Metatarsal Fractures

The anatomy of the foot is very complicated. It included muscles, bones, tendons, and soft tissues. There is a total of 28 bones in the foot. Out of these 28 bones, 19 are toe bones which are known as phalanges, and metatarsal bones the long bones in the mid-foot. Fractures of these bones occur commonly. In case of these fractures, an examination by a specialist surgeon of foot and ankle must be consulted for diagnosis and treatment.

Type of metatarsal fractures

A break in the bone is known as a fracture. There are two categories of fracture: traumatic fractures and stress fractures. Breaks in the metatarsal bones can be stress fractures or traumatic fractures.

Traumatic fractures: These fractures are also called acute fractures. These fractures are the result of a direct blow or impact, e.g., severely striking of a toe. These fractures can be displaced or non-displaced. When the bone is broken in such a manner that the position of the bone is changed, it is called a displaced fracture. Symptoms of traumatic fractures are as follows:

• An internal sound at the time of fracture
• Pain at the site of the impacted area at the time of fracture or after a while.
• Toe may appear crooked or abnormal.
• Swelling and bruising the next day at the site of impact.

Stress fractures: These are minor hairline breaks that generally occur due to repetitive stress. Usually, stress fractures occur in sportspersons or athletes who increase their running mileage rapidly. Other reasons for these fractures may include deformities, unusual foot structure, osteoporosis, and inappropriate footwear. Correct healing of these fractures also needs proper medical care.

Symptoms of stress fractures are as follows:

• Pain during or after normal activity

Pain relievers during resting but recurs during standing or normal activity.

• Pinpoint pain at the site of injury when touched.
• Swelling at the impacted area

Treatment of Metatarsal Fractures

Treatment of some specific fractures of the metatarsal bones is very challenging. As the fracture of the first metatarsal bone (at the back of the big toe) may lead to arthritis since the big toe bears more weight as compares to other toes and is also used more frequently. Arthritis in this part can make standing, walking, and bending very painful.

The other type of break occurs at the base of the fifth metatarsal bone (at the back of the little toe) which is also known as Jones fracture. It is usually mistaken for an ankle sprain. This misdiagnosis can have a grievous outcome. That is why a foot and ankle surgeon must be an expert so that he/she can evaluate the conditions adequately.

However, treatment is mainly decided considering the type of fracture and extent of the injury. Following are the methods of treatment of metatarsal fractures.

• Rest: To facilitate healing, rest is the best treatment for these fractures.
• Avoid stressful activity: As stress fractures are caused by repetitive stress, so offending activities must be avoided. Crutches or a wheelchair may be relied upon so that the foot weight can be offloaded for proper healing.
• Stiff-soled shoe, Immobilization, or casting: A stiff-soled shoe or another form of immobilization or casting is also used to protect the fractured bone during the healing process. Shoe or boot-walker can also be used after the surgery.
• Operative treatment: if the broken bone is displaced severely in case of traumatic fractures of the metatarsal bones, then operative treatment is required. Various implants such as: locking plates and locking calcaneal plate are made available by the orthopedic implant manufacturers for treating foot and ankle fractures.
• Post-surgery care. A surgeon should give clear instructions for care after the surgical or nonsurgical treatment. Physiotherapy, exercises, and rehabilitation can be advised so that a patient can resume his/her normal routine activities.