Most patients will have a clear history of trauma, usually a twisting injury. Athletes presenting with increasing pain, often with a further marked increase that precipitates presentation, should be suspected of having a stress fracture.
Examination will show local tenderness.
Lateral ligament injuries of the ankle are particularly common in association with 5th MT fractures. Check for the other injuries in each patient by palpation and radiography as indicated.
For midfoot injuries the standard radiographs are AP, lateral and oblique. The oblique view shows the TMT joints and also shows the relationship between the fracture line and the 4:5 joint most clearly. Other imaging techniques are unlikely to be required.
Standard images of a fracture of the 5th MT base. Note the oblique view shows the relationship of the fracture to the cuboid-metatarsal and 4:5 intermetatarsal joints more clearly than the AP.