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Treatment of Zone 1 Fractures of the Proximal Fifth Metatarsal With CAM-Walker Boot vs Hard-Soled Shoes.

Publication ,  Journal Article
Nishikawa, DRC; Aires Duarte, F; Saito, GH; Bang, KE; Monteiro, AC; Prado, MP; de Cesar Netto, C
Published in: Foot Ankle Int
May 2020

BACKGROUND: Zone 1 fractures of the proximal fifth metatarsal are usually treated nonsurgically using some type of immobilization. The aim of this study was to compare clinical and functional outcomes, time to return to prior activity levels, and rate of bone healing when using a hard-soled shoe (HSS) vs a controlled ankle motion (CAM)-walker boot (CWB). METHODS: Seventy-two consecutive patients with zone 1 fractures of the fifth metatarsal base were treated conservatively with either an HSS or CWB by 2 different providers. We included 57 women and 15 men, average age of 41.3 (range, 16-88) years. Radiographic findings, visual analog scale (VAS) for pain, and American Orthopaedic Ankle & Foot Society (AOFAS) midfoot score were assessed. Patients were followed at 4, 8, 10, 12, and 24 weeks or until asymptomatic and able to return to prior level of activities. Statistical analysis was performed using Mann-Whitney U, Fisher exact, and chi-square tests. P values <.05 were considered significant. RESULTS: Age and gender distributions were similar in both groups (P = .23 and P = .57). Patients had similar VAS and AOFAS scores after 8 (P = .34 and P = .83) and 12 (P = .87 and P = .79) weeks. Average time for bone healing was significantly faster using the CWB (7.2 weeks) when compared to the HSS (8.6 weeks) (P < .001). The average time to return to prior level of activities was similar in both groups (8.3 weeks for CWB and 9.7 weeks for HSS) (P = .11). Fracture displacement was equal in both groups, with a mean of 1.9 mm of displacement in patients using the HSS, and a mean of 1.6 mm in those using the CWB (P = .26). CONCLUSION: Zone 1 fractures of the proximal fifth metatarsal can be treated conservatively with either a hard-soled shoe or a CAM-walker boot. Even though patients treated in the CAM-walker boot demonstrated earlier signs of complete healing, similar clinical and functional results were achieved with both treatments. LEVEL OF EVIDENCE: Level III, retrospective comparative series.

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Published In

Foot Ankle Int

DOI

EISSN

1944-7876

Publication Date

May 2020

Volume

41

Issue

5

Start / End Page

508 / 512

Location

United States

Related Subject Headings

  • Young Adult
  • Shoes
  • Retrospective Studies
  • Recovery of Function
  • Pain Measurement
  • Orthotic Devices
  • Orthopedics
  • Middle Aged
  • Metatarsal Bones
  • Male
 

Citation

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ICMJE
MLA
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Nishikawa, D. R. C., Aires Duarte, F., Saito, G. H., Bang, K. E., Monteiro, A. C., Prado, M. P., & de Cesar Netto, C. (2020). Treatment of Zone 1 Fractures of the Proximal Fifth Metatarsal With CAM-Walker Boot vs Hard-Soled Shoes. Foot Ankle Int, 41(5), 508–512. https://doi.org/10.1177/1071100720903259
Nishikawa, Danilo Ryuko Cândido, Fernando Aires Duarte, Guilherme Honda Saito, Katrina E. Bang, Augusto César Monteiro, Marcelo Pires Prado, and Cesar de Cesar Netto. “Treatment of Zone 1 Fractures of the Proximal Fifth Metatarsal With CAM-Walker Boot vs Hard-Soled Shoes.Foot Ankle Int 41, no. 5 (May 2020): 508–12. https://doi.org/10.1177/1071100720903259.
Nishikawa DRC, Aires Duarte F, Saito GH, Bang KE, Monteiro AC, Prado MP, et al. Treatment of Zone 1 Fractures of the Proximal Fifth Metatarsal With CAM-Walker Boot vs Hard-Soled Shoes. Foot Ankle Int. 2020 May;41(5):508–12.
Nishikawa, Danilo Ryuko Cândido, et al. “Treatment of Zone 1 Fractures of the Proximal Fifth Metatarsal With CAM-Walker Boot vs Hard-Soled Shoes.Foot Ankle Int, vol. 41, no. 5, May 2020, pp. 508–12. Pubmed, doi:10.1177/1071100720903259.
Nishikawa DRC, Aires Duarte F, Saito GH, Bang KE, Monteiro AC, Prado MP, de Cesar Netto C. Treatment of Zone 1 Fractures of the Proximal Fifth Metatarsal With CAM-Walker Boot vs Hard-Soled Shoes. Foot Ankle Int. 2020 May;41(5):508–512.
Journal cover image

Published In

Foot Ankle Int

DOI

EISSN

1944-7876

Publication Date

May 2020

Volume

41

Issue

5

Start / End Page

508 / 512

Location

United States

Related Subject Headings

  • Young Adult
  • Shoes
  • Retrospective Studies
  • Recovery of Function
  • Pain Measurement
  • Orthotic Devices
  • Orthopedics
  • Middle Aged
  • Metatarsal Bones
  • Male