From the Guidelines
Fifth metatarsal pain should be initially managed with the RICE method, over-the-counter pain relievers, and avoidance of high-impact activities, with consideration for X-ray imaging if pain persists or worsens, as recommended by the Ottawa ankle rules and other clinical guidelines 1. To manage fifth metatarsal pain, it is essential to follow a step-by-step approach.
- Rest the foot and avoid activities that aggravate the pain.
- Apply ice for 15-20 minutes several times daily to reduce inflammation.
- Compress the foot with an elastic bandage to provide support.
- Elevate the foot when possible to reduce swelling. Additionally, taking over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) can help reduce pain and inflammation 1. It is crucial to wear supportive shoes with cushioning and avoid high-impact activities until the pain subsides. If the pain persists beyond 1-2 weeks, worsens with walking, or is accompanied by visible swelling or bruising, it is essential to seek medical attention, as an X-ray may be necessary to rule out a fracture, following the guidelines outlined in the Ottawa ankle rules and other clinical decision rules, such as the Bernese ankle rules 1. A healthcare provider may recommend a walking boot, crutches, or in severe cases, surgical intervention. Fifth metatarsal pain often results from overuse, improper footwear, or sudden increases in activity level, so gradually increasing exercise intensity and wearing proper footwear can help prevent recurrence, as suggested by the American College of Radiology guidelines 1.
From the Research
Fifth Metatarsal Pain
- Fifth metatarsal pain can be caused by various factors, including fractures, deformities, and gait mechanics 2, 3.
- Metatarsalgia, a common condition characterized by pain in the forefoot, can also contribute to fifth metatarsal pain, although it typically affects the second through fourth metatarsal heads 2.
- Fractures of the fifth metatarsal bone are common, with approximately 30% of metatarsal fractures affecting the base of the fifth metatarsal bone 4.
Treatment Options
- Treatment for fifth metatarsal fractures depends on the location and severity of the fracture, as well as the patient's overall health and activity level 4, 5.
- Early functional therapy is recommended for fractures in zones I and II, while surgical treatment is often necessary for fractures in zone III 4.
- Nonsurgical management, including immobilization and physical therapy, can be effective for some patients, while others may require surgical intervention, such as intramedullary screw fixation or plate fixation 6.
Specific Considerations
- Jones fractures, which occur at the metaphyseal-diaphyseal junction of the fifth metatarsal, are at increased risk for nonunion and continued pain, and may require specialized treatment, including biologic augmentation and primary bone grafting 6.
- Rehabilitation protocols, orthoses, and shoe wear suggestions can help optimize patient outcomes and reduce the risk of complications 6.