the Impact of Not Using a Cast for Fifth Metatarsal Fracture

Fifth metatarsal fracture without casting condition?

I rolled my right foot while walking without paying attention to the elevation changes.
I went to an orthopedic doctor for an X-ray, and the doctor said there is a fracture with a crack in the fifth metatarsal.
The orthopedic doctor mentioned that a cast could be applied or not, and he recommended a cast but said it depends on personal preference.
Since I need to go to work and for convenience, I chose not to have a cast and instead went to see a traditional Chinese medicine practitioner.
Now, it has been the fifth day, and the swelling and pain are not as severe as on the first day.
I would like to ask what the consequences of not having a cast might be.
How long after this should I return for another X-ray to check the healing progress? Is it normal for the side of my foot to have a bump? Thank you, doctor.
Here are the X-ray images: (front view) https://imgur.com/1EXNaiQ (side view) https://imgur.com/PVTO5Yr.

Tsai, 30~39 year old female. Ask Date: 2019/10/23

Dr. Zhan Xian reply Orthopedics

Hello Ms.
Tsai, based on the X-ray, it is recommended to use a cast or brace for one month.
This is due to the connection of the base of the fifth metatarsal with the peroneus brevis tendon, and there is a concern about potential fracture displacement if it is not stabilized.

Reply Date: 2019/10/23

More Info

When it comes to a fifth metatarsal fracture, the decision to use a cast or not can significantly influence the healing process and long-term outcomes. The fifth metatarsal is located on the outer side of the foot and is a common site for fractures, particularly due to its exposure to stress and trauma.
1. Impact of Not Using a Cast: Choosing not to use a cast for a fifth metatarsal fracture can lead to several potential complications. While some fractures can heal well without immobilization, others may not heal properly, leading to malunion or nonunion. Malunion occurs when the bone heals in an incorrect position, which can result in chronic pain, deformity, and functional limitations. Nonunion, on the other hand, refers to the failure of the bone to heal altogether, which may necessitate surgical intervention later on. Additionally, without a cast, there is a risk of further injury to the fracture site, especially if you are returning to normal activities too soon.
2. Monitoring Healing Progress: It is advisable to have follow-up X-rays to monitor the healing process, especially if you are not using a cast. Typically, follow-up imaging is recommended around 2-3 weeks after the initial injury to assess the fracture's healing status. This is crucial because it allows the physician to determine if the fracture is healing properly or if further intervention is needed.
3. Physical Changes and Symptoms: The presence of a "bump" or protrusion on the side of your foot may be a normal response to the fracture, as swelling and soft tissue changes can occur. However, if the bump is associated with increased pain, tenderness, or changes in skin color, it could indicate complications such as a hematoma or infection.
4. Alternative Treatments: Since you opted for traditional Chinese medicine (TCM) treatment, it's important to communicate with your TCM practitioner about your condition. TCM may provide supportive care that can help with pain management and swelling, but it is essential to ensure that the fracture is healing correctly.
5. Long-term Considerations: If you experience persistent pain, instability, or functional limitations after the initial healing period, further evaluation may be necessary. In some cases, surgical options may be considered, especially if there is a concern about malunion or nonunion.

In summary, while it is possible for some fifth metatarsal fractures to heal without a cast, careful monitoring and follow-up are essential to ensure proper healing. If you notice any concerning symptoms or if the pain persists, it is crucial to seek further medical advice. Always prioritize your foot's health, especially if you plan to return to activities that place stress on the metatarsal bones.

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