Fifth Metatarsal Base Fractures: Treatment Options and Recovery

Base of the fifth metatarsal fracture?

Hello Doctor, on March 1st, I sustained a lateral fracture of the base of the fifth metatarsal due to a fall.
On March 16th, the fracture gap had widened, and the doctor recommended surgery to insert a screw, but also mentioned that I could continue to wear a brace and use crutches at home for two weeks (essentially a month) before returning for a follow-up.
During my follow-up on March 30th, the fracture gap had become 80% obscured, indicating that healing had begun within the two-week period.
The doctor advised me to stop using crutches and to try walking outside with a walking boot to enhance rehabilitation.
However, during this time, I was hesitant to go out, so I primarily worked from home and occasionally removed the walking boot to walk slowly in the living room.
Throughout this month, the pain at the fracture site has significantly decreased, and I can increase weight-bearing while walking.
There is also a hard lump at the fracture site, which feels like a positive sign.
However, during my follow-up on April 27th, the fracture gap reappeared, returning to a state similar to that on March 16th.
At this point, the doctor strongly recommended surgery to insert a screw, stating that if I returned in a month and there was no healing, the surgery would be more complicated.
During this period, I inquired about dietary recommendations or other rehabilitation treatments to promote bone growth, but the doctor consistently stated that the only options were conservative management or surgery, and that nothing else was necessary or effective.
I would like to ask the doctor: 1.
Given that the fracture has been present for about two months, is surgery to insert a screw the only option? Are there no non-surgical treatments available to promote bone growth? 2.
I am unsure why the doctor advised me to walk, yet the fracture gap reopened.
Should I not have removed the brace, or could there be other reasons?

Ms. Wu, 30~39 year old female. Ask Date: 2024/04/27

Dr. Wang Shouji reply Orthopedics

You can visit the outpatient clinic for evaluation, explanation, and examination.

Reply Date: 2024/04/27

More Info

Fifth metatarsal base fractures, particularly those resulting from falls or twisting injuries, can be quite complex in terms of treatment and recovery. Your situation, where you experienced a transverse fracture of the fifth metatarsal base and have undergone a series of evaluations and treatments, is not uncommon. Let's break down your questions and provide a comprehensive overview of the treatment options and recovery process.

1. Surgical vs. Non-Surgical Treatment Options:
In cases of fifth metatarsal fractures, particularly those that are displaced or have not healed adequately with conservative management, surgical intervention may be recommended. The use of screws or pins (such as intramedullary screws) can stabilize the fracture and promote healing. However, there are non-surgical options that can be considered, especially in the early stages of healing. These include:
- Immobilization: Using a walking boot or a cast can help stabilize the fracture and allow for healing without surgical intervention.

- Physical Therapy: Once the initial pain and swelling have subsided, a structured rehabilitation program can help strengthen the surrounding muscles and improve range of motion.

- Nutritional Support: Ensuring adequate intake of calcium and vitamin D can support bone healing. Some studies suggest that certain supplements, such as collagen peptides or specific amino acids, may also aid in recovery, although these should be discussed with your healthcare provider.

2. Understanding the Setback:
The reopening of the fracture site after you began walking without the protective boot could be attributed to several factors:
- Weight Bearing Too Soon: If the fracture was not fully healed, putting weight on it prematurely could cause the fracture to reopen. It’s crucial to follow your physician's advice regarding weight-bearing activities.

- Inadequate Support: If the protective boot was removed too early or if the boot did not provide adequate support, this could lead to instability at the fracture site.

- Underlying Bone Health: If there are any underlying issues with bone density or health, this could affect healing. Conditions such as osteoporosis can complicate recovery from fractures.

3. Next Steps:
Given the current state of your fracture, it is essential to have an open discussion with your orthopedic surgeon about the necessity of surgery. If surgery is recommended, it is often because the risk of nonunion (the fracture not healing properly) is significant, which can lead to chronic pain and functional limitations.
4. Recovery Timeline:
Recovery from a fifth metatarsal fracture can vary widely depending on the severity of the fracture, the treatment method, and individual healing rates. Generally, if surgical intervention is performed, patients can expect to return to normal activities within 6 to 12 weeks, but this can vary.

5. Preventive Measures:
To prevent further complications, it is crucial to adhere to your physician's recommendations regarding activity levels and the use of protective footwear. Gradually increasing activity levels while monitoring for pain or swelling is essential.

In conclusion, while surgery may be necessary in your case, it is important to weigh the benefits and risks with your healthcare provider. Additionally, consider discussing alternative non-surgical treatments that may support your recovery. Always prioritize communication with your medical team to ensure that you are on the best path to recovery.

Similar Q&A

Understanding Fifth Metatarsal Base Fractures: Treatment Options and Recovery

Hello Doctor, I sustained an injury from a fall on March 1st, and on March 2nd, an orthopedic evaluation diagnosed me with a fracture at the base of the fifth metatarsal. During my follow-up on March 16th, it was noted that the fracture gap had widened, and the doctor recommended...

Dr. Chen Yongxue reply Orthopedics
Generally, fractures of the base of the fifth metatarsal typically do not require surgery. They usually heal well with approximately 8 to 10 weeks of cast immobilization, followed by about 4 to 6 weeks of rehabilitation after the cast is removed. However, a small number of patien...

Understanding Fifth Metatarsal Fractures: Treatment Options and Recovery

On December 26, 2019, I sustained a fifth metatarsal fracture. The original doctor opted for conservative treatment with a cast, but the recovery was not as expected. Below is the X-ray taken during a follow-up visit on May 20, 2020. The current doctor has provided the following ...

Dr. Chen Yongxue reply Orthopedics
Hello, a fifth metatarsal fracture usually does not require surgery, but your fracture is healing slowly, which may be due to inadequate stabilization in the early stages of the injury. If you are currently walking without symptoms, you can continue with conservative treatment an...

Understanding Fifth Metatarsal Base Fractures: Surgery or Conservative Care?

Hello, doctor. During my time overseas, I twisted my ankle while running and stepped on a rock. After an examination at a local hospital, they said I have a fracture at the base of the fifth metatarsal and recommended surgery. I was shocked. After researching for a day, I found m...

Dr. Shi Guozheng reply Orthopedics
Fractures of the base of the fifth metatarsal are typically recommended for surgical intervention, as non-surgical treatment would require casting for six to eight weeks. Surgical treatment involves the use of bone screws to facilitate easier healing of the fracture. If the fract...

Understanding Fifth Metatarsal Base Fractures: Treatment Options and Recovery

Hello! Over a month ago, I injured myself while running, resulting in a transverse fracture of the base of the fifth metatarsal in my left foot. The doctor advised me to wear a boot similar to a snowshoe and to continue working as usual. Four weeks later, I noticed a hard protrus...

Dr. Li Yongheng reply Orthopedics
Hello, since I haven't seen the X-ray, I cannot determine if there is any displacement of the fracture. If the displacement is not obvious, there may be a higher chance of degeneration in the future. Six months later, if there is no significant pain, you can gradually increa...