A, Elderly patient with spiral fracture of shaft of fifth metatarsal. B, Standing lateral view 15 months later. Posterior arrow indicates avulsed os peroneum from rupture of peroneus longus. Plantar arrow indicates second fracture at base of fifth metatarsal; oblique fracture has healed. Note cavus and varus posture of heel. C, Eighteen months after initial fracture and extended period of casting, fracture is uniting. Note new stress fracture at base of fifth metatarsal. D, Twenty-one months after initial fracture, union progressed sufficiently that patient is pain free; note osteopenia of fifth metatarsal. E, Bone scan shows uptake isolated to fifth metatarsal. F, Proximal arrow indicates bony avulsion by peroneus longus on opposite foot; distal arrow indicates stress fracture. G, CT scan; note in right foot bony fragment laterally at level of sustentaculum tali. H, CT scan shows bony fragment farther posteriorly with peroneus longus more proximal on left.