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.
| Articulations |
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|---|---|
| Landmarks |
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| Ossification | Primary centre in the shaft at 9 weeks fetal. Base apophysis (styloid process) appears at 10-12 years and fuses at 18 years, unfused apophysis may mimic Zone 1 fracture. |
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.
A fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal with a high rate of non-union.
Inversion of the ankle avulses the base of the fifth metatarsal at the peroneus brevis and lateral plantar fascia attachment.
A proximal diaphyseal stress fracture in athletes, often needing screw fixation.
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