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Forefoot Surgery SURGERY

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The metatarsal bone is the long bone that connects the toes to the midfoot bones.

Acute metatarsal fractures can occur from injuries such as tripping, falling from a height, and motor vehicle accidents. Metatarsal stress fractures occur from repetitive stress on the metatarsal bone from activities such as running and dancing. If the metatarsal fracture is displaced, you will need surgery.

In this article, we’ll discuss what to expect when undergoing metatarsal fracture surgery. 

metatarsal fracture

Metatarsal Fracture Surgery- What to Expect From the Procedure

If you have a metatarsal fracture you will need to have it repaired in the operating room under sedation or general anesthesia. The surgery will take one to two hours to complete. 

Your doctor will make an incision over the fracture site. If there is more than one metatarsal that is broken another incision may be needed to access the fracture site. 

Your doctor will realign the broken bones and fixate them using plates and screws. This is called Open Reduction Internal Fixation (ORIF). Sutures (thread) will be used to close the skin. 

A cast or cast boot will be then applied on the leg. 

Metatarsal fracture repairs can be done in the outpatient setting. This means that you can go home the same day after the surgery. 

Metatarsal Fracture Surgery Recovery- What to Expect

As soon as you get home, you will need to ice and elevate the foot to reduce pain and swelling. Your doctor will prescribe pain medications to keep your pain under control. 

You will need to stay non-weight-bearing in a cast boot for 6 to 8 weeks after the surgery. This is because bone healing takes 6-8 weeks. Premature weight bearing after a metatarsal fracture surgery can cause the fracture to shift and not heal properly.  

To help you stay off of your feet, you can use a knee scooter or crutches. Make sure to keep your cast boot dry while in the shower by using a cast protector. You can buy all these products on Amazon. 

You will need to follow up with your doctor every 3 weeks after surgery. This is so that your doctor can get x-rays of your foot to ensure that the bone is healing. Sutures will be removed 2-3 weeks after surgery. 

After 6-8 weeks, (if the metatarsal fracture is healed) you can gradually transition into athletic shoes. Keep in mind that your muscles may feel weak from being off of your foot for several weeks. You may need physical therapy to help you regain strength and balance.

If your doctor thinks you need physical therapy, they will recommend you go to therapy three times a week for one month.

Metatarsal Fracture Surgery Complications

Although metatarsal fracture surgery is a safe and effective procedure, there is a chance that complications can occur. 

Some complications of metatarsal fracture surgery include: 

  • Infection: Infections can happen after foot surgery. Symptoms of infection include pain, redness, swelling, and warmth at the incision site. If you have an infection, notify your doctor immediately. You will need oral antibiotics. If the infection is severe, you may need IV antibiotics. 
  • Nonunion: If the fracture site doesn’t heal properly after a few months, it is known as a “nonunion”. Nonunions can occur due to inadequate fixation of bones, poor blood supply, and infections. Smoking and diabetes can increase your risks of developing a nonunion. Nonunions can be painful. To treat a nonunion, your doctor may recommend a bone stimulator. A bone stimulator is a device that can help the fracture heal. In some cases, surgical repair using a bone graft may be needed to repair a nonunion. 
  • Nerve damage: Partial or complete nerve damage may occur after surgery. You may experience burning and tingling pain after surgery or complete numbness in a portion of the foot. 
  • Allergic reactions to sutures or hardware: Allergic reactions to hardware and suture can occur after surgery. Symptoms include local redness, swelling, and pain. However, you may experience severe reactions like hives, a rash, or chest pain. If this occurs, contact your doctor immediately or go to the Emergency Room. 
  • Pain and swelling: After foot surgery, you will experience some pain and swelling in the foot. However, some people may notice more swelling and pain, especially if there were multiple breaks in the foot that needed to be repaired. Your doctor will help you stay comfortable by prescribing pain medications. Elevating the foot on two pillows can help reduce swelling. 

How Long After a Metatarsal Fracture Surgery Can I Drive?

If the right foot was operated on, you should wait 6-8 weeks before driving. Your fracture will need to be healed before you can comfortably and safely drive. If your left foot was operated on, it’s best to start driving 2-3 weeks after surgery. You shouldn’t drive while taking narcotic pain medications. You should also focus on reducing swelling by keeping your foot elevated for the first couple of weeks after surgery. 

Do Screws in Your Foot Hurt?

The screws that are used to fix the metatarsal fracture will be in the bone, and thus you will not feel pain. If you do feel the screws (due to loosening or breakage) your doctor may suggest removing the screws. 

How Do I Transition From Walking Boots to Shoes?

Increase the amount of time you wear your shoe slowly. Wear it for an hour the first, day, two hours the second day, and so on. Do this until you can wear your shoe all day. 

After foot surgery, due to swelling, your shoe may feel tight. Make sure to wear compression stockings (strength 15-20mmHg) to help reduce swelling in the foot. Wear the stockings during the day and remove them at night. I prefer the Jobst 15-20mmHg compression stockings from Amazon.

Your doctor may also recommend you wear custom orthotics to help redistribute pressure away from the fracture site.  

How Long Will I Be Off Work After Metatarsal Fracture Surgery?

If your job requires you to stand or walk, you will need to stay off work for 6-8 weeks after the surgery. Once the fracture is healed, your doctor may allow you to return to work. If you have a sit-down job, you can return to work as early as 2 weeks after the surgery. 

What Happens if a Metatarsal Fracture Is Not Treated?

If a metatarsal fracture is not treated, the bone may not heal properly and could lead to long-term pain and disability. If the fracture is displaced, it may cause the adjacent toe to become deformed and make it difficult to walk. Untreated fractures can also lead to arthritis in the joint and an increased risk of future fractures in the same area.

man smoking cigarette

What Slows Down Bone Healing?

Certain factors like smoking, a history of diabetes, older age, and obesity can slow down bone healing. Other factors like peripheral vascular disease can also slow bone healing. 

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

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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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