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Forefoot Injuries INJURIES

Metatarsal Fracture: Causes, Symptoms, & Treatment of Metatarsal Fractures

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Sustaining a metatarsal fracture can be painful and stop an individual’s ability to engage in everyday activities. These fractures can occur suddenly as a result of an acute trauma, or develop progressively over time, as is the case with stress fractures.

The appropriate treatment for metatarsal fractures is dependent on a variety of factors, including which bones are affected and the type of fracture.

In this article, you’ll learn the causes, symptoms, diagnosis and treatment of metatarsal fractures and what you can expect during the recovery process. 

broken metatarsal

What Is a Metatarsal Fracture?

A metatarsal fracture refers to a break in any of the five metatarsal bones which connect the midfoot to the toes. These fractures can either be acute, occurring from sudden injuries such as falls or twists, or stress fractures, resulting from repeated pressure on the foot over time.

Each foot contains five metatarsal bones which vary in length, with the first typically being the shortest and widest, and the remaining bones, second, third, fourth, and fifth, increasing in length. 

These bones not only assist in shock absorption and foot support during movement, but they also serve as attachment points for certain foot muscles.

The causes of metatarsal fractures are diverse, ranging from sudden, acute incidents such as twists, falls, and crushing injuries, to the more gradual onset of stress fractures resulting from ongoing force exerted on the metatarsals. 

Most metatarsal fractures in the feet occur in the fifth metatarsal. The fifth metatarsal is the metatarsal bone on the outside of the foot. 

What Is a Metatarsal Stress Fracture?

A metatarsal stress fracture is a type of injury that happens when one or more of the metatarsal bones in the foot develops a small crack due to repeated stress or force. This type of fracture is a result of overuse rather than a single traumatic incident.

Certain individuals are at a higher risk for metatarsal stress fractures. Athletes, particularly those involved in sports like running, soccer, or basketball that involve a lot of foot impact, are commonly affected. 

Dancers, especially ballet dancers, are also at high risk due to the extreme stress that dance moves can put on the feet.

Individuals with low bone density, poor nutrition, or hormonal imbalances may also be more susceptible to stress fractures.

Improper footwear, poor training techniques, or sudden changes in a workout regimen can increase the risk of these injuries.

Symptoms

When it comes to identifying metatarsal stress fractures, being aware of key symptoms is vital for a proper diagnosis. 

Listed below are symptoms that individuals may experience with a metatarsal foot fracture. 

  • Immediate pain in one or more metatarsal bones.
  • Hearing a “crack” or “pop” noise at the time of injury 
  • Bruising and swelling at the site of injury.
  • Difficulty bearing weight on the affected fractured foot
  • Challenges with wiggling the toes.
  • Pain that worsens with activity and doesn’t improve with rest.
  • A dull, achy pain in the metatarsal bones that increases in severity.
fifth metatarsal fracture

Diagnosis

In diagnosing metatarsal fractures, a foot and ankle surgeon will conduct a thorough physical examination followed by an x-ray. They will assess whether the broken bone remains in proper alignment. 

It’s common for a gap to form when a bone breaks, and the doctor will gauge how far apart the bone fragments are. The doctor will inspect for any deviation and rotation in the fractured fragments.

Stress fractures, typically begin as barely noticeable cracks. These types of fractures can take a few weeks to become apparent on an x-ray. Therefore, the doctor may order a series of x-rays over time to confirm if a metatarsal stress fracture exists. 

The treatment for metatarsal fractures depends on the severity of injury. 

Treatment

When treating metatarsal fractures in the foot, several factors come into play. The specific metatarsal affected, the location of the fracture, the patient’s age and medical history, and the severity of the fracture.

Non-Surgical Treatment

In the case of non-surgical treatment, most fractures that have not shifted from their original position can be managed with immobilization. This typically involves the use of a cast boot or walking boot, which helps keep the foot stable while allowing for an equal distribution of forces across the foot.

A shorter walking boot might be recommended for its rigidity and relative ease of use compared to larger, bulkier alternatives.

While under this non-surgical treatment, patients may be instructed to avoid bearing weight on the affected foot for up to six to eight weeks, using a cast or splint for support during this period.

surgery foot

Surgical Treatment

If surgery is needed, it’s typically performed in an outpatient surgery center or hospital under anesthesia. 

Proximal fifth metatarsal fractures, called “Jones Fractures”,  which occur in a specific area of the fifth metatarsal of the foot, are often treated surgically due to the unique challenges posed by the blood supply to this region. 

The foot surgeon will realign the fracture and secure them in the correct position using surgical hardware like plates or screws.

Most patients are able to go home the same day after the operation. To manage post-operative pain, the doctor may administer a nerve block while the patient is asleep and prescribe pain medications for use after the surgery.

After the surgery, patients are usually instructed to avoid putting weight on the affected foot for six to eight weeks.

 During this recovery period, it’s recommended to keep the foot elevated using pillows and apply ice intermittently to manage swelling and discomfort. 

The combination of rest, elevation, and occasional cold therapy will significantly aid the healing process.

woman with fractured foot wearing boot

How Long Does a Metatarsal Break Take To Heal?

The healing time for a metatarsal fracture is approximately 6 to 8 weeks. However, some specific types of fractures, like a Jones fracture, may require a longer healing period. Depending on the severity and complexity of the fracture, the overall recovery period can extend up to 3 months. 

Can You Walk on a Broken Metatarsal?

The ability to walk with a broken metatarsal depends greatly on the specifics of the fracture. If the bone pieces haven’t shifted, one might be able to walk using a short cast boot for the initial 4 to 6 weeks, provided it doesn’t cause discomfort. 

However, if the pain is intense, it’s advisable to avoid weight-bearing activities until the foot can bear some weight without pain.

