Splint Type for 5th Metatarsal Fracture
For a 5th metatarsal fracture, use a short leg walking boot (CAM-walker boot) or posterior splint initially, transitioning to a walking boot for definitive immobilization. 1, 2
Initial Immobilization Strategy
Splint the foot in the position found to reduce pain and prevent further injury. 1 The primary goal of immediate immobilization is pain control—proper splinting provides superior analgesia compared to medications alone. 1
Specific Splinting Options by Fracture Type:
Zone 1 (Tuberosity Avulsion) Fractures:
- Apply a compressive dressing acutely, then transition to a short leg walking boot within the first few days 2
- A CAM-walker boot achieves faster radiographic healing (7.2 weeks) compared to hard-soled shoes (8.6 weeks), though functional outcomes are similar 3
- Weight-bearing as tolerated is safe immediately if pain permits 1, 4
Zone 2 (Jones) Fractures:
- Require a short leg non-weight-bearing cast for 6-8 weeks minimum, with healing potentially taking 10-12 weeks 2
- These have higher non-union risk and demand more rigid immobilization 5, 2
Shaft Fractures:
- Initial posterior splint followed by short leg walking cast or boot for 4-6 weeks 2
- Non-displaced fractures can bear weight progressively as tolerated 5
Critical Assessment Before Splinting
Check for vascular compromise immediately—if the foot appears blue, purple, or pale, this is a medical emergency requiring immediate intervention before any splinting. 1 Cover any open wounds with clean dressing prior to immobilization. 1
Common Pitfalls to Avoid
- Do not apply compression wraps too tightly, as this compromises circulation 1
- Do not attempt to straighten or manipulate the fracture—immobilize in position found 6
- Do not place ice directly on skin if using cryotherapy for swelling control 1
- Avoid prolonged immobilization beyond necessary healing time, as this causes stiffness and muscle atrophy 1, 7
Weight-Bearing Guidance
Progressive weight-bearing as pain permits does not compromise healing and may improve outcomes. 1 For tuberosity avulsion fractures, patients typically achieve full weight-bearing around 9 days with a walking boot. 8
Surgical Consultation Timing
Arrange orthopedic consultation within 24-48 hours for displaced fractures (>2mm displacement or >30% cubometatarsal joint involvement), Jones fractures in active patients, or any fracture with >10 degrees angulation. 1, 5