Management of Distal Nondisplaced Fifth Metatarsal Fracture
Nondisplaced fifth metatarsal fractures should be treated conservatively with a removable splint or hard-soled shoe for 4-6 weeks with protected weight bearing. 1, 2
Initial Assessment and Classification
- Evaluate for displacement (significant if >3mm), angulation (significant if >10°), and intra-articular involvement to determine appropriate treatment approach 2
- Confirm fracture pattern with radiographic evaluation to rule out Jones fracture (transverse fracture at metaphyseal-diaphyseal junction) which requires different management 3
- Assess for associated soft tissue injury or neurovascular compromise 4
Conservative Management for Nondisplaced Fractures
- Removable splint or hard-soled shoe is appropriate for nondisplaced fifth metatarsal fractures 4, 5
- Protected weight bearing for 4-6 weeks is recommended 1
- CAM-walker boot shows faster radiographic healing (7.2 weeks) compared to hard-soled shoes (8.6 weeks), though clinical outcomes are similar 5
- Active toe motion exercises should be performed following diagnosis to prevent stiffness 6
Radiographic Follow-up
- Radiographic evaluation should be performed at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 4
- Recent evidence suggests that routine radiographic follow-up may not significantly impact outcomes, with radiographs potentially only needed if clinically indicated (new trauma, significant pain, loss of range of motion, or neurovascular symptoms) 6
Indications for Surgical Management
- Surgery is indicated when:
- Surgical options include percutaneous K-wire fixation, plate fixation, or screw fixation depending on fracture pattern 7
Rehabilitation
- Active toe motion exercises should be initiated immediately to prevent stiffness 6
- Return to prior level of activities typically occurs at 8-10 weeks 5
- Monitor for complications such as skin irritation or muscle atrophy, which occur in approximately 14.7% of immobilization cases 4
Common Pitfalls and Caveats
- Do not confuse a nondisplaced fifth metatarsal fracture with a Jones fracture (fracture at metaphyseal-diaphyseal junction), which has higher non-union rates and may require surgical intervention 3, 2
- Inadequate immobilization may lead to displacement, delayed union, or non-union 1
- Prolonged immobilization can lead to joint stiffness and muscle atrophy 6
- Even with conservative treatment, patients should be monitored for fracture displacement during the healing process 4