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Foot Bone or Joint Injury

5th Metatarsal Fracture Advice

Minute Read


Posted 1 year ago


Last updated: 14/05/2023


by James McCormack

Can a 5th metatarsal fracture heal without a cast?

A 5th Metatarsal Fracture is unlikely to heal without a cast or walker boot as the impact and vibration from walking can irritate the fracture site, preventing it from healing.

More recently, all patients with a foot fracture are placed in an air cast walker boot rather than a cast so that they are more mobile. Air is pumped around the boot to act as an extra cushion for the foot, and weight-bearing facilitates for healing of the bone.

In some cases, patients have a fracture for an extended period of time before they receive a scan. In these cases, there may be signs that the fracture has begun to heal, and you may be recommended that cushioned trainers alongside Physical therapy are sufficient for recovery.

Related Article: Best Walker Boot for 5th Metatarsal Fracture

How long do you wear a boot for with a metatarsal fracture?

It is normally advised to wear a boot for 4-6 weeks if you have been diagnosed with a metatarsal fracture. When you are pain-free, you can wean out of the boot indoors between weeks 4 to 6 into cushioned trainers. We normally advise patients to practice walking around the house, and if there is no pain or swelling, then they can progress to walking outside in trainers.

There are some high-risk fractures, such as a fracture of the base of the second metatarsal that may require up to 8 weeks immobilised in a boot. For those with low vitamin D levels, osteopenia or osteoporosis may be required to stay in the boot for the full 6 weeks or sometimes longer if it is still not pain-free at that stage.

Related Article: How to transition from a walking boot to a normal shoe?

What is the fastest way to heal a 5th metatarsal fracture?

The following factors should be considered to all a 5th metatarsal fracture heal as quickly as possible:


  • Wear a walker boot all the time, even at home and if you get up for the toilet in the middle of the night.
  • Ask your GP for a simple blood test to check your vitamin D levels, and take Vitamin D tablets if required.
  • Keep your foot elevated for the first 10 days post-injury to reduce swelling or after activity during the full period of recovery.
  • See a Physical Therapist for soft tissue treatment and strengthening exercises. A comprehensive rehabilitation plan ensures a smooth and quick recovery while reducing the risk of recurrence.

Can you walk on a fractured fifth metatarsal?

The timeframe of when you can begin to walk on a fifth metatarsal fracture depends on the location and severity of the fracture.

If you are walking in a boot with a fractured 5th metatarsal, you can walk as long as there is little to no pain. Walker boots are to facilitate walking short distances and should not be used for exercise. Once your period in the boot has ended, it is recommended to wean out of the boot and to wear cushioned stability trainers when walking.

We usually recommend walking around your home with cushioned trainers for 7-10 days; if you have no new symptoms, you can begin to walk outside. Gradually increase your walking distance by 5-10 minutes daily if there is no pain.

It’s essential to make these transitions under the guidance of a medical professional, and no one case is the same as another. 

Related Article: Best walking boot for Metatarsal Fractures


How soon can I run after a 5th metatarsal fracture?

You can return to running 6-8 weeks after your initial diagnosis of a 5th metatarsal fracture if there are no complications during your recovery.

Depending on the fracture location and size, some athletes can return to running 6 weeks after a simple stress fracture to the 5th metatarsal, but complex fractures may require up to 8-10 weeks.

It is recommended to begin with pain-free walking followed by a hopping protocol before returning to running after a 5th metatarsal injury to reduce the risk of recurrence. We usually recommend that our patients practice hopping on one foot for 3 x 45 seconds; if there is no pain, they can progress onto running. 

Running could commence on a treadmill initially, as it has some cushioning and then progress to flat smooth surfaces outdoors. A running gait analysis before returning to running is essential to identify any factors in your gait that may lead to an overload of your 5th metatarsal. 

Wearing supportive, cushioned footwear when returning to running is one of the most important factors alongside your rehabilitation.

Related Article: Best Running Shoes after 5th Metatarsal Fracture

Can a broken 5th metatarsal heal with no cast?

It is possible for a simple 5th metatarsal fracture to heal without a cast, and this can often occur in patients who didn’t realise they had a fracture. 

However, in most cases, patients are placed in a cast or aircast walker boot, which significantly increases their recovery rate and reduces the risk of non-union.

What should I do if my metatarsal fracture is getting worse?

If you are wearing a walker boot and relatively resting from activity, but your pain worsens, you should return to the Fracture Clinic. These injuries usually heal without any issues, but this does not occur in some circumstances and an operation is required.

Your consultant may recommend a repeat x-ray as this can identify if there are signs of healing at the fracture site. In a minority of cases, a fracture may regress, and a more extended period of immobilization is recommended, or surgery may be required.

Surgery is often in the form of fixation or bone graft. A period of immobilization is usually required, followed by 6-8 weeks of Physical Therapy.

Physiotherapy with James McCormack

This is not medical advice, and we recommend a consultation with a medical professional such as James McCormack to achieve a diagnosis. You can have an online consultation with James.

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