The fifth metatarsal has three clinically important zones at its base: Zone 1 (tuberosity — peroneus brevis avulsion site, treated conservatively), Zone 2 (Jones fracture zone — at the proximal diaphysis-metaphysis junction, watershed blood supply, requires ORIF or internal fixation in athletes), and Zone 3 (diaphyseal stress fracture — high non-union risk). The tuberosity is the most common site of foot fracture overall.
Zone 1 tuberosity avulsion fractures from inversion: treated conservatively in a walking boot. Zone 2 Jones fractures: intramedullary screw fixation for athletes (high non-union rate with conservative treatment); Zone 3 stress fractures: intramedullary screw fixation for competitive athletes. The three-zone classification guides prognosis and treatment.
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