Putting the best forward: what you should know about metatarsal fractures

The metatarsal bones of the foot are the five long bones that are in the middle of the foot between the ankle and the toes. They make up the main arch of the foot and are essential for walking, weight-bearing, and other pedal activities. They enable us to wear high heels, balance, and flex our feet. They can get damaged, often in football players and professional ballroom dancers. In an interview with Mr Shelain Patel, a celebrated orthopaedic surgeon, we discuss metatarsal fractures and how they can be treated.

What are the common causes of metatarsal fractures?

Metatarsal fractures typically occur through either direct trauma or overuse. Direct trauma can involve twisting injuries of the foot and ankle which can classically lead to fractures at the base of the fifth metatarsal on the outer border of the foot. Overuse meanwhile can lead to stress fractures, and when this happens, it is the second or third metatarsals which are most commonly affected, which gives rise to pain in the middle of the foot.

What are the symptoms and signs of a metatarsal fracture, and how is it diagnosed?

Pain is the predominant feature of any fracture. It is uncommon for metatarsal fractures to give rise to significant visible deformity other than swelling. Bruising will be present and this may track into the toes as the clotted blood dissolves. Signs of injury vary depending upon severity. Walking on a fracture will be painful so a limp is a common sign along with tenderness over the site of the fracture. Diagnosis of acute traumatic fractures is made on x-ray but stress fractures may need an MRI for diagnosis unless the presentation is very late.

What are the treatment options for metatarsal fractures, and when is surgery necessary?

Most metatarsal fractures are managed in a pneumatic walking boot which protects the foot whilst weight is placed through the leg. This allows a fractured bone to heal by itself. However, if the fracture extends into the joint or is severely displaced or at risk of not healing, surgery will be recommended to reduce and stabilise the injury.

How long does it typically take to recover from a metatarsal fracture, and what is the rehabilitation process like?

Metatarsal fractures typically heal within six weeks of commencing treatment. Rehabilitation is variable and should be patient-centred. Some patients require little more than weaning out of their boot and starting simple exercises themselves. Other patients may however need the input of a physiotherapist to work on re-training their gait (walking) and improving the strength of muscles in the leg and foot.

Are there any complications or long-term effects associated with metatarsal fractures?

Unfortunately, metatarsal fractures can sometimes fail to heal. This is because metatarsals have areas where there is a good blood supply and other areas where there is a poor blood supply. Should a fracture occur in an area with a poor blood supply, then the risk of not healing is increased, and this in turn may need surgery to stimulate the bone to heal.

If you are experiencing pain or issues with your feet, Mr Shelain Patel is available for consultation via his Top Doctors profile.