What is the recommended treatment for a patient with a non-displaced 5th metatarsal fracture?

Elasticated Support for Non-Displaced 5th Metatarsal Fractures

Elasticated support refers to a functional compression bandage or wrap that provides mild stabilization while allowing ankle motion and weight-bearing, typically used in combination with a hard-soled shoe for treating minimally displaced proximal fifth metatarsal fractures. 1, 2

Definition and Clinical Application

An elasticated support is a flexible, compressive bandage that stabilizes the foot without rigid immobilization, distinguishing it from traditional plaster casts or CAM-walker boots. 1

Key Characteristics:

• Provides compression and mild support without restricting ankle range of motion 1
• Must be paired with a flat hard-soled shoe to protect the fracture site during weight-bearing 1
• Allows immediate weight-bearing as tolerated by pain 2
• Removable for hygiene and skin inspection, reducing complications like skin breakdown 2

Evidence-Based Treatment Protocol

For Non-Displaced Proximal 5th Metatarsal Fractures:

Elasticated support with hard-soled shoe achieves equivalent outcomes to rigid casting for Type 1 and Type 2 minimally displaced fractures, with no significant difference in healing rates or complications. 1

Treatment Algorithm:

• Apply elasticated bandage from toes to mid-calf with moderate compression 1
• Provide flat hard-soled shoe immediately to offload the fracture site 1
• Allow weight-bearing as pain permits from day one 2
• No routine follow-up required if patient receives structured discharge advice and helpline access 2
• Obtain repeat radiographs only if pain persists beyond 2 weeks or symptoms worsen 3

Advantages Over Rigid Immobilization:

Patients treated with elasticated support demonstrate earlier return to sports compared to cast immobilization, though overall healing times remain similar. 1

• Average return to full activity: 8-10 weeks 1, 4
• Reduced risk of stiffness and muscle atrophy from prolonged immobilization 5
• Patient satisfaction rate of 92% with functional treatment 6
• Cost-effective with minimal clinic visits required 2

Critical Monitoring Points

Displacement risk is equivalent between elasticated support and rigid casting (mean 1.6-1.9mm displacement in both groups), making either option safe for non-displaced fractures. 4

Red Flags Requiring Reassessment:

• Persistent pain beyond 2 weeks may indicate inadequate healing 3
• Inability to bear weight after initial week suggests possible displacement 2
• Patients with diabetes and neuropathy require special attention to prevent complications from inadequate offloading 5

Common Pitfalls to Avoid:

• Do not apply elasticated bandage too tightly, as this compromises circulation 5
• Ensure patient understands importance of wearing hard-soled shoe consistently, as non-adherence extends healing time by median of 3 months 3
• Type 3 fractures (Jones fractures) achieve worse results with conservative treatment and may require different management 1

Comparison with Alternative Immobilization

CAM-walker boots demonstrate faster radiographic healing (7.2 weeks) compared to hard-soled shoes alone (8.6 weeks), but clinical outcomes and return to activity times remain equivalent. 4

• Elasticated support + hard-soled shoe: 8.6 weeks to healing 4
• CAM-walker boot: 7.2 weeks to healing 4
• Both achieve similar AOFAS scores and pain levels at 8 and 12 weeks 4

Early functional treatment with elasticated support allows full weight-bearing after approximately 9 days with average sick-leave of 19 days, making it a reliable and cost-effective option. 6