Summary
Metatarsal shaft fractures are associated with pain and swelling in the forefoot. They typically occur from having a heavy object dropped on the foot, or direct loading and twisting on the foot, such as might occur in an automobile accident. Most metatarsal shaft fractures can be treated non-surgically, with limited weight bearing in a stiff-soled shoe or boot for 6 to 8 weeks, provided that the bones are in an acceptable position. Some displaced fractures will benefit from surgery to reposition and stabilize the bones.
Clinical Presentation
Metatarsals are the main bones of the forefoot. A break (fracture) in one or more of the metatarsals is associated with fair bit of swelling and pain in this area. Usually the soft tissue overlying the bones remains intact, but in some instances, the bones will break through the skin creating an open injury which is a surgical emergency. Common mechanisms for having a metatarsal shaft fracture(s), include, falling from a high height and landing on your feet, jamming your foot into the break pedals in the course of a motor vehicle collision, loading the foot and twisting it in the course of changing directions during a sporting event and perhaps, most commonly, dropping a heavy object on the forefoot.
Physical Exam
In the case of an isolated metatarsal shaft fracture there will be tenderness and swelling localized to the injured area. In the case of multiple fractures, the painful, swollen area will be larger and correlate to the involved bones. There may be some numbness in the toes. It will be important to assess the blood supply to the toes; at times this can be affected.
It is important to assess the position of the metatarsal heads. These are the end of the metatarsals that represent the “ball of the foot”. This is the area that we walk on and it is possible to have a prominent metatarsal head result from a displaced metatarsal fracture.
Imaging Studies
Plain x-rays of the foot will usually identify the fracture. The location of fracture, as well as, the fracture pattern, and the associated angulations are all things that the treating physician will consider.
Treatment
Most metatarsal fractures can be treated non-surgically. If the fractured metatarsals are in an acceptable position, these fractures can be treated without surgery. Occasionally, a manipulation of the bones to reposition them is necessary. Occasionally, an open reduction internal fixation is required.
Treatment involves protecting the area until the bones have healed. It typically takes 6-8 weeks for the bones to knit together enough for full weight bearing. Prior to this, limited weight bearing through the heel in a very stiff soled walker boot or shoe, may be possible. It’s often 4 to 6 months before a full recovery is obtained.
Surgery may be indicated in the case of a significantly displaced metatarsal shaft fracture or multiple metatarsal shaft fractures that are displaced. There is some suggestion that for a displaced metatarsal shaft fracture, surgical stabilization can produce a slightly faster recovery time, albeit with the associated risks of surgery.
Revised 10.12.2011
