Treatment of Fifth Metatarsal Base Avulsion Fracture
A walking boot is the appropriate treatment for your fifth metatarsal base avulsion fracture and does not require casting. 1
Recommended Treatment Approach
Immediate immobilization with a walking boot provides adequate stabilization while allowing earlier return to function compared to traditional casting. 1, 2
Walking Boot Protocol
- Begin weight-bearing as tolerated immediately in the walking boot, which provides sufficient immobilization for avulsion fractures 2, 3
- Continue boot immobilization for 2-4 weeks depending on pain and clinical progress 3, 4
- NSAIDs can be used concurrently for pain management 1
Why Walking Boot Over Cast
The evidence strongly favors walking boots for fifth metatarsal base avulsion fractures:
- Patients recover 3 weeks faster with walking boots (9 weeks) compared to short-leg casts (12 weeks) 2
- Significantly less pain at 9 weeks post-injury (p=0.020) 2
- Better functional outcomes at 3,6, and 9 weeks (p<0.01) 2
- Earlier return to driving (6 weeks vs 12 weeks with cast, p=0.006) 2
- Less time off work (31.5 days vs 39.2 days with cast) 2
- Walking boots more effectively offload the fifth metatarsal base during gait activities compared to postoperative sandals (p<0.01) 5
Critical Distinction: Avulsion vs Jones Fracture
Your fracture is an avulsion fracture at the tuberosity, NOT a Jones fracture (which occurs at the metaphyseal-diaphyseal junction 1.5-3cm distal to the tuberosity). 3
- Jones fractures require 6-8 weeks in a non-weight-bearing cast due to high nonunion risk and poor blood supply 6, 3
- Avulsion fractures have excellent healing potential and do not require the same rigid immobilization 3, 4
Common Pitfalls to Avoid
- Do not use below-ankle offloading devices (such as postoperative sandals alone) as they provide inadequate immobilization 1, 6
- Avoid premature return to high-impact activities before adequate healing to prevent complications 1
- Do not confuse this with a Jones fracture, which would require much more aggressive non-weight-bearing treatment 6, 3
Rehabilitation Phase
- After 2-4 weeks of boot immobilization, transition to supportive footwear with a rigid sole for an additional 2-3 weeks 3
- Physical therapy may be beneficial to restore range of motion and strength after immobilization 1
- Gradual return to activities as pain allows 1
When to Reassess
If persistent pain continues after 6-8 weeks of appropriate conservative management, further evaluation with advanced imaging may be warranted to rule out nonunion or other complications 1