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. 2020 Sep 18;8(9):2325967120947725.
doi: 10.1177/2325967120947725. eCollection 2020 Sep.

Anatomic Characteristics of Tissues Attached to the Fifth Metatarsal Bone

Fumiya Kaneko  1 , Mutsuaki Edama  1   2 , Masahiro Ikezu  1 , Kanta Matsuzawa  1 , Ryo Hirabayashi  1 , Ikuo Kageyama  2
Affiliations

Anatomic Characteristics of Tissues Attached to the Fifth Metatarsal Bone

Fumiya Kaneko et al. Orthop J Sports Med. .

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.

Keywords: Jones fracture; fifth metatarsal bone; gross anatomy; traction stress.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This study was supported by Japan Society for the Promotion of Science (JSPS) KAKENHI, grant JP19K11358, and a grant-in-aid program from Niigata University of Health and Welfare. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Zone determination method; left side, lateral view. ① Long axis of the fifth metatarsal (a line connecting the midpoints of 2 diaphyses). ② The vertical line to the fifth metatarsal long axis from the proximal end of the fourth to fifth intermetatarsal joint. ③ The vertical line to the fifth metatarsal long axis from the distal end of the fourth to fifth intermetatarsal joint. 1 (blue area), zone 1; 2 (red area), zone 2; A, anterior; P, posterior.
Figure 2.
Figure 2.
Footprint area measurement method. (A) Measurement using the MicroScribe system; left side. (B) Digitizing around the footprint area; left side, lateral view. 1 (blue), peroneus brevis muscle; 2 (red), peroneus tertius muscle; 3 (green), lateral band of the plantar fascia; A, anterior; P, posterior.
Figure 3.
Figure 3.
Classification of the peroneus brevis muscle; left side, lateral view. Type I, attached proximal to the border line between zones 1 and 2 (vertical gray line). Type IIa, attached to the border line between zones 1 and 2 with one attached part. Type IIb, attached across the border line between zones 1 and 2 with two or more attached parts. A, anterior; P, posterior; dotted line around the blue-shaded area signifies the peroneus brevis muscle attachment.
Figure 4.
Figure 4.
Classification of the peroneus tertius muscle; left side, lateral view. Type IIa, attached to the border line between zones 1 and 2 (vertical gray line) with one attached part. Type IIb, attached across the border line between zones 1 and 2 with two or more attached parts. A, anterior; P, posterior; dotted line around the red-shaded area signifies the peroneus tertius muscle attachment.
Figure 5.
Figure 5.
Classification of the lateral band of the plantar fascia; left side, lateral view. Type I, attached proximal to the border line between zones 1 and 2 (vertical gray line). Type IIa, attached to the border line between zones 1 and 2 with one attached part. A, anterior; P, posterior; dotted line around the green-shaded area signifies the lateral band of the plantar fascial attachment.
See this image and copyright information in PMC

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