Foot & Ankle · Fracture & Bone
Fifth metatarsal base fracture: is a cast always necessary?
Sometimes you twist your ankle, go to the hospital, and are given the unfamiliar diagnosis of “fifth metatarsal base fracture.” It is a fairly common injury in which the bony prominence on the outer side of the foot, toward the little toe, is pulled off by a ligament. Once diagnosed, people usually worry about two things: “Do I need surgery?” and “Do I need a cast for a long time?”
Surgery is not often needed
Acute fractures from a misstep in daily life are mostly treated without surgery. Surgery may be considered, though, when the gap between fragments is wide, when other injuries are present, or in fractures at sites where bone heals poorly, such as an athlete's stress fracture.
A cast or a hard-soled shoe
Randomized studies comparing a cast with a protective shoe with a firm sole for this fracture have been reported. Pain and bone healing were similar with the two methods, and some results show that return to daily life was somewhat faster with the shoe. The shoe is easier to wash and lighter; the cast gives the reassurance of firm immobilization.
What we decide together in clinic
- Where the fracture is and how far the fragments are displaced
- Your job, sports and walking plans
- How much weight to put on the foot during the protection period
The protection period is usually given as around a month, but it varies from person to person. Do not stop protection on your own just because the pain lessens; confirm with a follow-up X-ray.
This article is general information. Treatment can differ depending on the location and displacement of the fracture, your age and lifestyle, so please confirm with an examination.