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When you break your metatarsal bone, it can be incredibly painful and limit your activities significantly. Injury to the metatarsal bones can occur suddenly due to trauma, or it can occur over time like in the case of a stress fracture.
Treatment for broken metatarsals will vary depending on the bones involved, the type of fracture, as well as many other factors.
In this article we’ll discuss metatarsal foot fractures in detail as well as management of these fractures.
What Are Metatarsal Bones?
The metatarsals are the long bones that connect the midfoot to the toes. There are 5 metatarsal bones in your foot. The metatarsals can vary in length. In most cases, the first metatarsal is the shortest and widest in length (1).
The second metatarsal is slightly longer, followed by the third, fourth, and fifth metatarsals. The metatarsals are insertion points for some of the muscles in the foot. The metatarsal bones help with shock absorption and also provide support when you are walking.
What Causes a Broken Metatarsal?
Acute metatarsal fractures can occur from twisting, falling, and crush injuries. With these injuries, you may have one or more broken metatarsals.
Closed metatarsal fractures is when the metatarsal is broken but the skin is not broken.
Open metatarsal fractures is when both the skin and metatarsal is broken. This is more often seen in crush injuries and falls. Both fractures will need to be treated differently.
Metatarsal fractures can also occur due to repetitive stress on the metatarsal bones. This is called a “metatarsal stress fracture”. These metatarsal stress fractures can occur due to excessive forces on the metatarsal bone. Stress fractures are commonly seen in athletes, dancers, and even runners.
How Do You Know if You Have a Broken Metatarsal in Your Foot?
Acute metatarsal fractures
- Immediate pain to one or more metatarsal bones
- You hear a “crack” or “pop” noise during injury
- Bruising and swelling at the site of injury
- Difficulty bearing weight on the foot due to pain
- Difficulty wiggling your toes
- Pain is exacerbated with activity and doesn’t improve with rest
Metatarsal stress fractures
- A dully, achy pain in the metatarsal bones that increases in severity
- Pain in the foot that has not improved
- Bruising and swelling in the foot
- Difficulty bearing weight on the foot due to pain
- Pain is exacerbated with activity and doesn’t improve with rest
How Do You Treat a Broken Metatarsal?
Treating a metatarsal fracture will depend on:
- The metatarsal or metatarsal(s) that are involved
- The location of the fracture
- Whether the metatarsal fracture is non-displaced or displaced (shifted)
- The age of the patient and their medical history
- Whether the patient is an athlete/active
- Whether the metatarsal fracture is open or closed
Closed Metatarsal Fractures
If you sustain a closed metatarsal fracture, you should start RICE therapy and visit a Podiatrist (foot doctor). Your doctor will do a physical exam and order an x-ray. Your doctor will be looking to see if the fractured bone is in good alignment. When your bones break, there is a gap. Your doctor will measure the gap to see how far apart the bones are.
Depending on the type of injury, the fracture pattern can vary. Some fractures are transverse, some are vertical, some are spiral, and some are comminuted (consisting of multiple fragments). Your doctor will check for angulation and rotation of the fracture fragments.
In general, fractures that are 3mm or 4mm displaced or more, with more than 10 degrees of angulation, should be fixed surgically (2).
In most cases, non-displaced fractures can be immobilized in a cast boot or walking boot.
I recommend the short walking boot from Amazon. It has a rigid foot bed that will keep your foot immobilized and allow equal distribution of forces. It is less cumbersome than the tall cast boot.
Fifth Metatarsal Fractures
Most metatarsal fractures in the feet occur in the fifth metatarsal (3). The fifth metatarsal is the metatarsal bone on the outside of your foot. The peroneus brevis tendon as well as the plantar fascia ligament inserts at the fifth metatarsal base.
Fifth metatarsal fractures can occur at the tuberosity, the base, the shaft, the neck, or the head of the metatarsal.
As long as the 5th metatarsal head, neck, shaft and tuberosity fractures are not displaced, they can be treated with immobilization.
However, if you sustain a fracture at the fifth metatarsal base, this is known as a “Jones fracture”. Jones fractures can be difficult to heal due to poor blood supply at the fifth metatarsal base. Due to this, fracture healing can be delayed.
To read more about Jones fractures in detail, check out this supplemental post.
In this case, your doctor may opt to surgically repair your fracture to expedite the healing process. This is especially true if you are an athlete.
Stress Fractures
Stress fractures often start as hairline cracks in the metatarsal bones due to repetitive pressure. Stress fractures can often take 3 weeks to show up on x-ray. Your doctor will order a series of x-rays to determine whether a stress fracture is present.
Just like with acute metatarsal fractures, stress fractures that are 3mm or 4mm displaced or more, with more than 10 degrees of angulation, should be fixed surgically.
Most stress fractures however, can be managed conservatively with immobilization.
To read more about stress fractures in the foot, check out this supplemental post.
Open Metatarsal Fractures
If you sustain a crush injury and develop an open metatarsal fracture, you should go to the Emergency room to be evaluated. This is because crush injuries can damage the bones, skin, blood vessels and nerves in the foot. You will need antibiotics.
