From the Guidelines
The management of a base of 5th metatarsal fracture should prioritize early identification and treatment to prevent progression to more serious fractures and complications, with high-risk stress fractures, including the base of the 5th metatarsal, often necessitating prompt intervention. The base of the 5th metatarsal is considered a high-risk area for stress fractures due to its tendency for nonunion or delayed union 1. When managing a base of 5th metatarsal fracture, it is essential to consider the fracture location and type, with most requiring conservative treatment, but high-risk fractures, such as Jones fractures, may require non-weight-bearing cast immobilization or surgical fixation with an intramedullary screw, especially for athletes or active individuals. Some key considerations in the management of base of 5th metatarsal fractures include:
- Early identification and treatment to prevent progression to more serious fractures and complications
- Conservative treatment, such as a walking boot or hard-soled shoe, for avulsion fractures and shaft fractures
- Non-weight-bearing cast immobilization or surgical fixation for high-risk fractures, such as Jones fractures
- Monitoring with follow-up X-rays to assess healing and potential complications, such as delayed union, non-union, and refracture. The most recent and highest quality study, published in 2024, highlights the importance of early identification and treatment of high-risk stress fractures, including those at the base of the 5th metatarsal 1. In contrast, older studies, such as the 2002 American College of Foot and Ankle Surgeons guidelines, may not provide the most up-to-date recommendations for management 1. Therefore, the management of a base of 5th metatarsal fracture should prioritize early identification and treatment, with a focus on preventing progression to more serious fractures and complications, and considering the most recent and highest quality evidence.
From the Research
Base of 5th Metatarsal Fracture Management
- The management of base of 5th metatarsal fractures can be done through various methods, including immobilization, functional therapy, and surgery 2, 3, 4, 5, 6.
- A study published in 2014 found that a short controlled ankle movement (CAM) walker boot can effectively offload the fifth metatarsal during common gait activities, making it a beneficial rehabilitative tool for patients undergoing rehabilitation after treatment of Jones fractures and other base of fifth metatarsal fractures 2.
- Another study published in 1997 found that early functional treatment of a fracture of the base of the fifth metatarsal bone with an orthopedic boot allowed full weightbearing after approximately 9 days, with an average time of sick-leave of 19 days and no long-term complications 3.
- A 2020 study compared the use of a hard-soled shoe (HSS) and a controlled ankle motion (CAM)-walker boot (CWB) in the treatment of zone 1 fractures of the proximal fifth metatarsal, finding that patients treated with the CWB demonstrated earlier signs of complete healing, although similar clinical and functional results were achieved with both treatments 4.
- A randomized controlled trial published in 2016 found that symptomatic treatment was not inferior to immobilization in a cast for the treatment of avulsion fractures of the base of the fifth metatarsal, with similar patient-reported outcome measures (PROMs) at four weeks and six months after injury 5.
- A systematic review published in 2021 recommended early functional therapy for fractures in zones I and II, and surgical treatment for fractures in zone III, based on the analysis of nine studies comparing different treatments of zone I fractures 6.