Treatment of Avulsion Fractures of the Fifth Metatarsal Foot

Initial Assessment and Imaging

Radiographs are the initial imaging study of choice for suspected fifth metatarsal fractures, with standard anteroposterior, lateral, and mortise views that include the base of the fifth metatarsal, as recommended by the American College of Radiology 1, 2
Weight-bearing radiographs, when possible, provide important information about fracture stability, according to the American College of Radiology 1
CT and MRI are not routinely used as first-line imaging for acute trauma to the ankle/foot but may be considered for complex cases or when occult injuries are suspected, as stated by the American College of Radiology 1, 2

Patients with diabetes require special attention to prevent complications, including proper fitting of orthotic devices to prevent pressure sores, careful offloading to prevent ulceration at the fracture site, and thorough wound care and management, as recommended by medical guidelines 3

Progressive weight-bearing as tolerated after immobilization period is recommended, as stated by the American College of Radiology 2

Avoid manipulation of the ankle prior to radiographs in the absence of neurovascular deficit or critical skin injury, as advised by the American College of Radiology 1
Do not perform unnecessary foot or knee radiographs in the presence of isolated fifth metatarsal fractures, as they have low yield, according to the American College of Radiology 1
For patients with diabetes, monitor closely for signs of skin breakdown or infection at the fracture site, as recommended by medical guidelines 3