MANUAL MINORS
Metatarsal fractures are common injuries affecting one or more of the five long bones located in the midfoot. These fractures can result from direct trauma, falls, sudden twists, or repetitive overload (as seen in stress fractures). Symptoms include localised pain, swelling, bruising, and difficulty walking or bearing weight on the affected foot. Common fractures include the Jones fracture (fifth metatarsal) and stress fractures, especially in athletes.
Diagnosis
Diagnosis is based on the trauma or overload history and physical examination, which reveals localised pain, tenderness, and sometimes visible deformity in the affected area. X-rays are essential to confirm the fracture and evaluate the alignment of bone fragments. In cases of stress fractures, where initial X-rays may appear normal, an MRI or bone scan may be necessary.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Foot ligament sprain | Pain and instability, without visible fracture on X-ray. |
Phalangeal fracture | Pain and localised deformity in the toes. |
Plantar fasciitis | Pain on the sole of the foot, especially in the morning, without metatarsal involvement. |
Bone contusion | Pain after a direct blow, with no visible fracture on X-ray. |
Metatarsophalangeal joint dislocation | Visible joint deformity, associated with displacement of the foot joint. |
Emergency Management
Initial management of a metatarsal fracture in the emergency department includes immobilisation of the foot with a splint or orthopaedic boot, along with elevation of the affected foot to reduce swelling.
Ice is applied to relieve pain and reduce inflammation, and analgesics or non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed. If the fracture is displaced or associated with a more severe injury, the patient should be referred to orthopaedics for further evaluation and possible surgical intervention.
Definitive Treatment
Treatment of metatarsal fractures varies depending on the location, type of fracture, and severity of the injury:
Fracture Location | Conservative Treatment | Surgical Treatment |
|---|---|---|
Jones fracture (fifth metatarsal) | Immobilisation with orthopaedic boot (6-8 weeks), no weight-bearing. | Screw fixation in displaced fractures or those at risk of non-union. |
First metatarsal fracture | Immobilisation and weight-bearing restriction if non-displaced. | Surgical fixation with screws or plates in displaced or unstable fractures. |
Fractures of the 2nd, 3rd, 4th metatarsal | Partial immobilisation and limited weight-bearing in non-displaced fractures. | Open reduction and internal fixation (ORIF) in displaced or unstable fractures. |
Stress fractures | Rest, activity reduction, orthopaedic boot if needed. | Surgery in chronic cases or fractures unresponsive to conservative treatment. |
Rehabilitation
Rehabilitation is essential for restoring foot function after a metatarsal fracture. Once the fracture begins to heal, strengthening, mobility, and balance exercises are introduced to prevent stiffness and improve foot stability. Physical therapy is crucial to ensure full recovery and reduce the risk of recurrence.
Complications
Metatarsal fractures, especially the Jones fracture and stress fractures, carry a higher risk of complications, such as:
Non-union (pseudoarthrosis): Occurs when the fracture fails to heal properly.
Post-traumatic arthritis: Can develop if the fracture affects joint surfaces.
Chronic instability: May result from poorly treated injuries or fractures associated with ligament damage.
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