Metatarsal Fractures and Metatarsal Stress Fractures

The metatarsals are the long cylindrical bones of the foot located between the bones of the toes (phalanges) and those of the hind foot (tarsus). There are five metatarsal bones corresponding to each toe. The metatarsals, along with other bones of the foot, support the weight of the body and provide the necessary propulsion during walking.

The metatarsals are the most commonly fractured foot bones, especially in sportspersons and dancers. A fracture can either be traumatic or stress related.

Traumatic fractures:

Traumatic fractures result from direct injury to the bone, such as:

A heavy load falling on the foot

Someone stepping on it or kicking the foot (as occurs with soccer players)

Twisting the foot or ankle (common in ballet dancers)

Symptoms:

The first, second and fifth metatarsal bones are mostly involved. Pain is sharp and instant. Sometimes, one can even hear the cracking sound of the bone. Swelling and bruising occur within 24 hours.

The broken ends of the fractured bone may remain in place or get dislocated (usually with severe impact), in which case the outer shape of the foot is deformed. The area becomes tender and unable to bear any pressure.

Treatment:

Treatment is mainly aimed at relieving pain and supporting the damaged bone.

Initially, ice application and elevating the injured foot helps to control pain and swelling.

If the fractured ends are in place or just slightly displaced sideways, just A supportive dressing is enough, along with the use of crutches to keep the weight off the injured foot.

For severe pain, a short cast may be applied for 2-3 weeks to completely immobilize the fractured bone.

For greatly displaced fractures, surgery may be required to re-align the fractured ends.

Anti-inflammatory drugs help relieve pain and swelling.

Stress Fractures:

The metatarsals are the second most common location after the tibia (the lower leg bone), for stress fractures. Stress fractures appear gradually. These start as micro-fractures resulting from excessive workout or stress put on the bones (usually due to a sudden increase in activity). Mostly, the second and third metatarsals are affected, as these bones have to bear maximum stress during walking and running.

These fractures are quite common in military recruits and are also called march fractures (extensive marching being the causative factor).

Athletes, runners, ballet dancers, postmenopausal women, people suffering from osteoporosis (reduced bone density) are all at risk of developing these fractures. However, a biomechanical imbalance such as over-pronation or oversupination may also contribute to the development of metatarsal stress fractures.

Symptoms:

There is diffuse pain on activity, which usually subsides with rest initially. With time, pain becomes localized to the area and persists, even at rest. The fractured metatarsal becomes tender and there may be swelling, however, bruising is uncommon. If the condition is left untreated and no recovery time allowed to the stressed bone, it may result in a complete fracture.

Treatment:

Rest is the best treatment for stress fractures.

Apply ice and elevate the foot to help control pain and swelling in the initial stages.

Give the bone sufficient time to heal, meanwhile keeping weight off it and supporting the damaged bone using crutches.

For severe pain, a cast may be applied; surgery is rarely required.

Metatarsal fractures require approximately six to eight weeks to heal completely. Previous activity levels should only be resumed gradually.