Metatarsal Fracture

What is a Metatarsal Fracture?

A metatarsal fracture occurs when one of the long bones in your foot is broken.

Each foot has 5 metatarsal bones that are the ones that connect your ankle to your toes.

Metatarsal bones keep your balance when you stand and walk.

A metatarsal fracture is the most common fracture in foot bones and it has the following epidemiology:

• First metatarsal fracture: around 5%
• Second metatarsal fracture: around 10%
• Third metatarsal fracture: around 15%
• Fourth metatarsal fracture: between 10 and 15%
• Fifth metatarsal fracture: more than 50%
• Multiple metatarsal fractures: around 15%

What may cause a metatarsal fracture?

There is some category of people that are at higher risk of developing  a metatarsal fracture such as:

• Athletes
• People who practise a sport  like jogging, dance, gymnastics
• Obese people
• People with other underlying conditions such as osteoporosis, rheumatoid arthritis, diabetes have an increased risk of developing metatarsal fractures.

Most of the metatarsal fracture is caused by a direct injury on the foot:

• someone stepping on your foot or kicking it
• twisting the foot or the ankle, for example, landing from a jump
• falling on to the foot

A metatarsal fracture may be caused also by repeated stress to the foot.

Stress fractures typically occur in people who run for long distances, such as runners who increase their mileage or run in poor footwear.

Do ageing and osteoporosis make a metatarsal fracture more likely?

Metatarsal fractures are common in pediatric patients and account for around 60% of all pediatric foot fractures. This is also due to the fact that they are more likely to be involved in sports activities.

However, as we become older our metatarsal bones may weaken and become thinner because of osteoporosis.

In this case, supportive footwear may help in decreasing the risk of a fracture.

Metatarsal fracture symptoms

The first symptom is pain that sometimes increases when putting full weight on the foot.

Tenderness to the touch is another typical symptom.

The pain is like a “pinpoint pain” because it is usually well localised at the site of injury.

An acute metatarsal fracture may also make an audible sound.

Other typical signs may be:

• bruising and swelling
• difficulty putting weight on the affected foot.

If the metatarsal fracture is a repetitive strain injury there is usually no usually no bruising and no cracking sound.

Also, people with a stress fracture may be able to walk for some time, while pain increases day by day.

Metatarsal fracture diagnosis

You should see an orthopedic surgeon if you suspect that you have a metatarsal fracture.

The doctor may order some test such as X-ray, CT scan, MRI (magnetic resonance imaging) in order to determine if the fracture is displaced suggest the best treatment.

Stress fractures may not show up easily on x-rays if they are small.

Treatment of metatarsal fractures

Treatment depends on:

• Which metatarsal bone is fractured and which part of the bone is injured.
• How severe the damage is (Whether the fractured bone is displaced or not)
• Whether it is an open fracture (that involves also the tissues of the foot) or not.

The basic first aid tips are as follow:

• Relief pain with anti-inflammatory drugs such as paracetamol or ibuprofen
• Apply ice as soon as possible for 10-30 minutes
• Rest and keep the foot up in order to reduce swelling

Treatment can be conservative or operative.

Conservative treatment is preferred when there is a multiple metatarsal fracture without dislocation.

In this case a short leg cast may be applied for a few days. The leg cast can be replaced by a specific brace for several weeks.

Follow-up

Rehabilitation and walking therapy are fundamental for a full recovery.

In case of an acute metatarsal fractures it takes around six to eight weeks to heal.

While a stress fractures normally heal without complications from six to twelve weeks and then it is possible to gradually start again your normal activities including sport.

Prof. Nicola Portinaro’s experience.

Prof. Portinaro is has been treating metatarsal fractures and foot fractures in general for more than 30 years.