Treatment for Non-Displaced Proximal Third Metatarsal Fracture
Non-displaced fractures of the proximal third metatarsal should be treated conservatively with protected weight-bearing in a cast shoe or walking boot for 4-6 weeks, as these fractures typically heal well without surgical intervention.
Conservative Management Approach
Non-operative treatment is the standard of care for non-displaced metatarsal fractures, which consistently demonstrates excellent outcomes when displacement is minimal 1. The treatment protocol includes:
- Protected weight-bearing in a cast shoe or walking boot for 4-6 weeks 1
- Activity modification with avoidance of high-impact activities during the healing period 2
- Appropriate analgesia for pain management during the initial inflammatory phase 3
Key Clinical Considerations
When Conservative Treatment is Appropriate
Non-operative management is indicated when the fracture meets these criteria 1:
- No displacement or minimal displacement (less than 3-4 mm)
- No angulation exceeding 10° in any plane
- Intact skin without soft tissue compromise
- No associated Lisfranc injury or tarsometatarsal joint involvement 2
Important Caveats
Be vigilant for specific fracture patterns that require different management:
- Proximal fifth metatarsal fractures (Jones fractures at the metaphyseal-diaphyseal junction) are a distinct entity requiring individualized treatment, often with surgical fixation in athletes 4, 5, 6
- First metatarsal fractures may require internal fixation even when minimally displaced due to their weight-bearing importance 2
- High-energy trauma mechanisms warrant careful evaluation for associated soft tissue injury, compartment syndrome, and Lisfranc ligament disruption 2
Follow-Up Protocol
- Clinical reassessment at 2 weeks to ensure appropriate healing trajectory
- Radiographic follow-up at 4-6 weeks to confirm union 1
- Gradual return to activity once clinical and radiographic healing is confirmed
- Consider stress fracture if pain persists beyond expected healing time, particularly in athletes 4, 6
Surgical Indications (When Conservative Treatment Fails)
Operative intervention becomes necessary if 1:
- Displacement exceeds 3-4 mm after attempted conservative management
- Angulation exceeds 10° in any plane
- Delayed union or non-union occurs after 12 weeks of conservative treatment
- Multiple metatarsal fractures with significant displacement requiring anatomic restoration
The overwhelming majority of non-displaced proximal metatarsal fractures heal successfully with simple immobilization and protected weight-bearing, making this the evidence-based first-line treatment 2, 1.