Fractures of the fifth metatarsal are among the most common injuries in the foot, often presenting significant challenges for treatment, particularly when they occur at the base. This area is especially problematic due to its unique blood supply, which can result in delayed or non-union. The treatment of these fractures has been a subject of extensive debate among surgeons for many years. Various treatment approaches have been proposed, reflecting differing opinions on the best methods to ensure optimal patient outcomes. This review offers a comprehensive overview of the anatomy, classifications, and mechanisms of injury. It also discusses the different non-operative and operative approaches and highlights the latest concepts in managing fifth metatarsal fractures. The review offers valuable insights for clinicians, helping them choose the most effective treatment protocols based on the fracture type and the patient’s level of activity and needs.