Predictors of Pain Recovery and Functional Outcomes After Conservative Management of Fifth Metatarsal Fractures: A Retrospective Cohort Study.

Background

Patient-related predictors of pain and functional recovery after conservative fifth metatarsal fracture management remain unclear.

Purpose

To evaluate clinical outcomes and identify factors associated with pain reduction. STUDY

Design

Retrospective Cohort Study.

Methods

Ninety-nine patients with conservatively managed fractures were evaluated (minimum 12-month follow-up). The primary outcome was pain reduction (ΔNRS%), with absolute NRS change reported alongside. Secondary outcomes included time to union (bridging callus), return to daily activities, clinical recovery, and functional scores (FAAM, AOFAS). Multivariable regression evaluated independent associations.

Results

The cohort (41 women, 58 men; mean age 43.2 years, BMI 26.5 kg/m²) predominantly sustained zone 1 fractures. All achieved early radiographic healing (bridging callus; mean 4.0 weeks), and complete union without complications. Mean NRS decreased from 6.79 to 0.68 (mean absolute reduction, 6.11 ± 0.79 points). Mean FAAM and AOFAS scores were 98.37 and 97.68. Most returned to daily activities within 5 weeks (n=65) and recovered within 8 weeks (n=74). Within this cohort, BMI was the only variable independently associated with ΔNRS%, with higher BMI associated with less pain improvement.

Conclusion

Conservative management yielded favorable outcomes in this predominantly zone 1, minimally displaced cohort (mean initial displacement 0.53 ± 0.79 mm; median 0 mm). BMI was the only variable independently associated with the magnitude of pain recovery; however, because metabolic, nutritional, occupational, and adherence-related variables were unavailable, BMI is best regarded as a pragmatic clinical marker of slower symptomatic recovery rather than a demonstrated causal determinant. Zone-specific findings require caution given limited zone 3 cases. LEVEL OF EVIDENCE Level IV, Therapeutic.