We retrospectively reviewed the office records of the senior author - which include two national ballet companies - and identified 35 dancers who sustained distal shaft fractures of the fifth metatarsal. The usual fracture pattern is a spiral, oblique fracture starting distal-lateral and running proximal-medial. Treatment consisted of open reduction and internal fixation for 2 patients, closed reduction and percutaneus fixation for 2 patients, short leg weightbearing cast for 7 patients, and an elastic wrap and treatment of symptoms for 24 patients. Patients with marked displacement of the fracture underwent internal fixation early in the study period; but more recent treatment emphasized nonoperative means, even for displaced fractures. The average time to pain free walking was 6.1 weeks (range, 0 to 16); return to barre exercises, 11.6 weeks (range, 4 to 48); and return to performance, 19 weeks (range, 6 to 52). There was one delayed union (7 months) and one refracture (2 months) that subsequently healed. All patients returned to professional performance without limitation and no patient reported pain with performance at followup. Spiral fractures of the distal shaft of the fifth metatarsal are common injuries and can usually be treated nonoperatively for these high performance athletes without long-term functional sequelae.