Optimizing Return to Sport After 5th Metatarsal Fractures

The treatment of 5th metatarsal base fractures in athletes can vary depending on the specific type of fracture, the athlete's overall health, and the goals of returning to sports. These fractures are relatively common in athletes, particularly in sports that involve cutting, jumping, or high-impact activities. There are two main types of 5th metatarsal base fractures: avulsion fractures and Jones fractures.

1. Avulsion Fractures:
   

• Avulsion fractures typically occur when the peroneus brevis tendon pulls off a piece of bone from the 5th metatarsal base. These fractures are often less severe than Jones fractures.

• Treatment usually involves immobilization in a cast or walking boot for a period of 4-6 weeks to allow the fracture to heal. In some cases, a non-weight-bearing period might be recommended.

• Athletes may use crutches during the initial phase to avoid putting weight on the injured foot.

• Physical therapy and rehabilitation exercises are important to regain strength and range of motion in the foot and ankle.

• Athletes may gradually return to sports activities as they progress in their rehabilitation, but this should be guided by a sports medicine specialist to minimize the risk of re-injury.

1. Jones Fractures:
   

• Jones fractures occur at a specific location in the 5th metatarsal, approximately 1.5 cm from the base of the bone. These fractures can be more challenging to treat due to the limited blood supply in this region.

• Treatment options for Jones fractures may include non-surgical or surgical approaches, depending on the severity and location of the fracture:

  • Non-surgical treatment: A non-displaced or minimally displaced Jones fracture may be treated with a cast, walking boot, or rigid immobilization for 6-8 weeks.

  • Surgical treatment: For displaced or more severe Jones fractures, surgery may be necessary. Surgeons often use internal fixation, such as screws or plates, to stabilize the fracture. This promotes faster and more reliable healing.

• After surgery, athletes typically have a period of non-weight-bearing or limited weight-bearing on the affected foot for several weeks. Crutches or a knee walker might be necessary during this phase.

• Physical therapy and rehabilitation are essential for athletes to regain strength, stability, and range of motion in the foot and ankle.

• The timing of return to sports after a Jones fracture is often more conservative than with avulsion fractures, and athletes should follow a gradual and supervised return-to-play protocol.