Anatomic Characteristics of Tissues Attached to the Fifth Metatarsal Bone

Abstract

Background: Two types of stress, bending stress and traction stress, have been reported to be involved in the mechanism of Jones fracture. However, little is known about the risk factors for traction stress. Purpose: To classify the attachment position of the peroneus brevis muscle (PB), peroneus tertius (PT), lateral band of the plantar aponeurosis (LB), and the long plantar ligament (LPL), focusing on the zone where a Jones fracture occurs (zone 2), and to compare the footprint area of each tissue type. Study Design: Descriptive laboratory study. Methods: This study examined 102 legs from 55 Japanese cadavers. Type classification was performed by focusing on the positional relationship between each tissue attachment and the zone where Jones fracture occurs (zone 2). The classifications were as follows: type I, attached proximal to the border between zones 1 and 2; type IIa, attached to the border between zones 1 and 2 with one attached part; and type IIb, attached across the border between zones 1 and 2 with two or more attached parts. The footprint areas of the PB, PT, LB, and LPL were compared between tissue types and within each attachment classification. Results: The PB was recorded as type I in 41 feet (40.2%), type IIa in 56 feet (54.9%), and type IIb in 5 feet (4.9%); the PT was recorded as type IIa in 54 feet (60.0%) and type IIb in 36 feet (40.0%); and the LB was recorded as type I in 27 feet (26.5%) and type IIa in 75 feet (73.5%). The LPL did not attach to the fifth metatarsal bone. No significant difference was found in the footprint area between type I PB and type I LB. Conclusion: The results indicate that type I, which attaches proximal to zone 2, occurs with PB and LB, and there was no significant difference in the footprint area between them. These findings suggest that type I is involved in traction stress. In the future, biomechanical research based on the results of this study will be necessary. Clinical Relevance: The results of this study provide basic research for investigating the mechanism of Jones fracture and the cause of delayed healing.

Fifth metatarsal fractures: an update on management, complications, and outcomes

“…Kavanagh et al in a force platform analysis demonstrated that a vertical or medial lateral force is often required for a fracture to occur (13). Inversion injuries are responsible for tuberosity avulsion fractures (14), where peroneus brevis is already contracted during stance phase and has the potential of pulling the tuberosity fragment when the plantarly flexed foot is subjected to an inversion stress; the firm attachment of the lateral band of plantar aponeurosis, on the other hand, is implicated for fractures distally to the tuberosity (15, 16,17,18). Furthermore, Gu used a three-dimensional model to study stress loads on the metatarsals during landing, reporting that one of the peak stress points was in the proximal fifth metatarsal.…”

Classification of avulsion fractures of the fifth metatarsal base using three‐dimensional CT mapping and anatomical assessment: a retrospective case series study

“…In addition, for the anatomical study, the lateral band of the plantar fascia and peroneus brevis are attached to the dorsolateral aspect of the fifth metatarsal base. Since the attachment point of the peroneus tertius is farther away from the fifth metatarsal base and the peroneus tertius has less strength than the other two tendons [ 16 ], we propose that the peroneus tertius does not play a major role in the avulsion fracture of the fifth metatarsal base. Following this, separate heat maps were generated for the fracture lines in the three zones that appeared most frequently on the overall heat map.…”

Fifth Distal Phalanx Avulsion Fracture in a High-Level Marathon Runner

“…The fifth metatarsal bone base is involved in 30% of metatarsal fractures due to the anatomy and biomechanics of the pes quintus (fifth foot) [ 1 ]. The tuberositas ossis metatarsi quinti, which is a projection on the lateral surface of the fifth metatarsal bone and serves as an insertion point for ligaments and tendons [ 2 ], is highly prominent and increases the lever arm of the bone, leading to greater stress in this area [ 3 ]. Avulsion fractures of the tuberosity are frequent and caused by the sudden inversion and plantar flexion of the foot [ 4 ].…”