Gait changes in daily life during the healing process of fifth metatarsal fracture: a case report

The fifth metatarsal is a major component of the lateral longitudinal arch of the foot. Damage to this area reduces foot function and impairs gait. Furthermore, immobilization used to treat fractures causes muscle weakness and contracture of the ankle joint, which impedes walking. Most studies on gait after fractures have been conducted in controlled laboratory environments, and the limitations of gait on patients' daily lives remain unclear. This case report aimed to quantitatively demonstrate the decline in gait function in daily life after a fifth metatarsal fracture and to report its duration and recovery over time.

This report describes a 39-year-old Japanese man who sustained a tuberosity avulsion fracture of the fifth metatarsal after slipping and falling on stairs. The fracture was immobilized with a splint, and the patient was instructed to use crutches for ambulation. The splint was removed 4 weeks post-injury, and crutches were discontinued. Daily walking was measured using inertial sensors embedded in insole devices worn on both feet. Walking speed and stride length decreased after the fracture and then gradually improved, reaching prefracture values 16 weeks postfracture. A significant decrease in the left push-off angle was observed, which decreased from approximately 77° before fracture to 54°. However, it improved weekly and reached prefracture values at 16 weeks. A decrease in the contact angle of the right foot was also observed, which took approximately 16 weeks to improve.

This is a case report on the temporal changes in gait pattern pre- and postfracture in a patient treated conservatively for a fifth metatarsal fracture. The fifth metatarsal fracture and subsequent immobilization strongly suggest a decrease in push-off force on the injured side during walking. This also affects the movement of the right lower limb. Decreased push-off on the fractured side reduces propulsion and limits the walking performance in daily life. Walking speed improved after 16 weeks, and this improvement was consistent with an improvement in the push-off angle. As this report measured gait in daily life, the patient's real-life mobility was affected for 15 weeks after the fracture.