Treatment of Non-Displaced 5th Metatarsal Fractures
The standard treatment for a non-displaced fracture of the 5th metatarsal is protected weight bearing in a cast shoe or orthopedic boot for 4-6 weeks. 1, 2
Treatment Algorithm
Initial Management
- Radiographic confirmation with three standard views (anteroposterior, lateral, and mortise) is necessary to properly diagnose the fracture 3
- Non-displaced fractures of the 5th metatarsal can be treated conservatively with protected weight bearing 1
- Initial treatment should include a posterior splint and avoidance of weight-bearing activities 2
Definitive Treatment Based on Fracture Location
Shaft Fractures
- Non-displaced shaft fractures should be treated with a short leg walking cast or orthopedic boot for 4-6 weeks 1, 2
- Progressive mobility can be allowed after initial immobilization 2
- Full weight bearing can typically be achieved after approximately 9 days with an orthopedic boot 4
Tuberosity Avulsion Fractures (Base of 5th Metatarsal)
- Initial treatment with a compressive dressing 2
- Transition to a short leg walking boot for 2 weeks 2
- Progressive mobility as tolerated after initial immobilization 2
- Surgical treatment is only indicated if the fracture is displaced more than 2mm or when more than 30% of the cubometatarsal joint is involved 5
Jones Fractures (Transverse Fracture at Metaphyseal-Diaphyseal Junction)
- Requires more conservative approach due to higher risk of non-union 2
- Treatment requires at least 6-8 weeks in a short leg non-weight-bearing cast 2
- Healing time can be as long as 10-12 weeks 2
- Treatment should be individualized based on the patient's activity level and Torg classification 5
Monitoring and Follow-Up
- Regular radiographic assessment to ensure proper healing and alignment 3
- Average time of sick leave is approximately 19 days with functional treatment using an orthopedic boot 4
- Weight-bearing radiographs provide important information for fractures of uncertain stability 3
Potential Complications
- Malunion can be a source of pain and disability if not properly treated 1
- Jones fractures have higher risk of non-union and require more careful monitoring 5, 2
- Symptomatic post-traumatic deformities may require surgical correction, typically by osteotomy across the former fracture site 1
Special Considerations
- If displacement is more than 3-4mm or angulation is more than 10 degrees, surgical intervention with percutaneous K-wires, plate, or screw fixation is indicated 5, 6
- Even grossly displaced fractures have good to excellent prognosis following surgical treatment with high union rates and rare complications 6
- For patients with diabetes and neuropathy, special attention should be paid to offloading the foot to prevent complications 3