Essential Insights On Treating Fifth Metatarsal Fractures

Author(s): 
By Nicholas Romansky, DPM, and Todd Becker, DPM

In Conclusion
Podiatric physicians commonly see fractures of the fifth metatarsal when treating active patients. Choosing between conservative and surgical treatment is imperative because conservative treatment can sometimes lead to an extremely slow recovery or long-term problems. Both competitive and recreational athletes should be geared to a more rapid recovery. Accordingly, intramedullary screw fixation may be a more suitable option. In addition, long-term immobilization and rest can lead to muscle atrophy and stiffness, thus leading to a long recovery before the patient can achieve full athletic participation.
In the athletic and active population, one must consider ORIF as a primary treatment option for Jones type fractures whereas cast immobilization may be more appropriate for the elderly and sedentary population. Late bone grafting may be necessary for avascular nonunions and severe comminution with autogenous grafting from the tibia or calcaneus. Fractures of the base of the fifth metatarsal may require ORIF only in the presence of articular involvement or distraction.
It is also important postoperatively to consider the use of orthotics or shoe gear modifications to decrease the possibility of recurrent fracture. Some have also proposed that low-intensity ultrasound or other forms of bone stimulation may be beneficial in accelerating the healing time for delayed and non-unions but further research is still necessary in this area.

Dr. Romansky is a Fellow of the American College of Foot and Ankle Surgeons and is a Diplomate of the American Board of Podiatric Surgery. He is a team physician for the United States Olympic and World Cup Men’s and Women’s soccer teams. Dr. Romansky is in private practice in Media and Phoenixville, Pa.

Dr. Becker is a third-year resident at Crozer Keystone Health System in Pennsylvania.

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