What is your diagnosis?

The patient is diagnosed with a dancer’s fracture, a spiral or oblique fracture of the distal 5th metatarsal.

• Pearl: This fracture can occur even with a low energy mechanism of injury and is more commonly seen in the female population [1].

What is the mechanism of injury? How do patients present?

Patients may describe a mechanism where they roll over their foot or land after a jump. Often there is a reported “twisting” injury [2]. On exam, patients have swelling, tenderness, and sometimes ecchymosis over the 5th metatarsal shaft. 

• Pearl: Be careful not to confuse this with a Jones fracture (proximal 5th metatarsal fracture) or metatarsal stress injury, as management varies.

How is it diagnosed?

This diagnosis is made with x-ray imaging. Most commonly, the fracture line extends from the lateral metatarsal distally and then travels medially at the more proximal end [1].

Figure 1: Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID: 28104

What is your management in the ED? What is your disposition?

These fractures are usually managed non-operatively [3]. In the ED, patients should be placed in a walking CAM boot or post-operative shoe. Patients can weight-bear as tolerated and can be discharged with sports medicine or orthopedic follow up. 

• Pearl: These fractures take approximately 6-8 weeks to heal. In severely displaced or nonunion cases, surgery may be required [3].