The five metatarsal bones are the long bones of the midfoot. A metatarsal fracture occurs when one of these long bones is fractured. This may be due to sudden, acute injury or fracture, or due to stress fracture. Stress fractures usually affect athletes, but can basically affect anyone.
In acute fractures you may hear a sound at the time of the break, and experience pain, swelling, bruising and difficulty putting weight on the affected foot. Stress fractures have similar symptoms, although there is usually no bruising. Treatment depends on the type and specific site of the fracture.
Anatomy of the foot
The foot is a complicated part of the body, made up of multiple bones, muscles, tendons and soft tissues. Your feet have to bear the weight of your body when you stand and move, and to make constant balancing adjustments to allow you not to fall over as you do so. There are 26 bones in your foot:
Fourteen toe bones (phalanges): three each for the small toes and two for the big toe.
Five long metatarsal bones, named from the first (connected to the big toe) to the fifth.
Seven tarsal bones which make up the back part of the foot (hindfoot) and heel (calcaneum).
Each metatarsal bone has a base (nearest to the heel), a shaft (the straight part of the bone), a neck and a head. The fifth metatarsal differs slightly as it also has a bulge (tuberosity) at its base. The bones, ligaments and tendons of your foot form arches, one lengthways and one across the foot. These arches are called the longitudinal and transverse arches of the foot. It is your foot arches that allow your foot to hold up the weight of your body. When the foot is healthy and the arches are as they should be, your wet footprint is not a footprint of the whole of the underside of your foot, as they hold a part of the foot off the ground.
What are the different types of metatarsal fracture
The metatarsal bones are some of the most commonly fractured bones in the foot. There are two main types of metatarsal fracture:
Acute fracture - due to a sudden (acute) injury to the foot (typically dropping a heavy object on to the foot, a fall, or a sporting injury).
Stress fracture - due to overuse or repetitive injury to a normal metatarsal bone.
Metatarsal fractures occur much more easily if the metatarsal bones are weakened due to osteoporosis.
Acute metatarsal fractures
Acute metatarsal breaks (fractures) can be displaced or non-displaced. They may be open or closed. Open metatarsal fractures are normally caused by severe trauma such as a road accident.
The fifth metatarsal bone is the most common metatarsal bone to be fractured in sudden (acute) injury to the foot. It may be fractured at various points along its length, depending on the mechanism of injury. The other metatarsal bones can also be fractured. The first, second and fifth metatarsals are the most commonly injured in sport. Several English footballers have had metatarsal fractures in recent years.
What is the cause for acute metatarsal fracture
Acute metatarsal fractures can be caused by direct injury to the foot. This may happen, for example, through someone stepping on or kicking the foot, by dropping something on to the foot or by falling on to the foot. Twisting of the foot or the ankle can also cause fractures of the base of the fifth metatarsal. In this injury, the twisting mechanism pulls on a strong ligament that attaches to the base of the fifth metatarsal which then pulls off a fragment of bone. The shaft of the metatarsal is commonly injured because of twisting of the foot on landing from a jump. This is a common problem in ballet dancers.
Symptoms of an acute metatarsal fracture
You may hear a sound at the time of the break, and will usually have immediate excessive pain and tenderness around the area of the fracture. The pain is usually called 'pinpoint pain' as it is quite well localised at the site of impact to the bone. Fractured bones bleed, so bruising and swelling can develop and you may have difficulty putting weight on the affected foot. Movement of your foot may also be limited. Surprisingly, however, pain can settle within a few hours.
Acute metatarsal fractures generally take around six to eight weeks to heal. However, it may be longer than this before a sportsperson is fully back in action.
What is a metatarsal stress fracture?
Metatarsal stress (march) fractures
A metatarsal stress fracture is a small “hairline” break in a bone, caused by repetitive stress. Stress fractures tend to occur as a result of overuse and are known as overuse injuries.
Metatarsal stress fractures have been called march fractures because they were seen in soldiers who marched for long periods of time.
Metatarsal stress fractures generally occur due to repeated stress to the bone, which is also termed overuse. They most commonly affect the second and third metatarsal bones, as these bones have the most amount of stress placed on them when you are moving.
Possible complications
If properly treated then metatarsal fractures should settle down without long-term consequences. If not recognised and treated then problems can occur:
A fracture of the first metatarsal bone can lead to later arthritis of the big toe joint.
A fracture at the base of the fifth metatarsal bone is usually mistaken for an ankle sprain. This would usually result in it not being rested or supported enough. This could lead to problems in healing and continuing pain.
The consequences of not treating fractured bones well can also include:
The bone not healing straight + permanent deformity.
The ends of the bone fragments not healing together (non-union deformity).
Препоръчани клиники за такъв тип заболявания
