From the Guidelines
The treatment for a non-displaced fracture of the base of the 5th metatarsal typically involves conservative management with a short period of immobilization. This approach is recommended because the base of the 5th metatarsal has a good blood supply, and non-displaced fractures in this area typically heal well without surgical intervention 1. The patient should wear a walking boot or a hard-soled shoe for 4-6 weeks to protect the fracture site while allowing for weight-bearing as tolerated.
- Pain management includes acetaminophen (500-1000mg every 6 hours) or NSAIDs like ibuprofen (400-600mg every 6-8 hours) for the first 1-2 weeks as needed.
- Elevation of the foot above heart level and ice application for 15-20 minutes several times daily during the first 48-72 hours can help reduce swelling.
- Most patients can gradually return to normal activities after 6-8 weeks, though athletic activities may require 8-12 weeks for full return. It's essential to note that the base of the 5th metatarsal is considered a high-risk area for stress fractures due to its tendency for nonunion or delayed union 1. Therefore, close monitoring and follow-up are crucial to ensure proper healing and to address any potential complications promptly. If pain persists beyond 6-8 weeks or if follow-up X-rays show delayed healing, further evaluation may be necessary to rule out a Jones fracture, which has a higher risk of non-union and might require surgical fixation.
From the Research
Treatment for Non-Displaced Fracture of the Base of the 5th Metatarsal
The treatment for a non-displaced fracture of the base of the 5th metatarsal (MTP) can vary depending on the specific location and characteristics of the fracture.
- For non-displaced fractures, conservative management is often recommended 2, 3.
- A study published in 2020 found that conservative management of spiral diaphyseal fractures of the fifth metatarsal in a rigid sole shoe resulted in better outcomes and was reported to be less restrictive by the patients in comparison to a boot 2.
- Another study published in 2017 found that functional treatment for fractures to the base of the 5th metatarsal, including non-displaced fractures, resulted in excellent outcomes with immediate full weightbearing 3.
- However, some studies suggest that surgical management may be necessary for displaced fractures or fractures with certain characteristics, such as intra-articular involvement or comminution 4, 5, 6.
Conservative Management
Conservative management of non-displaced fractures of the base of the 5th metatarsal may include:
- Immobilization in a rigid sole shoe or boot 2, 4
- Full weightbearing with early range of movement of the ankle 2
- Pain management and monitoring for complications 3, 6
Surgical Management
Surgical management may be necessary for: