On examination, they will have swelling and tenderness localized to the fracture site. These fractures can generally be treated conservatively in a cast or wooden shoe for 6 weeks with weight bearing as tolerated until the patient's pain and tenderness subside. They typically result from training errors such as too rapid an increase in mileage in a runner. Patients will report activity-related pain that gradually increases. They will generally have tenderness over the fracture site with minimal edema.
Poor shoes can also contribute.
Multiple fractures frequently require open reduction and internal fixation because of significant displacement. Residual displacement of a metatarsal fracture can predispose a patient to develop a callus. This is because a displaced metatarsal, whether plantar or dorsally displaced, alters the pressure pattern in the forefoot, and a callus forms in the area of increased pressure. The callus, or intractable plantar keratosis, will cause persistent pain with weight bearing and will require an orthosis or possibly even surgical correction of the underlying bony deformity. Patients will say that they sprained their ankle, but the tenderness will be localized over the base of the fifth metatarsal.