What is a metatarsal fracture?
A metatarsal fracture is a term for a fracture or break to one of the five metatarsal bones of the foot. The metatarsal bones are the connection between the back of the foot (the heel) and the toes. The foot itself is made of three sections of different bones. The bones at the back of the foot under the ankle joint are known as the tarsal bones and include the calcaneus (which forms your heel), the talus (which forms part of the ankle), navicular, cuboid, and the lateral, intermediate and medial cuneiforms. The next section is the mid foot consisting of the five long metatarsal bones, numbered in the sense that your big toe is first and your little toe is your fifth. The metatarsals connect at the back to the cuneiforms and cuboid bones and at the front to the toes. The toes are the last section consisting of five bones called phalanges which like the fingers are individually divided into three parts (distal, middle and proximal) and the big toe is referred to as the hallux. The metatarsals play an important role in the biomechanics of the foot. They contribute to and support the structure of the foot arch, thus affecting balance and they also act like a lever in the push off movement of the foot. Although it is possible to fracture any portion of the metatarsal, the most commonly affected area is the long middle shaft of the bone.
What is the difference between a metatarsal fracture and a metatarsal stress fracture?
A metatarsal stress fracture is similar to a metatarsal fracture only the crack or break along the metatarsal shaft is incomplete. Metatarsal stress fractures also normally happen as a result of gradual build up in tension and micro-trauma from the connecting muscles on the sole of the foot. However, a full fracture is normally the result of a high impact injury or direct trauma to the foot. Metatarsal stress fractures most commonly occur within the second metatarsal which is the one next to the big toe. Metatarsal fractures on the other hand most commonly affect the second, third and fourth Metatarsal bones. The fifth metatarsal that connects to the little toe is also commonly fractured as the result of football injuries. High profile players such as Wayne Rooney and David Beckham having suffered such an injury.
Why and when does a metatarsal fracture happen?
Metatarsal fractures are most common in the young people and are generally the result of high impact trauma or a severely sprained ankle. The injury is common in sports like football, normally as the result of a tackle that has ended in a direct blow to the opposition’s shoe or having your foot stood on during or after the tackle. Severe ankle sprains from impact or landing from a jump awkwardly can torsion the foot with excessive force and result in multiple metatarsal fractures. However some minor injuries, such as ankle sprains can result in a metatarsal fracture, this typically only happens when there is an underlying bone weakening condition like osteoporosis.
What to do if a metatarsal fracture is suspected after trauma?
If you suspect someone has sustained a metatarsal fracture after any type of trauma then you must immediately call for medical help. As mentioned previously most people injured by high impact accidents may have sustained other injuries, as well as the fracture making medical attention vital. It is important to make sure the individual is safe and comfortable without having to move without support as any walking or weight bearing on the fractured foot will be very painful. Due to the possible risk of damage to the surrounding arteries and nerves fractures are considered a medical emergency.
What does a metatarsal fracture feel like?
A metatarsal fracture from trauma causes a very intense, immediate, sharp pain around the fracture site. This pain can radiate up into the ankle and shin and down into the sole of the foot and toes. The fracture is often accompanied by swelling and bruising and is aggravated by most ankle and foot movements, which makes weight bearing and walking excruciating. The intense pain after a break will last for several hours and will be aggravated or prolonged by any treatment options like manipulation or traction. Post-surgery or after treatment when the bone starts to heal there will be a dull continuous ache from the swelling and healing process that will last weeks to months. During the healing process the bone is trying to knit together and re-unite, this stage can be quite painful and it is very important to rest and avoid weight bearing on the foot to ensure that the bone reconnects properly. The soft tissue surrounding the fracture also starts to form scar tissue to bind everything together allowing the structure to try and restore its original state and function.
How will a metatarsal fracture be diagnosed?
Patients will be taken to A&E and a full examination done to rule out any additional injuries or complications. Your doctor will order an X-ray of the foot to confirm the diagnosis and identify the location and the extent of the fracture. Occasionally, if the extent of the fracture isn’t fully visible on an X-ray, an MRI or a CT scan will be ordered as this will give a more detailed view of the fractured site. Doctors will also use an MRI scan to assess whether the pain felt after trauma is coming from injury to the leg muscles, ligaments or joint capsule and not indeed from a fracture. The occurrence of a metatarsal fracture from very mild trauma may prompt doctors to investigate for any underlying bone weakening conditions.
What treatment options are available for a metatarsal fracture?
The treatment options and healing times for metatarsal fractures vary depending on the position and severity of the fracture and also on the complications from any additional injuries, such as infection with open fractures. Most cases of metatarsal fractures do not need surgery, however it is occasionally necessary to surgically stabilise multiple fractures or complete breaks most likely with the insertion of a screw fixation. Traction or manipulation may be used to correct the position of the fractured bone and a splint or a cast will be used to reinforce and stabilise the fracture until it is well healed. Patients will initially have to rest and avoid weight bearing and will be required to use crutches whilst recovering. The doctor will most likely prescribe anti-inflammatory medication to reduce any swelling and painkillers for pain relief. A metatarsal fracture can take anything from 8 -12 weeks to heal, if not longer for more severe breaks. Patients will be referred through to a physiotherapist who will provide exercises to strengthen the ankle and foot muscles and ligaments to aid the healing process. It is vital that during the healing process the patient moves around as much as possible to reduce the risk of a DVT. Fluctuating pain levels will be experienced throughout the healing process, however most of the discomfort towards the end of the healing process comes from stiffness levels caused by long term immobility. The rehabilitation exercises as well as massage and some manipulative therapies such as osteopathy or chiropractic can aid in recovering your ankle and knee flexibility once the fracture site has healed.