Metatarsal Fracture

Breaks (or fractures) can be acute or caused immediately by injury. They can also occur over a longer period of time, when they are called stress fractures. An acute metatarsal fracture may be open or closed, and displaced or not displaced, as described below:

Open or closed

An open fracture is one where the skin is broken over the fracture so that there is a certain route of possible infection from the outside into the broken bones. This is a more serious type of fracture, with more damage to the soft tissues around it, making treatment and healing more complicated.

Displaced or not displaced

A displaced fracture is one where, following the break, the bones have slipped out of line. A displaced fracture needs specialist care, as the bones will then need to be properly lined up and stabilized. This can involve an anesthetic and some kind of metal pinning or plating to the bones.

Below are more common causes between acute metatarsal fractures and stress fractures:

Stress fractures

This type of metatarsal fracture usually occurs due to repeated stress to the bone, which is also termed “overuse”. They are typically seen in those who have marched or run for a long distance, especially if carrying heavy packs. It often affects athletes and sportsmen, although it can also affect any runners. They are commonly seen in the military during training exercises.

They are generally common in runners who:

• Suddenly increase their running mileage or intensity.
• Run in long or even short distances whilst already having a stress fracture.
• Run in poor footwear that does not suit their feet.
• Have just changed their running shoes and not fit them in properly.
• Continue to exercise despite having foot pain.

People’s choices and needs for running shoes vary. However, before choosing something more uncommon (such as barefoot shoes or corrective shoes), it is recommended to take advice. For instance, for barefoot running, you may need to be taught the right technique before doing so.

Overall abnormalities of the structure of the foot, and abnormalities of the bones and joints, such as rheumatoid arthritis or osteoporosis, can make stress fractures more likely. In more severe cases, stress fractures can also occur in people who have lost nerve sensation in their feet due to neurological problems; for example, diabetes that has affected the feet.

Acute metatarsal fractures

These can be caused by direct injury to the foot. This may happen, for example, through a patient stepping on or kicking the foot, by dropping something onto the foot, or by falling onto the foot. Twisting of the foot or the ankle can also cause fractures on the base of the fifth metatarsal. In this injury, the twisting mechanism pulls on a strong ligament that attaches to the base of the fifth metatarsal which then pulls off a fragment of bone. Lastly, the shaft of the metatarsal is commonly injured because of the twisting of the foot on landing from a jump.

Most metatarsal fractures occur in younger people, as they are more likely to be involved in the kinds of sports and marching activities that make them more likely. However, as we become older the springiness and padding of our feet tend to reduce; this means that our feet absorb impact less well and it is easier to fracture bones. Supportive footwear will make this much less likely.

Other certain risk factors linked to metatarsal fractures include:

• Sports – Metatarsal fractures are more likely to occur in individuals who engage in sports, such as track and field, tennis, gymnastics, or basketball.

• A sudden increase in activity – Metatarsal fractures often occur in patients who suddenly shift from a sedentary lifestyle to an active training regime or whom rapidly increase the intensity, duration, or frequency of training sessions.

• Gender – Women, especially those who have abnormal or absent menstrual periods, are at a higher risk of developing metatarsal fractures.

• Foot problems – Certain people who have flat feet or high, rigid arches are more likely to develop metatarsal fractures. Worn footwear contributes to the problem.

• Lack of nutrients – Eating disorders and lack of vitamin D or calcium can make bones more likely to develop metatarsal fractures.

• Weakened bones – Conditions such as osteoporosis can weaken your bones and make it easier for metatarsal fractures to occur.

Some metatarsal fractures do not heal properly, which can cause chronic problems. If underlying causes are not taken care of, you may be at a higher risk of additional stress fractures. Additionally, metatarsal fractures occur more easily if the metatarsal bones are weakened due to thinning of the bones (which leads to osteoporosis). Given that older women are at increased risk for osteoporosis, an increased incidence of fifth metatarsal fractures with increasing age in women suggests that such injuries could serve as an early point of entry into osteoporosis treatment and fracture prevention. Fractures of the fifth metatarsal bone are a common injury encountered not only in the offices of foot and ankle specialists, but also frequently in primary care, sports medicine, and general orthopedic settings. In addition, multiple reports suggest fractures of the fifth metatarsal are the most common metatarsal fracture.

