From the Guidelines
Treatment for a fracture at the base of the fifth metatarsal typically involves immobilization with a short leg cast or walking boot for 6-8 weeks, with consideration for surgical fixation in cases of displacement or high-risk patients, such as athletes, due to the increased risk of delayed union or non-union 1. The management of this type of fracture prioritizes minimizing complications and promoting optimal healing, given the relatively poor blood supply to the area. Key considerations in the treatment plan include:
- Weight-bearing status, which may vary depending on the fracture type, with avulsion fractures potentially allowing immediate weight-bearing as tolerated, and Jones fractures often requiring an initial period of non-weight-bearing 1
- Pain management, which can be achieved with acetaminophen or NSAIDs like ibuprofen for a limited period, alongside elevation and ice application to reduce swelling 1
- Regular follow-up with orthopedics, including X-rays at 2,4, and 6-8 weeks, to monitor the healing process and adjust the treatment plan as necessary 1 The decision to proceed with surgical fixation, such as with a screw, is influenced by factors including fracture displacement, the patient's activity level, and the presence of conditions that may impair healing, such as osteoporosis 1.
From the Research
Treatment Options for Base of the Fifth Metatarsal Fracture
- Non-operative treatment is recommended for non-displaced tuberosity avulsion fractures, also known as zone 1 fractures, as they generally heal well 2, 3, 4.
- For displaced fractures, surgical treatment is indicated, especially when the fracture extends into the fourth-fifth intermetatarsal joint (zone 2) or in athletes and high-demand patients 2, 3, 4.
- Stress fractures of the proximal diaphysis (zone 3) are preferably treated operatively, particularly in the presence of signs of delayed union 3, 4.
- Early functional therapy is recommended for fractures in zones 1 and 2, as it leads to faster return to full function and similar outcomes compared to immobilization 3.
- Surgery is the primary treatment for zone 3 fractures, as it leads to statistically significant improvement in outcomes 3.
Fracture Classification and Treatment
- The Lawrence and Botte classification is commonly used to divide the location of proximal fifth metatarsal fractures into 3 zones with respect to their healing potential 3, 4.
- Zone 1 fractures are avulsion fractures of the tuberosity of the base and generally heal well with non-operative treatment 3, 4.
- Zone 2 fractures extend into the fourth-fifth intermetatarsal joint and may require internal fixation, especially in displaced fractures or high-demand patients 3, 4.
- Zone 3 fractures are stress fractures of the proximal diaphysis and are preferably treated operatively, particularly in the presence of signs of delayed union 3, 4.
Surgical Techniques and Fixation
- Several operation techniques have been described for the treatment of fifth metatarsal fractures, including percutaneous K-wires, plate, and screw fixation 2.
- Recent advances in surgical techniques and fixation have helped facilitate healing and improved outcomes for patients with metatarsal fractures 5.