Stress fractures of the fifth metatarsal have been reported with increasing frequency, especially in athletes. Prolonged healing time and the risk of refracture follow ing conservative treatment have led to recommenda tions for operative treatment including bone grafting of these fractures. An axial intramedullary screw, inserted without opening the fracture site, was used in 10 ath letes with stress fractures of the fifth metatarsal. Union was obtained in all patients in an average of 7.5 weeks. All patients returned to their sports in an average of 8.5 weeks postoperatively. There were no operative com plications or refractures after screw insertion. Com plaints of local pain over the screw head and/or the fifth metatarsal head, seen in 7 of the 10 patients, were relieved by local shoe modifications.