5th MT Avulsion Fracture – Shoe or Cast?
January 29, 2021
Editor’s note: This post was modified 31 January 2021. There was confusion (mostly with me – Clay Smith, who edited this post) about the definition of a dancer’s fracture. See comments. This article was about 5th MT base avulsion fractures.
Written by Aaron Lacy
Spoon Feed
In patients with 5th metatarsal base avulsion fractures, pain at 6 months after treatment with a hard-soled shoe and weight bearing as tolerated was non-inferior to a short-leg cast. Patients treated with hard-soled shoe also had reduced time to return to pre-injury activity.
Why does this matter?
The 5th metatarsal base avulsion fracture is a common foot injury. Optimizing treatment for these common injuries should be patient and outcome centered. If we can increase function while injured, and reduce time to recovery, that would be an optimal treatment plan.
These hard-soled shoes were made for walkin’…
78 patients (aged 18-65) with 5th metatarsal zone 1 tuberosity avulsion, comminuted, or displaced fractures were placed in a short leg posterior splint after initial ED or outpatient clinic visit. At a 1-week follow up appointment, participants were prospectively randomized to either treatment with a hard-soled shoe or short leg cast, with both groups having weight bearing as tolerated restriction. Primary outcome was mean difference in the 100-mm Visual Analogue Score (a validated pain score) at 6 months after the fracture. The absolute difference comparing the hard-soled shoe group to the short leg cast was -1.3 mm (95% CI -4.3 to 1.8mm, 8.6 ± 7.0 mm vs 9.8 ± 7.3 mm). A secondary outcome, return to pre-injury activity (days), was significantly reduced in the hard-soled shoe group (37.2 ± 14.4 vs 43.0 ± 11.1, p = 0.04). Patient satisfaction was similar between groups.
While several key types of patients were excluded (i.e. obesity, diabetes, concurrent lower-extremity injury, open or pathologic fractures), this opens the door for future studies for possible immediate treatment with hard-soled shoe. This would be faster for providers and, most importantly, seems to be more patient centered. Our orthopedic group recommends immediate use of a walking boot for these fractures, which is nice.
Source
Hard-Soled Shoe Versus Short Leg Cast for a Fifth Metatarsal Base Avulsion Fracture: A Multicenter, Noninferiority, Randomized Controlled Trial. J Bone Joint Surg Am. 2020 Dec 2. doi: 10.2106/JBJS.20.00777. Online ahead of print.