The Ottawa Ankle and Foot Rules should be used to help determine whether radiography is needed when evaluating patients with suspected fractures of the proximal fifth metatarsal.Įarly surgical management of a Jones fracture allows for an earlier return to activity than nonsurgical management and should be strongly considered for athletes or other highly active persons. Nondisplaced or minimally displaced (less than 3 mm) fractures of the second to fifth metatarsal shafts with less than 10° of angulation can be treated conservatively with a short leg walking boot, cast shoe, or elastic bandage, with progressive weight bearing as tolerated. The use of musculoskeletal ultrasonography may be considered to diagnose subtle metatarsal fractures. Lesser toe fractures can be treated with buddy taping and a rigid-sole shoe for four to six weeks. Great toe fractures are treated with a short leg walking boot or cast with toe plate for two to three weeks, then a rigid-sole shoe for an additional three to four weeks.
A Jones fracture has a higher risk of nonunion and requires at least six to eight weeks in a short leg non–weight-bearing cast healing time can be as long as 10 to 12 weeks. A fifth metatarsal tuberosity avulsion fracture can be treated acutely with a compressive dressing, then the patient can be transitioned to a short leg walking boot for two weeks, with progressive mobility as tolerated after initial immobilization. Proximal fifth metatarsal fractures have different treatments depending on the location of the fracture. Metatarsal shaft fractures are initially treated with a posterior splint and avoidance of weight-bearing activities subsequent treatment consists of a short leg walking cast or boot for four to six weeks. Management is determined by the location of the fracture and its effect on balance and weight bearing. Diagnosis requires radiographic evaluation, although emerging evidence demonstrates that ultrasonography may be just as accurate. Patients typically present with varying signs and symptoms, the most common being pain and trouble with ambulation. They most often involve the metatarsals and toes. Foot fractures are among the most common foot injuries evaluated by primary care physicians. Fractures of the fifth metatarsal bone are one of the most frequent fractures to the foot and ankle ().Such fractures are considered to be relatively innocuous (2, 3).Some surgeons prefer an open reduction and internal fixation (47) for fractures of the fifth metatarsal.
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