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Support bandaging is best for avulsion fractures of the base of the fifth metatarsal

Three Part Question

In [an adult with an avulsion fracture at the base of the fifth metatarsal] is [immobilisation in a below knee cast better than simple support bandaging] in [controlling symptoms and speeding time to functional recovery]?

Clinical Scenario

A 38 year old woman presents to the emergency department following an inversion injury of the right ankle. Clinical examination and x-ray confirm that there is an avulsion fracture at the base of the fifth metatarsal. You wonder whether immobilisation in a plaster cast is better than simple support bandaging.

Search Strategy

Medline 1966-12/98 using the OVID interface.
[{metatars$.mp AND} AND {exp fractures OR fracture$.mp}] LIMIT to human and english language.

Search Outcome

82 papers found of which 77 were irrelevant to the study question and 4 were of insufficient quality for inclusion.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Wiener BD et al
89 consecutive patients with avulsion fractures of the base of the fifth metatarsal. Short leg cast vs soft (Jones) dressing Followed at 2, 4, 8 and 12 weeks.PRCTTime in supportNo significant differenceNo power study. Not blinded. 33% drop out rate
Modified foot score (pain, gait, function, walking distance)No significant difference
Time to full activitySignificantly shorter in soft dressing group 33 vs 46 days (p < 0.05)
Time to bony healingNo significant difference


This is the only trial identified in this area and it has a number of weaknesses. Further well designed and executed studies are warranted.

Clinical Bottom Line

On current evidence simple support bandages are the treatment of choice.


  1. Wiener BD, Linder JF, Giattini JF. Treatment of fractures of the fifth metatarsal: a prospective study. Foot & Ankle International 1997;18(5):267-269.