Have you been diagnosed with an avulsion fracture of the foot? Are you wondering how long it is going to take to heal and the treatment options available? You are in the right place.
As a diagnostic radiographer I will answer the most common questions from the patients I see in x-ray. And of course, I have consulted scientific resources on the subject matter.
For any questions or experience feel free to leave a comment at the end of this article.🙋
Happy reading!😀
Summary: An avulsion fracture to your foot or ankle is treated like a soft tissue injury (sprain) to your ankle. You may require a cast or walking boot.
In rare cases, if the bone fragment and main bone are too far apart to fuse naturally, surgery may be necessary to reunite them. Healing can take approximately 6 weeks, although pain and swelling can be ongoing for 3 to 6.
▶️What does an avulsion injury to the foot look like? Is it a real fracture?
An avulsion fracture of the fifth metatarsal, also called a (Jones fracture) is the most common type of fifth metatarsal fracture. The fifth metatarsal is the bone that runs from the midfoot to the base of the small toe on the outside of the foot.
An avulsion fracture of the fifth metatarsal can occur where a tendon attaches to the bone at this point (the peroneus brevis tendon) pulls off a tiny fragment of bone.
These fractures are usually not badly out of place. Patients I see for x-ray often presents with:
🔵 Localised pain and swelling around the 5th metatarsal area.
🔵Tender to touch and sometimes skin turning blue or purple (bruising).
🔵 And inability to bear weight or walk on the lateral aspect of the foot.
🔵Bruising along the outside of the foot extending into the toes
Usually, the doctor examines the area around the foot and ankle for these signs before x-ray for diagnosis confirmation.
If a fracture is present, it will typically be one of two of these types:
1️⃣ A tuberosity avulsion fracture.
2️⃣ A Jones fractures.
Image of a Tuberosity and Jones ankle avulsion fractures.
▶️Treatment option of ankle avulsion fractures
Following this diagnosis, your doctor will likely recommend a personalised treatment based on.
🟦The type of fracture
🟦Your overall health
🟦Any work or personal commitments you may have.
In most cases, the treatment for Nondisplaced tuberosity avulsion fractures can generally be treated with.
This means that there is no surgery involved. The usual recommendations include.
⏺️Compressive dressings e.g., ace bandage or air cast.
⏺️With a compressive dressing, then you will be able to transition to a short leg walking boot for two weeks or a rigid-sole shoe.
⏺️ Initial management includes immobilisation in a posterior splint. use of crutches, and avoidance of weight-bearing activities.
⏺️Sometimes you will be advised to apply ice.
⏺️ Elevating the foot above heart level and using pain killer as needed.
There is evidence that transitioning to a walking boot and then to a rigid-sole shoe at four to six weeks, with progressive weight bearing as tolerated.
Results in improved functional outcomes compared with cast immobilisation, with no differences in healing time or pain scores (Zenios,2005)
⏺️ Occasionally, emphasis is placed on partial weight-bearing while walking, avoid putting pressure on the foot. This may involve using crutches to allow for proper healing.
To reassure you if you have had nondisplaced acute metatarsal shaft fracture. Most of them heal well without complications.
▶️Jones fracture treatment options.
Jones fractures are in a “watershed” area for blood supply and have high rates of delayed union and non-union. (Mehlhorn,2014)
Initial management of a Jones fracture includes a posterior splint and avoidance of weight-bearing activity, with follow-up in three to five days.
After that, you will be recommended to wear a short leg non-weight bearing cast with a radiographic follow up at six weeks to eight weeks to assess healing.
If evidence of healing is present (callus formation and lack of point tenderness) at that time.
Then weight-bearing activity can progress gradually, along with physical therapy and rehabilitation.
If no healing has occurred at six to eight weeks, avoidance of weight-bearing activity should continue for another four weeks.
Typical length of immobilisation is 6 to 10 weeks, and healing time is typically up to 12 weeks.
Caution! For Jones fracture immobilisation and healing may take longer because there is a higher risk of non-union due to the poor blood supply in that area.
Bica, 2016
▶️Surgery after ankle avulsion fracture.
If an avulsion fracture results in a large, displaced fracture fragment and there is a risk of poor healing, surgical interventional will be the last option.
Your doctor may need to do an open reduction and internal fixation with plates or intramedullary screw to fix the fracture.