Your surgeon will clean your open fracture site to prevent further bacterial contamination. Your doctor will stabilize your fractures by using pins or an external fixator. You will need to stay non-weight bearing in a cast or splint for up to 6-8 weeks.
What Does Surgery for Broken Metatarsals Involve?
Surgery can usually be done in the outpatient surgery center or the hospital under anesthesia. Your foot doctor will reduce the fractures and fixate them in the correct position using plates/screws or Kirschner wires. Kirschner wires are pins that help stabilize fracture fragments.
You can expect to go home the same day after surgery. Your doctor will likely perform a nerve block on your foot when you are sleeping to help minimize pain post-operatively. Your doctor will also prescribe pain medications to help manage pain after surgery.
You will need to stay off of your foot for 6-8 weeks after surgery. You will need to elevate the foot using pillows and ice the foot intermittently.
How Long Does a Metatarsal Fracture Take To Heal?
In general, metatarsal fractures can take 6-8 weeks to heal. If you have a Jones fracture, it may take longer to heal. If the fracture fragments are non-displaced, they will more easily than displaced fracture fragments.
Depending on the severity of the metatarsal fractures, recovery can take up to 3 months.
Can You Walk on a Broken Metatarsal?
If the metatarsal fracture is non-displaced, you can walk in a short cast boot for the first 4-6 weeks if you can tolerate it. If the fracture is too painful, stay non-weight bearing in the cast boot until you are ready to bear some weight on the foot.
If the metatarsal fractures are displaced or if you have a Jones fracture, you should stay off your foot for 4-6 weeks minimum, followed by gradual weight bearing.
You will need x-rays taken every month to assess healing of the broken bones. Walking on a displaced fracture can make the fracture shift further and can lead to worse outcomes. It’s best to keep the boot on at night. This avoids the risk of accidentally bumping your foot when you are sleeping.
While wearing the cast boot, you should use crutches to help you stay off your foot. If you are over 300lbs, you may have difficulty using crutches and may want to consider obtaining a knee scooter. You can obtain one from Amazon.
You can also check with a medical equipment store near you on whether your insurance will cover the knee scooter. Sometimes it can be cheaper to rent the knee scooter per month instead of buying it. Renting a knee scooter for one month costs around $75-$100 in most places.
When Do You Stop Wearing a Walking Boot?
You can stop wearing a walking boot and slowly transition into athletic shoes after about 6-8 weeks, unless healing is delayed. Your doctor will order x-rays every 3-4 weeks to examine the fracture site to make sure it is healing appropriately.
If you undergo surgery for a metatarsal fracture, it may take longer, around 8-10 weeks before you can return to regular shoes. This is due to swelling associated with surgery.
Transition into athletic shoes slowly, by wearing the shoe for 1-2 hours a day and then returning to the cast boot. The next day try wearing the shoes for 2-3 hours a day, and then returning to the cast boot. Gradually increase the amount of time you wear your athletic shoes.
I would recommend wearing compression stockings to reduce swelling. I recommend the Jobst 15-20mmHg compression stockings. These stockings are very effective and should be worn daily. Wear the stockings during the day, and remove them at night when your legs are elevated.
How Long Does It Take for Metatarsal Pain to Go Away?
Pain associated with a broken metatarsal can linger until the metatarsal fracture is healed. In some cases, if there is malalignment of the fracture fragments, you may experience continued pain in the ball of your foot due to improper healing. Metatarsal fractures that extend into the joint can also cause pain due to traumatic arthritis.
When Can I Drive After a Broken Metatarsal?
You can start driving after your broken metatarsal has healed. This can take 6 to 8 weeks with non-displaced fractures. If your metatarsal fracture is displaced and you undergo surgery on your foot, driving may need to be delayed for up to 8-12 weeks.
What Happens if a Fracture Is Left Untreated?
Many people go without treating metatarsal fractures. The problem is that if the fracture fragment is very displaced and angulated, it can heal in a misaligned position, causing painful bony prominences in your foot.
This can cause painful transfer calluses to form in your foot. This can affect walking and can cause significant pain. You may also have difficulty fitting your foot into your shoes. If the metatarsal fracture extends into the joint, you may experience chronic joint pain.
Who Is Prone to Getting Metatarsal Fractures?
Elevated BMI, female gender, and history of osteoporosis are risk factors that can result in increased rate of metatarsal fractures. When your bone quality is weak, you are at a higher risk for developing stress fractures. This can be seen more often in females during menopause. Obesity can also make you more prone to developing fractures.
Vitamin D and calcium supplements can help strengthen the bone and help prevent metatarsal fractures. A large study was done on female navy recruits that showed that Calcium 2000mg and Vitamin D 800IU daily resulted in 20% lower incidence of stress fractures compared to the placebo group (4).
Conclusion
As you can see, treatment for metatarsal fractures can vary. It’s important to consider all of the different factors when treating metatarsal fractures to optimize good outcomes. It’s best to see your foot doctor for evaluation if you feel that you may have a metatarsal fracture.
Have you ever broken your metatarsal? How long did it take to heal? I would love to hear your thoughts! Leave a comment below.
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References
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