What are the metatarsal bones?

Metatarsals are five long bones in the foot, found between the bones of the toes and the tarsal bones. Each metatarsal is attached to one of your toes. They are positioned side by side in the shape of an arch, which gives the foot its arch. They are important for maintaining balance when standing and walking.

What are the most common conditions that affect the metatarsal bones?

Sudden injuries to the foot, which are known as acute, cause fractures in the area. The most common is the fifth metatarsal fracture and it can break at various points. The first and second metatarsals are the most commonly injured in sport and it's well known that David Beckham, Lionel Messi and Steven Gerrard, among many other football stars, have broken their metatarsal bones.

Fractures can also occur over a longer period of time. These are known as stress fractures. There are various types of breaks a metatarsal bone can have. These are:

Open

Where the skin is broken over the fracture. This means there is a possible route for infection from the outside going into the broken bone or bones. This is a serious fracture and damage to the soft tissue surrounding the damaged area makes treatment and healing more complicated.

Displaced

After a break, the bones have slipped out of line meaning they will need to be stabilised and lined up. it may involve an anaesthetic and some kind of metal pinning or plating to the bones.

The bone can also not be displaced, and the break can also be closed.

What can cause metatarsal bone injuries?

Acute metatarsal fractures can be caused by direct injury to the foot such as someone stepping on or kicking it. A twisted foot or ankle can also cause injury to the base of the fifth metatarsal or the shaft of the metatarsal.

Causes of stress fractures include: 

• Repeated stress to the bone
• Marching or running long distances
• Running short distances, especially if there is a sudden increase in speed
• Poorly fitting or unsuitable footwear
• Continuing exercise despite having foot pain
• Neurological problems and rheumatic conditions such as osteoporosis and rheumatoid arthritis can increase the likelihood of stress fractures.

What are the symptoms of metatarsal bone injuries?

Symptoms of metatarsal bone injuries can differ depending on whether it's an acute of stress fracture. An acute metatarsal fracture has symptoms that include:

• An audible sound at the time of the break. There will usually be immediate 'pinpoint' pain and tenderness around the fracture area.
• Bruising and swelling may occur, as broken bones bleed.
• You may have difficulty putting weight on the affected foot, while movement may be limited.

A stress fracture has symptoms that include:

• Immediate pain and tenderness around the area of the injury. There may be some swelling but usually there is no bruising or sound.
• The main symptom may just be pain in the foot during exercise, which is relieved by rest. It tends to be widespread around the foot. However, after some time, the pain may continue despite rest. It tends to become more localised to the area of the fracture.
• A tender area along the line of the second and third metatarsal bone.

How are metatarsal bone injuries diagnosed?

X-rays and computerised tomography (CT) or magnetic response imaging (MRI) scanning can be used to diagnose acute metatarsal fractures. Most of them can be see in X-rays. A doctor also needs to determine whether the fracture is displaced and it might mean the bones need to be realigned and held in place.

Stress fractures don't show up as easily in X-rays as an acute metatarsal fracture. Specialised ultrasound scans, bone scans and MRI scans may show ones that can't be seen in X-rays.

How are metatarsal fractures treated?

Several factors, including which metatarsal bone is broken or fractured, which part of the metatarsal bone is broken, and how severe the damage is, all play a part in what type of treatment is required. Furthermore, it depends whether it is an acute or a stress fracture, if the bone is displaced or not displaced, and whether the tissues surrounding the break are badly injured, too.

Generally, metatarsal fractures can be treated using the following:

• Painkillers
• Ice
• Rest and elevation
• Support, such as elastic tubular bandages, special shoes or even plaster casts
• Surgery

Regarding surgery, it may be required to re-align the bone. However, surgery isn't required for stress fractures.

Which specialist treats metatarsal injuries and fractures?

Podiatrists specialise in the examination, assessment, and treatment of foot problems. If you see your GP about a foot problem and they are unable to make a diagnosis themselves they are likely to refer you to a podiatrist. In the UK podiatrists are also known as chiropodists.

Depending on the treatment recommended, you may also see a physiotherapist or orthopaedic surgeon.