From the Guidelines
An ortho boot can be adequate for treating a 5th metatarsal fracture, but only when the fracture fragments are small, nonarticular, or minimally displaced. The treatment of 5th metatarsal fractures depends on various factors, including the location, severity, and displacement of the fracture. According to the American College of Foot and Ankle Surgeons, as reported in the American Family Physician in 2002 1, simple immobilization with an ortho boot is appropriate for small, nonarticular, or minimally displaced fractures. Some key considerations for the use of an ortho boot in treating 5th metatarsal fractures include:
- The location of the fracture: fractures at the base of the 5th metatarsal, such as Jones fractures, may require more aggressive treatment due to the relatively poor blood supply in this area.
- The severity of the fracture: non-displaced avulsion fractures or shaft fractures may be treated with an ortho boot, while displaced fractures may require surgical intervention.
- The displacement of the fracture: minimally displaced fractures may be treated with an ortho boot, while more significantly displaced fractures may require reduction and stabilization. It is essential to note that symptoms should gradually improve during treatment, with pain decreasing and the ability to bear weight increasing. If pain persists or worsens despite appropriate boot immobilization, further medical evaluation is necessary to determine the best course of treatment.
From the Research
Treatment Options for 5th Metatarsal Fracture
- An ortho boot can be an adequate treatment option for certain types of 5th metatarsal fractures, such as nondisplaced tuberosity avulsion fractures or non-displaced shaft fractures 2.
- A study published in 1997 found that early functional treatment of a 5th metatarsal fracture using an orthopedic boot allowed full weightbearing after approximately 9 days, with an average time of sick-leave being 19 days, and showed no long-term complications 3.
- However, the decision to use an ortho boot should be based on the specific type and severity of the fracture, as well as the patient's activity level and other factors 2, 4.
Comparison of Treatment Outcomes
- A study published in 2020 compared the outcomes of patients with zone 1 fractures of the proximal fifth metatarsal treated with either a hard-soled shoe or a controlled ankle motion (CAM)-walker boot, and found that patients treated with the CAM-walker boot demonstrated earlier signs of complete healing, although similar clinical and functional results were achieved with both treatments 5.
- Another study published in 2014 found that a short CAM walker boot more effectively offloads the fifth metatarsal during common gait activities than a postoperative sandal or a standard athletic shoe, suggesting that it may be a beneficial rehabilitative tool for patients undergoing rehabilitation after treatment of Jones fractures and other base of fifth metatarsal fractures 6.
Factors Influencing Treatment Choice
- The type and severity of the fracture, as well as the patient's activity level and other factors, should be taken into account when deciding on a treatment option 2, 4.
- Surgical treatment may be indicated for displaced fractures, or for patients with a high activity level or certain types of fractures, such as Jones fractures 2, 4.
- Non-operative treatment, including the use of an ortho boot, may be suitable for non-displaced or minimally displaced fractures, or for patients with a low activity level 2, 3.