What is the role of surgery in the acute treatment of metatarsal stress fractures?

Updated: Jan 16, 2019
  • Author: Valerie E Cothran, MD; Chief Editor: Craig C Young, MD  more...
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Answer

Stress fractures of the second or third metatarsals rarely require surgical intervention. Most of these fractures heal uneventfully, and nonunion is rare. However, stress fractures of the fifth-metatarsal base are more problematic. Displacement of these fractures tends to increase with continued weight bearing. The treatment options are 2-fold as follows:

  • Less-active patients should be non-weight bearing in a short-leg cast for 6-8 weeks or until there is radiographic evidence of healing. If an established nonunion develops, screw fixation and/or bone grafting may be required. [22]

  • For active patients, early intramedullary screw fixation, with or without bone grafting, is often recommended. [23]


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