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Saturday, January 3, 2015

5th Metatarsal Fractures: General Treatment Thoughts

  The top 10 initial treatments for 5th metatarsal fractures are:

  1. X ray evaluation to decide on surgery vs conservative care.
  2. If surgery, protocol to be set by surgeon and not purpose of this writing.
  3. If conservative care chosen, some form of immobilization for 8-12 weeks is typically done based on injury (Immobilization Phase).
  4. During the Immobilization Phase, lower limb strengthening with some cardio should be orchestrated by a physical therapist. Even one legged stationary bike is very beneficial.
  5. Bone health is analyzed with dietary calcium and Vit D3, consideration of a bone density screen, and typically healthy diet.
  6. Transition period from cast to no cast, with or without surgery, can be very difficult. Custom orthotics with full lateral arch support very helpful. At times, extra big shoes as a transition can be purchased so added padding/accommodation can be used.
  7. When not using a permanent cast, 24/7 compression bandages, ice pack 15 minutes twice daily, contrast bathing each evening, as much as possible elevation, 3 times daily 10 minute self massage for desensitization and swelling reduction, and hourly pain free ankle circles are initiated.
  8. Weight bearing for bone mineralization, even in casts or boots, is done as early as safe (Good Pain vs Bad Pain)
  9. All fifth metatarsal fractures, except a few styloid process avulsion fractures, should have a Exogen Bone Stimulator for 6 months (when insurance allows).
  10. Follow up xrays need only be done when symptoms plateau or worsen. As long as the patient makes steady, gradual, progress, it is better to base improvement on function, not x ray or palpable tenderness.

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.