Fracture of Base of 5th Metatarsal


There are three types of proximal fifth metatarsal fractures:

 

Management Guidelines for Proximal Fifth Metatarsal Fractures:
  STYLOID AVULSION METAPHYSEAL-DIAPHYSEAL JUNCTION DIAPHYSEAL STRESS
Splint type & position Firm-soled shoe  Lower extremity splint or cast
Ankle at 90 degree
Lower extremity splint or cast
Ankle at 90 degree
Initial follow-up visit 4 to 7 days  3-5 days 3-5 days
Pt instructions

Weight bearing as tolerated

Non-weight bearing Strict non-weight bearing
  Follow-up Care    
Cast or Splint type & position SLWC if significant  symptoms
Anke at 90 degrees
SLNWBC
Ankle at 90 degrees
SLNWBC
Ankle at 90 degrees
Length of immobilization  2 wks max 6-10 wks up to 20 wks
Healing time 4-8 wks 6-12 wks up to 20 wks
Follow-up visit interval q 2-4 wks At 6-8 wks to document healing q 4-6 wks
Repeat radiography interval May be done at 6-8 wks to document healing At 6-8 wks to document healing.
4 wks later if necessary.
If symptoms worsen after healing (rule out recurrence).
q 4-6 wks
If symptoms worsen after healing (rule out recurrence)
Pt instruction Advance activity as tolerated Gradually advance activity after cast removed Strict non-weight bearing
Cautiously advance activity after cast removed
Indications for Ortho consult Displaced > 3mm Displaced
Nonunion at 3 months
Pt reluctant to undergo up to 3 months of casting
Consider in all cases, especially type II & II
Not healed at 3-4 months
Recurrence.
SLNWBC, short-leg non–weight bearing cast; SLWC, short-leg walking cast.