title: Aircast walking boot and below-knee walking cast for avulsion fractures of the base of the fifth metatarsal: a comparative cohort study.
abstract: BACKGROUND
  Acute avulsion fractures of the base of the fifth metatarsal are common and are treated in a variety of ways. The aims of this study were to compare pain, functional outcome, and time taken off work after treatment with a walking boot or a short-leg cast.
  
  
  METHODS
  Of 39 patients with acute avulsion fractures of the base of the fifth metatarsal, 23 were treated with a short-leg cast and 16 with a walking boot, according to the preference of the consultant present at outpatient clinic. Functional outcome was assessed by the Visual Analogue Scale Foot and Ankle Questionnaire (VAS FA), pain, and other complaints on presentation and at 3, 6, 9, and 12 weeks after injury. The VAS FA scores were compared between the 2 groups by a paired Student t test.
  
  
  RESULTS
  The mean time to return to the level of pain and function before injury was approximately 9 weeks after treatment in the walking boot group and 12 weeks with a short-leg cast. Patients with walking boots reported less pain between 3 and 12 weeks than did those with short-leg casts after 6 (P = .06), 9 (P = .020), and 12 weeks (P = .33). Function was significantly better with Aircast walking boots after 3 (P = .006), 6 (P = .002), and 9 weeks (P = .002) but not after 12 weeks (P = .09). Patients returned to their preinjury level of driving after 6 weeks with walking boots and 12 weeks with short-leg casts (P = .006). Employed patients took a mean of 35.8 days off work (range, 28-42 days), fewer with boots (31.5 days) than with short-leg casts (39.2 days).
  
  
  CONCLUSIONS
  The walking boot was better treatment than a short-leg cast for avulsion fractures of the base of the fifth metatarsal. Patients had an improved combined level of pain and function 3 weeks earlier, at 9 weeks post injury, when managed in a walking boot.
  
  
  METHODS
  Level II, prospective comparative series.
authors: Department of Orthopaedics and Traumatology, Yeovil District Hospital, UK. kamren35@hotmail.com
authors: Mohammad Kamran
authors: MK
authors: Shahid
authors: Shahid
authors: S
authors: Punwar
authors: Caroline
authors: C
authors: Boulind
authors: Gordon
authors: G
authors: Bannister
mesh_terms: D001334:Automobile Driving; D002370:Casts, Surgical; D015331:Cohort Studies; D005260:Female; D061826:Foot Orthoses; D017102:Fracture Healing; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000293:injuries*; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010147:Pain Measurement; D020127:Recovery of Function; D062707:Return to Work / Q000706:statistics & numerical data; D018582:Sick Leave / Q000706:statistics & numerical data