To summarize the latest progress in the treatment of acute proximal fifth metatarsal fractures, in order to provide best choice for clinical treatment. The domestic and foreign literatures related to acute proximal fifth metatarsal fractures were reviewed and summa- rized to make a detailed introduction of the new conceptions and methods on the treatment. Different methods of treatment should be adopt- ed based on the different zones of fractures. The fractures involving zone I and II should be treated conservatively with rehabilitation thera- py, while the fractures involving Zone III should be treated surgically with close reduction and intramedullary screw fixation as the first choice. The treatment plans should be made alternatively according to the different fracture types and the needs of individual patients.