From the Research
A base fifth metatarsal fracture can be effectively managed with early functional therapy, using an orthopedic boot, allowing for full weight-bearing after approximately 9 days, as evidenced by a study published in 2021 1. This approach is supported by the most recent and highest quality study, which found that early functional therapy resulted in a faster return to work and full function, with similar outcomes to immobilization and surgery. The use of a post-op shoe or hard-soled shoe with a wide toe box may be considered after the initial period of immobilization, but it is not necessarily required for all patients. Key considerations in the management of base fifth metatarsal fractures include:
- The location and severity of the fracture, with zone 1 fractures typically treated conservatively and zone 2 and 3 fractures potentially requiring surgical intervention 2
- The patient's overall health and activity level, with athletic individuals potentially benefiting from early surgical fixation 2
- The importance of regular follow-up and monitoring of healing progress to determine when normal footwear can be resumed. It is also worth noting that the classification of fifth metatarsal base fractures has been a source of confusion, and a 2-zone system may be the best available classification given its high interrater reliability 3. However, the specific classification system used is less important than the overall approach to management, which should prioritize early functional therapy and careful monitoring of healing progress.