There are three types of proximal fifth metatarsal fractures, which are classified anatomically into zones. Zone 1 and 2 fractures tend to be caused by trauma, while Zone 3 fractures are seen in the setting of stress fracture.

Zone 1 fracture, also known as an avulsion fracture, is the most proximal fracture type.

Zone 2 fracture, commonly known as a Jones fracture, occurs at the fifth metatarsal metaphyseal–diaphyseal junction. Strictly speaking, a Jones fracture refers to a fracture at the metaphyseal–diaphyseal junction without intra-articular extension to the articulation of the fourth and fifth metatarsals; however, in common usage, the term “Zone 2 fracture” is often used synonymously with “Jones fracture”.

Zone 3 fracture is a diaphyseal fracture, typically occuring as a stress injury.

The peroneus brevis tendon attaches at the lateral base of the fifth metatarsal.

The lateral aspect of the plantar aponeurosis attaches slightly more proximally at the plantar base of the fifth metatarsal.

Avulsion fractures at the base of the fifth metatarsal are thought to be due to combined forces of the peroneus brevis tendon and lateral aspect of the plantar aponeurosis.

Radiographs are the primary modality for imaging proximal fifth metatarsal fractures.

Once the fracture has been identified on radiographs, attempts should be made to describe the zonal location, etiology (acute or stress fracture), degree of displacement, and the presence of intra-articular extension.

As a general principle, indications for surgical treatment include a more distal fracture, displacement of more than 2 mm, and intra-articular extension. Competitive athletes may also be treated surgically without these indications. Otherwise, most fractures are treated conservatively.

The junction of the metatarsal metaphysis and diaphysis has a watershed vascular supply. With repetitive mechanical forces from weight-bearing, fractures in this tenuously vascularized region are susceptible to delayed healing.