To summarize the latest progress in the treatment of acute proximal fifth metatarsal fractures, in order to provide best choice for clinical treatment. Review and analyze the domestic and foreign literatures related to acute proximal fifth metatarsal fractures, make a detailed introduction of the new conceptions and methods on the treatment. Different methods of treatment should be adopted based on the different zones of fractures. The fractures in zone I and II should be treated conservatively with rehabilitation therapy. While the fractures in Zone III should be treated surgically, close reduction and intramedullary screw fixation is advocated. The treatment plans should be chosen alternatively according to the different fracture types and the needs of different patients.