The fifth metatarsal is the long bone that runs along the outer edge of the foot, connecting the ankle area to the little toe. Pain in this region is common because the bone is exposed and serves as an anchor point for several tendons and ligaments. Its position makes it vulnerable to both acute traumatic injuries and chronic strain from repetitive use and structural mechanics. Understanding the underlying cause—whether a fracture, soft tissue problem, or structural deformity—is the first step in finding relief.
Common Fractures of the Fifth Metatarsal
Fractures of the fifth metatarsal are categorized into three zones based on their location, which dictates the required treatment. The most common fracture is the avulsion fracture, occurring in Zone 1 at the base of the metatarsal, near the ankle. This injury typically happens during an ankle sprain when the foot rolls inward, causing the peroneus brevis tendon to pull a small piece of bone away. Symptoms include sudden pain, swelling, and bruising on the outer foot. These fractures usually have a good blood supply, allowing for non-surgical treatment.
A Jones fracture occurs in Zone 2, located slightly further down the bone at the junction between the metaphysis and diaphysis. This area has a poor blood supply, which slows the healing process and increases the risk of nonunion. Jones fractures are often caused by direct trauma or a high-force injury, such as shifting weight while the forefoot is fixed, common in sports like basketball or football. Patients report acute pain at the fracture site and often struggle to bear weight.
The third type is a stress fracture, which develops further along the shaft of the bone, in Zone 3. Unlike the sudden pain of the other two types, a stress fracture is an overuse injury resulting from repetitive microtrauma. It is frequently seen in runners or individuals who suddenly increase their activity level. The pain starts gradually, often feeling like a persistent ache that worsens with activity and lessens with rest.
Soft Tissue and Structural Causes of Pain
Pain on the outer foot not caused by a fracture is often related to the tendons or the underlying foot structure. Peroneal tendinopathy involves inflammation or degeneration of the peroneal tendons, which run along the outside of the ankle and attach near the fifth metatarsal base. This condition causes pain and tenderness along the outer ankle and foot, often exacerbated by activities that involve pushing off or stabilizing the foot. The tendon sheath can become irritated from overuse or abnormal foot mechanics.
A bunionette (Tailor’s Bunion) is a structural cause of pain near the little toe. This condition is an enlargement of the fifth metatarsal head, where the bone begins to splay outward. The deformity creates a painful bump that is frequently irritated by tight footwear, causing redness, swelling, and localized pain from friction.
The cuboid syndrome is another source of lateral foot pain, sometimes feeling similar to a persistent sprain. This condition involves a slight misalignment or subluxation of the cuboid bone, which is situated just behind the fifth metatarsal. Pain is localized to the midfoot on the outside and may worsen when standing or walking. The peroneal tendon may be involved, as it courses under the cuboid, potentially contributing to the misalignment.
When to See a Doctor and Initial Self-Care
If you experience pain on the outside of your foot, certain signs indicate the need for immediate medical evaluation. Seek prompt care if you are unable to bear weight, if the pain is severe enough to wake you from sleep, or if you notice any visible deformity, numbness, or tingling. These symptoms suggest an acute fracture or severe injury. If the pain and swelling fail to improve after 48 hours of home care, a doctor’s visit is also warranted to rule out a significant injury.
For mild pain or suspected soft tissue injuries, initial self-care should focus on the R.I.C.E. protocol:
- Rest: Avoid any activity that causes pain and stay off the foot to prevent further damage.
- Ice: Apply to the painful area for 20 minutes at a time, using a thin towel to protect the skin, and wait at least 40 minutes before reapplying.
- Compression: Use an elastic bandage to help control swelling, wrapped snugly without restricting blood flow.
- Elevation: Raise the foot slightly above the level of the heart to help reduce swelling and throbbing.
Avoid walking off a traumatic injury, as this can worsen an undiagnosed fracture.