The Approach to Proximal Fifth Metatarsal Fractures in Athletes

Fractures of the proximal fifth metatarsal are injuries that occur more frequently in the elite athlete population and have the potential to significantly impact the ability of the athlete to return to play if not treated appropriately. These fractures can be separated into three types: tuberosity fractures, Jones fractures and diaphyseal stress fractures. For the treating physician, a thorough understanding of the bony and vascular anatomy, mechanism of injury and treatment options are vital to provide the elite athlete with the optimal outcome. Most fractures of the tuberosity can be treated non-surgically with a stiff soled shoe or controlled ankle motion boot with most athletes returning to play by 8 weeks. When treating the Jones fracture in the high level athlete the trend in the literature is towards intramedullary screw placement for immediate fixation and subsequent faster return to play. This is also the case for diaphyseal stress fractures of the fifth metatarsal. This paper provides a critical review of the current literature with the author’s preferred method of treatment of these injuries in the elite athlete population to provide the orthopaedic surgeon with a basis for treatment of these injuries based on the most recent literature.