Image on the left shows a post surgery of base of 5th fracture
It is believed that this kind of treatment allows for an earlier return to activity than nonsurgical management and should be strongly considered for athletes or other highly active persons (Cakir, 2011)
Follow-up visits should occur every two to four weeks after surgery, with repeat radiography at 4 to 6 weeks to document healing.
At 6 weeks, callus formation showing on x-ray and lack of point tenderness generally will signify adequate healing, after which immobilisation can be discontinued.
▶️ How long does it take for an avulsion fracture of the 5th metatarsal of the foot to heal?
It’s completely normal to be concerned about the recovery time! Be aware that predicting it with certainty is impossible. Many factors come into play:
♦️The type of avulsion fracture you have had.
♦️Your overall health, weight and history with the foot in question.
♦️Whether you smoke or not and more.
Here are the average timelines I got from a physical therapy in the NHS in England who treats individuals in a fracture clinic at my place of work.
| Phase /stage | Recovery timeline from day of fracture |
| Rest your ankle on a cushion or stool to help reduce swelling, you can use an ice pack wrapped in a towel to help with swelling | First 3 days Every 15 minutes every few hours |
| Wear your boot whenever standing & walking start using it 3 weeks after injury to 6 weeks | For 3 to 6 weeks (you can take it off when sleeping |
| Less pain | A few days |
| Removing the cast, boot, or brace | Within 3 to 6 weeks often after a follow-up x-ray. |
| Going back to cyclingResuming other sports activities | 2 to 3 weeks to 61 to 6 months depending on activity. |
| Swelling and pain | 3 to 6 weeks after injury you may still feel pain and soul |
| Wearing your boot | For the first 2 weeks it is very important. |
| Healing completely without surgery | 6 weeks with surgery it can take more |
| Using crutches in the early stagesNot using crutches after | Immediately often with support or withoutOften within a few weeks, maximum 1 to 2 months |
▶️What is the fastest way to heal an ankle avulsion fracture?
There is no medical, surgical, natural, or physical treatment that can directly speed up the healing time of any bone.
Your body does this quite well on its own. However, you can facilitate the natural healing and consolidation process by not hindering it.
Here are some suggestions.
Make sure you rest the ankle, use icing on the affected area as instructed by your doctor.
Activities like indoor seated cycling, walking, and swimming will help you restore range of motion, improve muscle strength, and promote bone healing.
If you are a smoker, you can stop smoking as this substance can slow down consolidation.
A balanced diet and good vitamins D, calcium if you cannot get them in food will help with bone healing.
I hope I have answered your main questions, feel free to leave any questions in the comments section.
Wishing you a quick recovery.🙋
You may also like:
⚫Ankle fracture: All you need to know.
📚Source
Thevendran G, Deol RS, Calder JD. Fifth metatarsal fractures in the athlete: evidence for management. Foot Ankle Clin. 2013;18(2):237-254.
Smith TO, Clark A, Hing CB. Interventions for treating proximal fifth metatarsal fractures in adults: a meta-analysis of the current evidence-base. Foot Ankle Surg. 2011;17(4):300-307.
Quill GE. Fractures of the proximal fifth metatarsal. Orthop Clin North Am. 1995;26(2):353-361.
Bica D, Sprouse RA, Armen J. Diagnosis and Management of Common Foot Fractures. Am Fam Physician. 2016 Feb 1;93(3):183-91. PMID: 26926612.
Ekinci S, Polat O, Günalp M, Demirkan A, Koca A. The accuracy of ultrasound evaluation in foot and ankle trauma. Am J Emerg Med. 2013;31(11):1551-1555.
Mehlhorn AT, Zwingmann J, Hirschmüller A, Südkamp NP, Schmal H. Radiographic classification for fractures of the fifth metatarsal base. Skeletal Radiol. 2014;43(4):467-474.
Smith TO, Clark A, Hing CB. Interventions for treating proximal fifth metatarsal fractures in adults: a meta-analysis of the current evidence-base. Foot Ankle Surg. 2011;17(4):300-307.
Cakir H, Van Vliet-Koppert ST, Van Lieshout EM, De Vries MR, Van Der Elst M, Schepers T. Demographics and outcome of metatarsal fractures. Arch Orthop Trauma Surg. 2011;131(2):241-245.