A metatarsal fracture occurs when one of the long bones of the midfoot is cracked or broken. This may be due to sudden injury (an acute fracture), or due to repeated stress (stress fracture). Show
Where are the metatarsal bones?The metatarsal bones are some of the most commonly broken (fractured) bones in the foot. There are five metatarsal bones in each foot. They are the long slim bones which run the length of the foot to the base of the toes. For more information on foot anatomy, see the separate leaflet called Heel and Foot Pain (Plantar Fasciitis). Heel and foot bonesA metatarsal fracture is a break in one of the five long bones which form the middle part of your foot. 5th metatarsal fractureThe fifth metatarsal bone is the most common metatarsal bone to be fractured in sudden (acute) injury to the foot. It may be broken at various points along its length, depending on the mechanism of injury. The other metatarsal bones can also be broken. The first, second and fifth metatarsals are the most commonly injured in sport. Several well-known footballers have had metatarsal fractures in recent years. Are there different types of break?Breaks (fractures) can be acute, or caused immediately by injury. They can also occur over a longer period of time, when they are called stress fractures. An acute metatarsal fracture may be open or closed, and displaced or not displaced:
Acute metatarsal fracture is usually caused by a sudden forceful injury to the foot, such as dropping a heavy object on to the foot, a fall, kicking against a hard object when tripping, or from a sporting injury. A stress fracture is a hairline break in a bone, caused by repetitive stress. This is cracking which goes only partway through the bone. There may be a single split in the bone, or multiple small splits. The hairline break or breaks do not go through the full thickness of the bone, so stress fractures are not generally displaced. However, several small stress fractures can develop around the same area, over time. What causes metatarsal fractures?Acute metatarsal fractures
Stress fractures
Does osteoporosis cause metatarsal fractures?Metatarsal fractures (of both types) occur more easily if the metatarsal bones are weakened due to 'thinning' of the bones (osteoporosis). See the separate leaflet called Osteoporosis for more detail. Does ageing make metatarsal fractures more likely?Most metatarsal fractures occur in younger people, as they are more likely to be involved in the kinds of sports and marching activities that make them more likely. However, as we become older the 'springiness' and padding of our feet tend to reduce. This means that our feet absorb impact less well and it is easier to fracture bones. Supportive footwear will make this much less likely. See the separate leaflet called Ageing Feet for more detail. What are the symptoms of a metatarsal fracture?Acute metatarsal fracture
People sometimes say that it isn't possible to walk on a broken foot but this is not correct. Whether you can walk on a broken foot depends on which bone is broken (and whereabouts along its length), whether the fracture is displaced, how supportive your shoes are, and your personal tolerance to pain. It is, therefore, possible to walk on a broken foot, although it is likely to be very uncomfortable to do so and it may well make matters worse if you do. Stress fractures
People who have stress fractures may continue to walk for some time. Eventually this becomes increasingly painful, as the splits in the bone tend to worsen and the bone itself starts to react and become inflamed, and it can become impossible to weight bear. A metatarsal stress fracture can progress to become a full-thickness fracture. Will the pain increase?Metatarsal stress fractures can begin as very small injuries which do not cause severe pain. However, if you carry on stressing the bone, the crack will often deepen and widen, becoming gradually more painful. Eventually, in the worst case scenario, the stress fracture may progress to become a full fracture. If you have an acute fracture and you continue to stress the bone, the pain will increase further as the broken ends of bone will start to rub slightly against one another, and the area will become inflamed. In the worst case scenario the fracture may become displaced. Do I need any investigations?Your doctor is likely to suggest an X-ray of your foot if they suspect a metatarsal fracture. Acute metatarsal fractures
Stress fractures
Do I need to see a doctor if I suspect metatarsal fracture?You should seek medical advice if you suspect that you have a metatarsal fracture. A doctor is able to do tests, including imaging, which will suggest the best course of action - not only to make things better as quickly as possible, but also to prevent making things worse. How are metatarsal fractures treated?This depends on:
It also depends on:
The basic principles of treating metatarsal fractures are as follows. Simple painkillersPainkillers such as paracetamol and non-steroidal anti-inflammatory painkillers such as ibuprofen which may help to relieve pain. IceApplying ice to your foot can also be helpful as pain relief. Ice should be applied as soon as possible after injury, for 10-30 minutes. (Less than 10 minutes has little effect. More than 30 minutes may damage the skin.) Make an ice pack by wrapping ice cubes in a plastic bag or towel, or by using a bag of frozen peas. Do not put ice directly next to skin, as it may cause ice burn. Gently press the ice pack on to the injured part. The cold is thought to reduce blood flow to the damaged area. This may limit pain, inflammation and bruising. Some doctors recommend re-applying for 15 minutes every two hours (during daytime) for the first 48-72 hours. Do not leave ice on while asleep. See the separate leaflet called Heat and Ice Treatment for Pain for more details. Rest and elevateElevation initially aims to limit and reduce any swelling. For example, keep the foot up on a chair to at least hip level when you are sitting. When you are in bed, put your foot on a pillow. Sometimes rest is the only treatment that is needed, even in traumatic fracture. Stop stressing the footIf you've been diagnosed with a stress fracture, avoiding the activity that caused it is important for healing. This may mean using crutches or even a wheelchair. ImmobilisationSome fractures just need support to help healing. For example, a supportive elastic tubular bandage with a supportive, rigid shoe or boot. If needed, special shoes are available to help to immobilise the fracture and support the foot so that you are able to walk. Progressive weight bearing on the foot can then follow as pain allows. Other fractures may need treatment with a below-the-knee plaster cast. SurgeryVery occasionally, surgery may be necessary - for example, to re-align any part of the bone that has moved out of position. Surgery is not needed for stress fractures. Follow-up carePhysiotherapy and a gradual return to exercise are a part of good follow-up care. When can I return to activity after metatarsal fracture?
What if the pain gets again worse?If the pain gets worse then you should seek medical advice. The expected pattern of healing, in bony injuries of any kind, is that they should gradually hurt less as healing occurs, and that any gradual worsening of pain suggests that the injury is also getting worse, or that you have a fresh injury. If your foot pain is increasing over time then your activity may be making an existing problem worse. In the case of a stress fracture this may mean progression to an acute fracture. In the case of an acute fracture it may be worsening displacement of the bones and preventing the two ends of the bone from knitting together. Always return to your doctor or health professional for further advice if you have gradually worsening symptoms. What are the complications of metatarsal fractures?If properly treated then metatarsal fractures should heal without long-term consequences. If not recognised and treated then some of these problems can occur:
Can metatarsal stress fractures be prevented?There are a number of things that you can do to help prevent stress fractures:
If stress fractures are recognised and treated quickly, this can reduce the amount of time that you need to stay away from activities. Can my foot be broken and not swelling?Some people may not have serious pain and swelling after a fracture, but they may still require treatment. Your doctor can also determine if you have a sprain or other minor injury instead of a fracture.
Can you have a foot fracture without bruising or swelling?It is common knowledge among orthopaedic surgeons that there may be no external signs of bruising in association with a fracture, and this is one of the many reasons why so much emphasis is placed on marking the limb before surgery.
Can you have a fracture in your foot and not know it?Sometimes a broken bone is impossible to ignore, especially when it causes a significant deformity. However, broken bones in the foot can be hard to detect with the naked eye, especially when you have a stress fracture.
How do I know if my foot is slightly fractured?If you have a broken foot, you may experience some of the following signs and symptoms:. Immediate, throbbing pain.. Pain that increases with activity and decreases with rest.. Swelling.. Bruising.. Tenderness.. Deformity.. Difficulty in walking or bearing weight.. |