reviewed.
Seek urgent help for calf swelling or breathlessness.
References & further reading
- 1.British Orthopaedic Foot & Ankle Society: Metatarsal fracture patient information
- 2.NHS: Broken toe or metatarsal
- 3.Royal College of Surgeons of England: Driving after surgery guidance
References are to UK clinical guidance and patient information from recognised organisations. This page is for general information and does not replace personalised advice from your own clinical team.