Fifth Metatarsal Base Fractures: Treatment Options and Recovery

Base of the fifth metatarsal fracture?

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 surgery to insert a screw.
I opted for conservative treatment for two weeks, and during my follow-up on March 30th (almost a month post-injury), the gap was observed to have 80% of its space appearing grayish-white.
The doctor indicated that healing was occurring, allowing me to discontinue the use of crutches and wear a protective shoe for walking to work.

In April, I continued to work from home, only walking to the convenience store once a week.
At home, I removed the crutches and wore the protective shoe in the living room, and I would walk barefoot for a few hours each day.
I noticed significant improvement in foot pain and stiffness in my joints, and pressing on the fracture site no longer caused much discomfort.
However, during my follow-up on April 27th, the doctor stated that the gap had reopened and insisted that I needed surgery, emphasizing the benefits of inserting a screw and the increased difficulty of conservative treatment if I were to wait until my next appointment in May.
Since my injury, every time I inquired about additional conservative treatment options to promote bone healing (such as nutritional supplements or physical therapy modalities like electrical stimulation), the doctor has stated that there are no alternatives, and I must choose between surgery and immobilization.
1.
I would like to ask if, after two months of the fracture, surgery is truly the only option left, as the doctor mentioned a high probability that healing would not occur further, or if there are any non-surgical treatment methods available to promote bone growth.
2.
During this period, should I avoid walking outside altogether, or should I continue to use crutches to prevent weight-bearing on the base to avoid further complications with the fracture healing?

Ms. Wu, 30~39 year old female. Ask Date: 2024/04/28

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 patients may experience more severe displacement or comminution of the fracture, making it difficult to achieve satisfactory healing with conservative treatment.
If a patient is unable to tolerate 3 months of conservative management, surgical intervention may be considered.
It is advisable to seek a second opinion from another physician in an outpatient setting.
Thank you.

Reply Date: 2024/04/28

More Info

Fifth metatarsal base fractures, particularly those that occur due to falls or trauma, can be challenging to manage, especially when conservative treatment does not yield the expected results. Your situation, where you initially opted for conservative management but later experienced complications, is not uncommon. Here’s a comprehensive overview of treatment options and recovery strategies for fifth metatarsal base fractures.

Understanding the Injury
The fifth metatarsal is the long bone on the outer side of the foot, and fractures in this area can occur due to direct trauma or stress. The base of the fifth metatarsal is particularly susceptible to fractures, often referred to as "Jones fractures" when they occur at the base. These fractures can be classified as either non-displaced or displaced, with the latter often requiring surgical intervention.

Treatment Options
1. Conservative Management: This typically includes rest, ice, compression, and elevation (RICE), along with immobilization using a walking boot or cast. The goal is to minimize movement and allow the bone to heal naturally. However, as you've experienced, if the fracture does not heal properly or if there is a significant increase in the fracture gap, conservative treatment may no longer be effective.

2. Surgical Intervention: If the fracture gap has increased and the bone is not healing, surgery may be necessary. This usually involves the insertion of screws or pins to stabilize the fracture and promote healing. Your doctor’s recommendation for surgery is based on the observation that the fracture has not healed adequately over the past two months.

3. Rehabilitation: Post-surgery, rehabilitation is crucial. Physical therapy can help restore strength and mobility to the foot. This may include exercises to improve range of motion, strength training, and gradual weight-bearing activities.

Recovery Strategies
1. Nutritional Support: While your doctor may have indicated that there are no additional treatments beyond surgery and immobilization, nutritional support can play a role in bone healing. Ensuring adequate intake of calcium and vitamin D is essential for bone health. Supplements may be beneficial, but it’s best to discuss this with your healthcare provider.

2. Physical Therapy: Once the fracture has stabilized, physical therapy can help enhance recovery. Techniques such as ultrasound therapy, electrical stimulation, and manual therapy may promote healing and reduce stiffness.

3. Activity Modification: It’s crucial to follow your doctor’s advice regarding activity levels. If your doctor has advised against weight-bearing activities, it’s important to adhere to this to prevent further complications. Using crutches or a walking boot can help offload the affected area.

4. Monitoring Symptoms: Keep track of any changes in pain levels or swelling. If you notice increased discomfort or instability, it’s essential to communicate this with your healthcare provider.

Conclusion
In summary, while surgery may seem daunting, it is often the most effective way to ensure proper healing of a non-union fracture. If you are hesitant about the surgical option, consider seeking a second opinion from another orthopedic specialist. They may provide additional insights or alternative treatment options. Meanwhile, continue to follow your doctor’s recommendations regarding activity levels and use of assistive devices. Proper management and adherence to treatment protocols are key to a successful recovery.

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