In cases where the bone pieces are shifted, or if a person has a Jones fracture, it’s typically recommended to avoid putting weight on the foot for a minimum of 6-8 weeks. This period should be followed by a gradual return to weight-bearing activities. 

Regular x-rays, often taken monthly, are required to monitor the healing progress of the broken bones. 

Walking prematurely on a fracture will cause further shifting of the bone, leading to more complicated recovery, so it’s safer to err on the side of caution.

When Do You Stop Wearing a Walking Boot?

The transition out of a walking boot and into regular athletic shoes typically begins around 6 to 8 weeks following a metatarsal fracture, provided the healing process is proceeding as expected. 

Regular x-rays, usually taken every 3 to 4 weeks, help the doctor monitor the fracture’s healing process.

However, if surgery has been performed, this transition might take a bit longer, potentially 8 to 10 weeks, due to the swelling associated with surgical procedures. 

The return to athletic shoes should be gradual, starting with wearing them for just 1-2 hours a day before switching back to the boot. Each subsequent day, the duration in regular shoes should be increased slowly, always returning to the boot afterward.

Using compression stockings, such as the Jobst 15-20mmHg compression stockings, can help manage swelling during this transition. 

They should be worn during the day and removed at night when the legs are elevated for rest.

Best Walking Boot for a Metatarsal Fracture

Regarding the best walking boot for metatarsal fractures, it largely depends on the specific needs and comfort of the patient. However, a boot like the United Ortho walking cast boot that provides good support and distributes weight evenly across the foot would typically be beneficial. 

Some boots also come with shock-absorbing soles to further reduce impact on the fractured area, promoting a more comfortable and supportive healing process.

How Long Does It Take for Metatarsal Pain to Go Away?

The duration of discomfort resulting from a metatarsal fracture typically extends until the healing process is complete, usually around 8 weeks. However, there are exceptions. When the fracture fragments are misaligned, the pain might continue due to improper healing. Additionally, if the fracture reaches into the joint, it may result in persistent pain caused by traumatic arthritis.

When Can You Drive After a Fifth Metatarsal Break?

Resuming driving after a fifth metatarsal fracture is contingent on the completion of the healing process. On average, this typically spans a period of around 8 to 12 weeks, ensuring that the foot has sufficiently healed and can handle the pressure required for driving.

What Happens if an Injury Is Left Untreated?

If a metatarsal fracture is left untreated, the repercussions can be severe. If a metatarsal fracture is neglected, it can escalate into serious medical complications. 

This is especially the case if the injury results in displaced bone fragments. Improper healing may cause bony protrusions, leading to substantial discomfort. This medical mismanagement could contribute to the formation of painful calluses, a common issue with foot and ankle health. This can hinder walking and cause persistent pain. 

It may even alter the foot’s shape, making it challenging to wear shoes. In Jones fractures where the fracture extends into a joint, the health outcome could be detrimental, potentially leading to long-term joint pain. 

Thus, immediate and appropriate medical management of metatarsal fractures is important.

Who Is Prone to Getting Metatarsal Fractures?

Certain individuals are more susceptible to metatarsal fractures. Key risk factors include a high BMI, being female, and a history of osteoporosis, all of which can increase the likelihood of such fractures. 

A reduction in bone quality can escalate the risk of developing metatarsal stress fractures, a condition often seen in post-menopausal women. Obesity is another contributing factor that can make an individual more prone to fractures.

Incorporating Vitamin D and calcium supplements into the daily diet can improve bone strength and aid in the prevention of metatarsal fractures. 

Evidence supporting this comes from a large-scale study by J.Lappe in the Journal of Bone and Mineral research conducted on female navy recruits. 

The study found that daily intake of 2000mg Calcium and 800IU Vitamin D led to a 20% lower incidence of stress fractures as compared to those in the placebo group.

When Should You See a Doctor?

One should consider seeking medical attention from a provider in the Orthopaedics department in the circumstances listed below.

  • If there’s a suspicion of a metatarsal fracture due to symptoms like severe pain, swelling, difficulty in bearing weight on the foot, or an audible “crack” or “pop” sound at the time of injury.
  • If the pain in the foot persists or worsens over time, despite rest and over-the-counter pain relievers.
  • If there’s a noticeable change in foot shape or function, difficulty in walking, or wearing shoes.
  • If there’s a history of conditions that increase the risk of fractures, such as osteoporosis, high BMI, or a previous metatarsal fracture.
  • If the foot has been subjected to excessive strain due to high-impact sports or activities involving repetitive stress on the foot, particularly if discomfort or pain is felt.

It is always safer to consult a healthcare professional if there’s any doubt about a potential injury or condition to prevent further complications and ensure appropriate treatment.

Conclusion

In conclusion, managing metatarsal fractures, which are prevalent in various ankle conditions, requires meticulous attention and detailed fracture care. Understanding the cause, symptoms, and potential treatments of metatarsal fractures can help patients seek timely medical intervention. 

Whether the fracture is localized to the shaft of the metatarsal bone, known as shaft fractures, or involves a larger portion of the bone, following appropriate care instructions provided by healthcare professionals is vital to successful recovery. For adults and children, follow-up is crucial to ensure proper healing and prevention of any long-term consequences. 

 Fractures, especially those involving metatarsals, require an individual’s patience and adherence to the prescribed treatment plan to ensure optimal healing. Early detection and intervention greatly assist in managing complications, making the journey from fracture diagnosis to full recovery more seamless. 

Metatarsal fractures, like any injury, are medical conditions that demand proactive care and management for optimal patient outcomes.

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Vaishnavi Bawa
Dr. Vaishnavi Bawa is a Podiatrist who specializes in treating foot and ankle pathology. LifesLittleSteps mission is to educate the public about foot health in an easy-to-understand manner using evidence-based medicine.
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