A 19-year-old male professional basketball player presents with pain to the lateral border of his left foot. The symptoms commence immediately after perceiving a snap to the left foot while attempting to jump. Forced inversion or flexion of the foot during injury is denied. Radiographs confirm a transverse stress fracture of the fifth metatarsal ( Fig. 2 ). Upon clinical examination, bilateral pes cavus and hindfoot varus alignment including peek-a-boo heel sign is observed ( Fig. 3A, B ). The patient is scheduled for intramedullary screw fixation with a 4.5-mm cannulated screw. 
 The surgical procedure was performed in regional anesthesia. The fracture was identified using a fluoroscan C-arm, and a small incision was made proximal to the base of the fifth metatarsal. An intramedullary guidewire was inserted into the fifth metatarsal and placed across the fracture site. The guidewire was then overdrilled protecting the soft tissue and tendon attachment with a drill sleeve. Counterpressure was placed along the longitudinal axis of the fifth metatarsal, and a correct length screw was inserted and tightened. All threads were placed distal to the fracture site. The screw head was embedded into the cortical part of the styloid process of the fifth metatarsal, avoiding screw head irritation ( Fig. 4 ). Fracture stability was ensured. The incision was closed with a single suture. The patient was equipped with a controlled ankle motion boot for 4 weeks, and nonweight-bearing for 14 days was advised. 
 The patient was assessed after 5 and 10 weeks after surgery, and radiographs of the fracture site were obtained ( Fig. 5A, B ). After 5 weeks after surgery, the patient was free of symptoms during functional activity and upon clinical examination. Return to competitive sport was permitted. After 10 weeks after surgery, radiographs demonstrated complete fracture consolidation, and the patient was free of symptoms during competitive sport and upon clinical examination. The patient was equipped with a varus unloading orthotic insert to reduce the risk of fracture recurrence. Hardware removal was not indicated.