Recommended Splinting for Distal 5th Metatarsal Fracture
For distal 5th metatarsal fractures, a short leg walking boot (CAM-walker) is the recommended initial treatment, providing better healing outcomes while maintaining patient mobility compared to other immobilization options. 1, 2
Treatment Approach
Initial Management
- Apply a short leg walking boot (CAM-walker) for distal 5th metatarsal fractures
- The boot should be worn for 4-6 weeks depending on fracture healing 1
- Weight-bearing as tolerated is permitted with the walking boot
Evidence Supporting Walking Boot Use
- CAM-walker boots demonstrate faster bone healing (average 7.2 weeks) compared to hard-soled shoes (8.6 weeks) 2
- Walking boots allow patients to return to pre-injury activity levels in approximately 8.3 weeks 2
- Patients treated with walking boots report significantly less pain and better function at 3,6, and 9 weeks post-injury compared to cast immobilization 3
Treatment Timeline
- Weeks 0-2: Strict immobilization in walking boot with weight-bearing as tolerated
- Weeks 2-4: Continue immobilization with gentle range of motion exercises
- Weeks 4-6: Transition to normal footwear with progressive strengthening exercises
- Follow-up: Clinical and radiographic reassessment at 2-3 weeks to evaluate healing progression
Important Considerations
Advantages of Walking Boot Over Cast
- Better accommodates swelling compared to rigid casts 3
- Allows for skin inspection and hygiene
- Enables earlier return to driving (6 weeks vs. 12 weeks with cast) 3
- Results in fewer days off work (31.5 days vs. 39.2 days with cast) 3
Special Patient Populations
- Diabetic patients: Require close monitoring of skin to prevent pressure points
- Athletes: May need longer immobilization for complete healing before return to sports
- Smokers: At higher risk for nonunion and inferior clinical outcomes
Potential Complications
- Excessive immobilization can lead to joint stiffness and muscle atrophy
- Inadequate immobilization may result in delayed healing or malunion
- Avoid low-intensity pulsed ultrasonography (LIPUS) as it does not accelerate healing
Pain Management
- NSAIDs for pain and inflammation control
- Ice application during first 3-5 days for symptomatic relief
- Consider vitamin C supplementation to prevent disproportionate pain
The evidence clearly demonstrates that walking boots provide superior outcomes for distal 5th metatarsal fractures, with faster healing times and improved functional recovery compared to more restrictive immobilization options 2, 3.