From the Guidelines
The management of a fifth metatarsal fracture should prioritize early identification and treatment to prevent progression to more serious fractures and complications, with high-risk stress fractures at the fifth metatarsal base often necessitating prompt surgical intervention. The fifth metatarsal base is considered a high-risk area for stress fractures due to its tendency for nonunion or delayed union 1. For non-displaced fractures, conservative treatment may be considered, but for Jones fractures or displaced fractures, surgical intervention with internal fixation using screws is often necessary due to the high risk of nonunion.
Key considerations in the management of fifth metatarsal fractures include:
- Fracture location and displacement
- Patient factors, such as osteoporosis, bisphosphonate therapy, or athletic status
- Risk of nonunion or delayed union
- Need for prompt surgical intervention in high-risk cases
Pain management for fifth metatarsal fractures typically includes NSAIDs like ibuprofen or naproxen, with acetaminophen as needed. Rehabilitation should begin after adequate healing, focusing on range of motion exercises, progressive weight-bearing, and gradual return to activities. According to the American College of Radiology, patients at high-risk for fracture completion, including those with osteoporosis or on bisphosphonate therapy, require timely identification and management to prevent serious complications 1.
In terms of specific treatment, the use of a short leg cast or walking boot for 6-8 weeks, with weight-bearing as tolerated, may be recommended for non-displaced fractures. However, for high-risk stress fractures, such as those at the fifth metatarsal base, early surgical fixation may be necessary to expedite healing and prevent complications 1. Athletes and active individuals with Jones fractures often benefit from early surgical fixation to expedite return to activities.
From the Research
Fifth Metatarsal Fracture Management
The management plan for a fifth metatarsal fracture depends on the type and severity of the fracture.
- Nondisplaced tuberosity avulsion fractures can be treated non-operatively 2.
- Surgical treatment is indicated when the fracture is displaced more than 2mm or when more than 30% of the cubometatarsal joint is involved 2.
- Non or minimally displaced shaft fractures can be treated non-operatively 2.
- If the dislocation is more than 3-4mm or the angulation is more than 10 degrees, percutaneous K-wires, plate or screw fixation is indicated 2.
Treatment Options
Different treatment options are available for fifth metatarsal fractures, including:
- Hard-soled shoes: can be used for non-displaced fractures, with average time to bone healing of 8.6 weeks 3.
- CAM-walker boot: can be used for non-displaced fractures, with average time to bone healing of 7.2 weeks 3.
- Rigid sole shoe: can be used for spiral diaphyseal fractures, with better outcomes and less restrictive for patients compared to a boot 4.
- Short CAM walker boot: can be used for Jones fractures, with significantly lower peak pressure at the fifth metatarsal during walking and heel-walking 5.
Specific Fracture Patterns
Different fracture patterns have distinct treatment options, including:
- Tuberosity avulsion fractures: majority heal with symptomatic care in a hard-soled shoe 6.
- Acute Jones fractures: best treated with non-weight-bearing cast immobilization for 6 to 8 weeks, or early intramedullary-screw fixation for high-performance athletes 6.
- Diaphyseal stress fractures: can be managed with operative fixation with either closed axial intramedullary-screw fixation or autogenous corticocancellous grafting 6.