Overall, metatarsal fractures can begin as very small injuries which do not cause severe pain. However, if you carry on stressing the bone, the crack will often deepen and widen, gradually becoming more painful. Eventually, in the worst-case scenario, the stress fracture may progress to become a full fracture. If you have an acute metatarsal fracture and you continue to stress the bone, the pain will increase further as the broken ends of the bone will begin to rub slightly against one another, and the area will be once inflamed.

A physical exam and X-ray are usually all that is needed to diagnose a metatarsal fracture. Advancing imagining such as CT scans or MRI are normally only ordered to diagnose fifth metatarsal fractures when history and physical examinations are suspicious of a fracture, but the X-rays are negative.

As for treatments, this depends on how bad the fracture is and where the fracture is on the bone. You may or may not need surgery; your doctor will recommend you insert a cast or splint to keep the foot stable. You may also be given crutches to use and keep the weight off your foot for a more rapid recovery.

A metatarsal fracture may take from 6 weeks to several months to heal. It is important to give your foot time to heal completely so that you do not hurt it again. It is also necessary to avoid activities until the foot has fully recovered and until advised by your doctor that you are free to return to activities. Your doctor may finally suggest that you get physiotherapy to help regain strength and range of motion in your foot.

Furthermore, the basic principles of treating metatarsal fractures include:

• Painkillers – Painkillers such as non-steroidal anti-inflammatory medications (NSAIDs) may help to relieve pain.

• Stop stressing the foot – If you have been diagnosed with a metatarsal fracture, avoiding the activity that caused it; this may mean using crutches or even a wheelchair.

• Surgery – In severe cases, surgery may be required; for example, to re-align any part of the bone that has moved out of position. However, surgery is often not needed for stress fractures.

Exercises may be suggested for a condition or for rehabilitation. Start each exercise slowly while easing off the exercises if you start to have pain. Here are some exercises for you to try:

Calf wall stretch

Stand facing a wall with your hands on the wall at about eye level. Put your affected foot about a step behind your other foot. Keeping your back leg straight and your back heel on the floor, bend your front knee and gently bring your hip and chest towards the wall until you feel a stretch in the calf of your back leg. Finally, hold this stretch for at least 15-30 seconds, then repeat 2-4 more times.

Marble pick-ups

Put some marbles on the floor next to a cup. Sit in a chair and use the toes of your affected foot to lift up one marble from the floor at a time. Then try to put the marble in the cup. It is often recommended to repeat this procedure 8-12 times.

Towel scrunches

Sit in a chair and place both feet on a towel on the floor. Scrunch the towel towards you with your toes. Then use your toes to push the towel back into place before repeating 8-12 times.

Towel inversion and eversion

Sit in a chair, and place both feet on a towel on the floor. Swivel your feet from side to side to slide the towel. First slide your toes, then your heels, as you move the towel with your feet. Then change directions and swivel your feet from side to side to slide the towel back to the starting position.

To help ease your metatarsal pain, it is recommended to try these at-home treatments:

Rest

Protect your foot from further injury by not stressing it. Elevate your foot after standing or walking. You might need to avoid your favourite sport for a while, but you can stay fit with low-impact exercises, such as swimming or cycling.

Ice application

Applying ice to your foot can be very helpful as a pain reliever. Ice should be applied as soon as possible after injury for 10-30 minutes. Make an ice pack by wrapping ice cubes in a plastic bag or towel, or by using a bag of frozen peas. Gently press the ice pack onto the injured part. The cold should reduce blood flow to the damaged area; limiting pain, inflammation, and bruising.

Wear proper shoes

Avoid too-tight or too-loose shoes and limit the wearing of high heels. Wear shoes appropriate to the sports you play.

Metatarsal pads

These pads are placed in your shoes just ahead of the metatarsal bone to help deflect stress from the painful area.