Outcomes of Nonoperative Treatment of Forefoot Fractures: Casting Versus Off-Loading Shoes

Background: Although forefoot fractures are of the most common orthopedic injuries, there are limited studies regarding the outcomes of nonoperative treatment of these fractures. In the current randomized clinical trial, for the first time, we evaluated the outcomes of nonoperative treatment of metatarsal bone fractures using off-loading shoes compared with casting. Methods: In this study, there were 60 patients with metatarsal fractures without indications for surgical management who were assigned to the two equal groups: casting (group C) and off-loading shoe (group OS). The rate of fracture union was investigated. Also, the pain severity and patient satisfaction were measured based on visual analogue scale (VAS). Patients were followed for six months. In the last examination, American foot and ankle score (AOFAS) was completed. Finally, the outcomes were compared between two groups. Results: Clinical and radiological unions were achieved in all of the fractures. In the last examination, the pain intensity (1.2 ± 0.8 in group C versus 1.8 ± 1 in group OS; P = 0.149) and AOFAS (91.7 ± 15.1 in group C versus 93.2 ± 12.9 in group OS; P = 0.407) were similar. Patients in group OS were significantly more satisfied (7.5 ± 1.1 and 9.2 ± 1.3; P 0.001). Complications of casting including skin problems, symptoms of deep venous thrombosis, and reflex sympathetic dystrophy developed in four patients. Conclusions: Off-loading shoes are suitable modalities to treat forefoot fractures. Although no statistically significant difference was found between the groups, but due to the comparable outcomes, high patient satisfaction, and lack of complications, nonop- erative treatment of forefoot fractures using off-loading shoes is recommended.