From the Research
For a 5th metatarsal mid shaft fracture, a walking boot is typically the best treatment option. This type of fracture usually requires immobilization for 6-8 weeks to allow proper healing. The walking boot provides adequate stability while still allowing the patient to bear weight and maintain mobility. The boot should be worn at all times except when bathing, and weight-bearing is generally allowed as tolerated with the boot on. A post-op shoe provides less stability and is more suitable for less severe foot injuries, while a splint is typically used as a temporary measure until definitive treatment can be established.
The walking boot is preferred because it provides circumferential support to limit movement at the fracture site while still allowing for some functionality. Non-displaced fractures in this location typically heal well with conservative management, though patients should be monitored with follow-up X-rays at 2-3 weeks and again at 6 weeks to ensure proper bone alignment and healing progression. If the fracture is significantly displaced (>2mm) or angulated, surgical intervention with internal fixation may be necessary instead of conservative treatment. According to a study published in the journal PM & R 1, a short controlled ankle movement (CAM) walker boot, such as a walking boot, more effectively offloads the fifth metatarsal during common gait activities than a postoperative sandal or a standard athletic shoe.
Some key points to consider when treating a 5th metatarsal mid shaft fracture include:
- Immobilization for 6-8 weeks to allow proper healing
- Use of a walking boot to provide adequate stability and allow for weight-bearing and mobility
- Monitoring with follow-up X-rays at 2-3 weeks and again at 6 weeks to ensure proper bone alignment and healing progression
- Consideration of surgical intervention if the fracture is significantly displaced or angulated. A study published in the American family physician 2 also supports the use of a short leg walking cast or boot for four to six weeks in the treatment of metatarsal shaft fractures.