From the Research
Weight-bearing after a base fifth metatarsal fracture can typically begin immediately with protected weight-bearing in a walking boot or cast, depending on fracture severity and stability, as supported by the most recent study 1 from 2022. For stable, non-displaced fractures, patients can often bear weight as tolerated while wearing a short leg walking boot or hard-soled shoe for 4-6 weeks. The study by 1 demonstrated that non-operative management of minimally displaced Jones fractures, in the adult, low demand population, without weight bearing restrictions in a walking boot offers similar outcomes to cast immobilization with weight bearing restrictions, resulting in bony union or asymptomatic fibrous nonunion. However, for displaced fractures or those with delayed healing, non-weight-bearing or partial weight-bearing may be recommended for 2-6 weeks before progressing to full weight-bearing, as suggested by the study 2 from 2024. The transition to normal footwear usually occurs around 6-8 weeks post-injury when radiographic evidence shows adequate healing, as indicated by the study 3 from 2017. This progressive approach to weight-bearing helps maintain bone alignment while promoting proper healing through controlled mechanical stress. Pain should guide activity levels, and patients should work closely with their healthcare provider to adjust weight-bearing status based on individual healing progress, as premature full weight-bearing could lead to displacement, delayed union, or non-union of the fracture. Key considerations include:
- Fracture severity and stability
- Patient's overall health and activity level
- Presence of any underlying conditions that may affect healing
- Regular follow-up with a healthcare provider to monitor healing progress and adjust weight-bearing status as needed. It's also important to note that the study 4 from 2021 suggests that fractures in zones I and II should be treated with early functional therapy, while fractures in zone III should primarily be treated surgically. Overall, the decision to start weight-bearing after a base fifth metatarsal fracture should be individualized and based on the specific characteristics of the fracture and the patient, with a focus on promoting proper healing and minimizing the risk of complications, as supported by the most recent and highest quality studies 2, 1.