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Metatarsal head stress fractures pose treatment challenges with no established consensus. In this article, we introduce a percutaneous treatment involving autologous bone marrow aspirate concentrate (BMAC) injection without surgical fixation in a 21-year-old basketball player with a stress fracture of the right fifth metatarsal head. He underwent this procedure following unsuccessful 8 months of conservative treatment. Twelve weeks after the procedure, a CT scan confirmed complete healing, facilitating his return to sports. This innovative method offers a promising alternative, avoiding the associated morbidity of surgical intervention. Further research, comparing refracture rates with surgical options, is warranted to inform treatment decisions for this uncommon injury and validate the efficacy of percutaneous BMAC injection. Plain Language Summary What is the study about? Metatarsal head stress fractures are uncommon and challenging to treat, often requiring surgery if conservative methods fail. This report introduces a successful alternative: a percutaneous injection of bone marrow aspirate concentrate (BMAC) directly into the fractured area, avoiding surgical risks. BMAC contains stem cells and growth factors that promote healing. In this case, a collegiate basketball player with a fifth metatarsal head fracture underwent this procedure after conservative treatments failed over 8 months. What were the results? Twelve weeks after the procedure, CT scan showed complete healing, allowing the player to return to sports without complications. What do the results mean? This innovative approach offers a promising option for refractory fractures, potentially sparing patients from surgery and its associated complications. Further research comparing refracture rates with surgical methods is needed to guide treatment decisions for this rare injury effectively. Article highlights Fifth metatarsal head fractures Rare foot injury with no consensus on the best approach for its management. Typically treated conservatively first before surgical interventions are pursued. Percutaneous bone marrow aspirate concentrate procedure detail A source of mesenchymal stromal stem cells and growth factors that has been utilized to enhance orthopedic procedures. Collected from posterior iliac crest. Injected into the intra-osseous space of the fifth metatarsal head under ultrasound-guidance. Clinical implications Percutaneous BMAC injection presents a novel treatment option for refractory metatarsal head stress fractures. Offers a promising alternative to surgical intervention, avoiding associated complications. Further research needed to compare refracture rates between percutaneous BMAC injection and surgical fixation. [ABSTRACT FROM AUTHOR]