Metatarsal fractures represent a relatively common injury, especially in athletes. Treatment remains relatively straightforward for the traumatic metatarsal injury. Traditional stress fractures typically heal with decreased activity. The problematic proximal fifth metatarsal fracture (Jones fracture) frequently requires surgical intervention in the patient who wants to avoid non-weight-bearing cast immobilization. The authors, current treatment for this fracture includes the option of intramedullary fixation versus cast immobilization. If surgical treatment is chosen, then the largest-diameter cannulated screw is used for intramedullary fixation. Patients are immobilized for 7 to 10 days until the wounds are healed. Weight bearing is instituted, as tolerated, with biking and swimming also allowed. Light jogging is typically begun at 6 weeks if early healing is noted and the patient is asymptomatic. In the high-performance athlete, a CT scan is obtained before release to full sports activity, which usually occurs at 8 to 12 weeks.