Introduction:
Five metatarsal bones in each foot connect the toes to the ankles. These bones help in keeping balance. A common type of fracture affecting the foot bones is called a metatarsal fracture. These fractures can occur if a person twists or suddenly changes the direction of their ankles or can also be caused by constant stress on the bones.
What Are Metatarsal Fractures?
Metatarsal fractures are complete or incomplete fractures of the bones that connect the toes to the ankle bone.
The important features of Metatarsal fractures include:
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Metatarsal fractures are widespread and can affect individuals of all ages.
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Causes of these fractures include crushing forces to the foot and twisting forces.
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Constant stress on the metatarsal bones can lead to fractures.
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Each foot consists of five metatarsal bones.
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The fifth metatarsal bone, linking the little toe to the ankle, is commonly affected. This bone causes more than 50 percent of cases with metatarsal fractures.
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The metatarsal region has a low blood supply, contributing to slower healing processes.
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The fracture of the first metatarsal bone is not very common but is seen commonly among kids. Only 5 percent of the metatarsal fractures are first metatarsal bone fractures.
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Third and fourth metatarsal bone fractures are rarely seen alone.
What Is a Non-displaced Fracture in Metatarsal Fracture?
A non-displaced fracture in metatarsal fractures means the bone is broken, but the pieces remain in their normal alignment. It is considered less severe than displaced fractures, as the bone stays relatively stable. Treatment typically involves rest, immobilization, and, in some cases, limited weight-bearing.
What Causes Metatarsal Fractures and Who Is More Commonly Affected by Them?
Metatarsal fractures are commonly associated with other leg injuries, such as Lisfranc fractures (fractures at the foot's arch that connects the forefoot and hindfoot area). This fracture can affect people of any age and sex. However, no country or region is specifically affected more by this fracture.
Significant causes of metatarsal fractures are:
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Direct crushing injury, caused to the foot when some heavy object crashes against the foot at high speed.
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A sudden twist in the ankle can occur during sports.
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A job or sports activity that requires putting a foot under constant stress can eventually lead to a fracture.
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Ballet.
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Runners.
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High-impact aerobics.
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High-intensity workouts that involve too much jumping.
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Falling from a great height and balancing weight on foot.
What Are the Symptoms of Metatarsal Fracture?
Some of the common signs and symptoms associated with metatarsal injuries are as follows:
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Painful Swelling of the Foot: The patient experiences significant pain accompanied by noticeable swelling in the affected foot area, indicating potential metatarsal injury.
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Inability to Stand or Bear Weight on Foot: The patient encounters difficulty in standing or bearing weight on the injured foot due to pain and potential instability associated with metatarsal injuries.
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Other Trauma-Related Symptoms: Observe additional symptoms such as gross deformities or bleeding in cases where the metatarsal injury is part of broader trauma to the foot.
What Are the Indications for Referral in Patients With Metatarsal Fractures?
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Open Fractures: Immediate specialized care is needed when the skin is broken in a metatarsal fracture.
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Severe Displacement: Referral to an orthopedic specialist is necessary if the fracture causes significant misalignment of the bones for proper realignment.
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Multiple Fractures: A specialist's evaluation is essential for comprehensive treatment planning, especially when multiple metatarsals are fractured in complex patterns.
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Associated Injuries: The presence of injuries to nearby structures such as tendons, ligaments, or joints may necessitate referral for a more thorough assessment and management.
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Complicated Fractures: Fractures involving joints or complications like nerve or blood vessel damage may require specialized care.
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Non-healing Fractures: Referral may be needed if the fracture fails to heal with conservative measures for further intervention, such as surgical options.
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High-Energy Injuries: Specialized care may be required for fractures resulting from high-energy trauma, like motor vehicle accidents, due to the potential for extensive damage.
How to Diagnose a Metatarsal Fracture?
Metatarsal fractures can be diagnosed by,
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Physical Examination After Injury: A thorough physical examination of the foot is conducted following an injury to assess for signs of a metatarsal fracture.
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X-Rays: Utilize X-rays with oblique, anteroposterior, and lateral views to obtain detailed images and identify potential fractures in the metatarsal bones.
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CT Scans (Computed Tomography): Consider performing CT scans for a more comprehensive and detailed assessment of the metatarsal fractures, providing three-dimensional imaging to aid in accurate diagnosis.
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MRI (Magnetic Resonance Imaging): Employ MRI scans to further evaluate metatarsal fractures, especially when additional information on soft tissues and detailed visualization is required for a comprehensive diagnosis.
What Is Jones Fracture?
A Jones fracture is a particular type of metatarsal break at the base of the fifth metatarsal bone in the foot. Treatment typically involves avoiding putting weight on it, which means resting and using a cast or walking boot. Initial care may include rest, elevation, and immobilization with a cast or boot. In cases where there's a risk of non-healing, especially with significant displacement or delayed recovery, surgery may be needed using methods like internal fixation with screws.
What Could Be the Other Possible Differential Diagnoses?
When a person experiences pain in the metatarsal region, there could be many possible conditions causing the pain, some of which are:
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Bone Tumors: Bone tumors rarely occur in the feet. However, some tumors, like giant cell tumors, osteochondroma (benign bone tumor involving excess bone and cartilage growth), and chondromyxoid fibroma(rare tumor with a lot of chondroid and myxoid tissue), can cause pain similar to metatarsal fractures.
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Benign Tumors: Benign tumors such as lipomas can lead to metatarsal pain.
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Synovial Sarcoma: It is a malignant tumor that could mimic metatarsal fractures.
What Are the First Aid Measures to Take After the Injury?
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Elevate the legs and rest without putting any weight on the injured foot.
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Place an ice pack on the injured foot by covering the ice bag with a cloth, as placing direct ice could harm the skin.
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Place an ice pack twice or thrice a day for the first 48 hours after the injury.
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Use painkillers like Ibuprofen to relieve pain.
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Please do not use these medicines for the first 24 hours after injury, as it may increase bleeding risks.
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Never take over-the-counter drugs to relieve pain without consulting a doctor.
How to Treat Metatarsal Fractures?
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Metatarsal fractures typically require approximately three to eight weeks for complete healing.
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Once the healing process is complete, engaging in mild exercises becomes beneficial to enhance foot mobility.
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Consider incorporating the following exercises into one’s routine to facilitate healing:
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Write a few alphabets or numbers with the foot in the air or on the floor, promoting controlled movement.
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Perform toe-pointing movements by flexing the foot up and down, and practice curling feet to improve flexibility.
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Seeking guidance from a physiotherapist is recommended to ensure that the exercises are tailored to specific recovery needs and to receive professional assistance in optimizing the healing process.
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For fractures in the second, third, and fourth metatarsal, non-weight-bearing measures such as rest and immobilization with a cast or walking boot are advised initially, accompanied by elevation and ice to reduce swelling. Follow-up visits are recommended to monitor healing progress, including possible imaging studies. As healing advances, a gradual reintroduction of movement and physical therapy is suggested.
Conclusion:
Metatarsal fractures are among the most common fractures that occur in the legs. These fractures are not life-threatening but can cause severe pain and discomfort. Severe fractures can lead to lifelong problems related to reduced mobility and flexibility. Therefore, proper care and precautions must be taken while performing any sports activity. In addition, any injury leading to swelling and excruciating pain should be brought to the doctor’s attention.
