Treatment of 5th Metatarsal Fractures
For 5th metatarsal fractures, treatment should be based on fracture type, location, and displacement, with non-displaced fractures generally managed conservatively with early weight bearing as tolerated in a protective boot or elasticated support. 1, 2
Classification and Assessment
- Proper radiographic evaluation with three standard views (anteroposterior, lateral, and mortise) is necessary for accurate diagnosis and classification of 5th metatarsal fractures 1
- Weight-bearing radiographs provide important information about fracture stability when available 1
- Fifth metatarsal fractures are commonly classified as:
- Avulsion fractures of the tuberosity (most common)
- Jones fractures (at the metaphyseal-diaphyseal junction)
- Shaft fractures 2
Treatment by Fracture Type
Non-displaced Tuberosity Avulsion Fractures
- Can be treated non-operatively with early functional treatment 2
- A soft dressing or elasticated support allows patients to return to pre-injury activity levels faster (average 33 days) compared to short leg casting (average 46 days) 3
- Weight bearing as tolerated is recommended with appropriate supportive footwear 4
Displaced Tuberosity Fractures
- Surgical treatment is indicated when:
- Fracture is displaced more than 2mm
- More than 30% of the cubometatarsal joint is involved 2
Shaft Fractures
- Non or minimally displaced shaft fractures can be treated non-operatively 2
- Surgical fixation is indicated when:
- Displacement exceeds 3-4mm
- Angulation is more than 10 degrees 2
- Options include percutaneous K-wires, plate, or screw fixation 2
Jones Fractures
- Treatment depends on activity level and Torg classification:
- Type I (acute fracture): Can be treated non-operatively
- Type II (delayed union): Treatment depends on patient activity level - active patients may benefit from surgical fixation
- Type III (non-union with sclerosis): Should be treated operatively due to higher complication rates 2
- Intramedullary fixation is often preferred for athletes and active individuals to avoid prolonged non-weight bearing 5
Immobilization and Weight Bearing
- For non-operative management, a removable boot or elasticated support with weight bearing as tolerated is recommended 4, 6
- Early functional treatment using an orthopedic boot allows full weight bearing after approximately 9 days 6
- Average sick leave duration with functional treatment is around 19 days 6
Follow-up Care
- Routine outpatient follow-up may not be necessary for uncomplicated 5th metatarsal fractures 4
- Patients can be safely discharged with appropriate information and access to fracture clinic staff if needed 4
- Regular radiographic assessment is recommended for Jones fractures to ensure proper healing 1
Special Considerations
- For patients with diabetes and neuropathy, special attention should be paid to offloading the foot to prevent complications 1
- The Ottawa rules can help determine when imaging is necessary for foot trauma, with specific attention to point tenderness at the base of the fifth metatarsal 7
- Early introduction of physical training and muscle strengthening followed by balance training is recommended after the immobilization period 1