Metatarsal Fracture – Causes, Symptoms, Treatments, Surgery, Recovery, and FAQ
A metatarsal fracture is a break or crack in one of the five long metatarsal bones in the middle of your foot. It is one of the most common foot injuries and can be caused by either a sudden injury or repeated stress over time, known as a stress fracture. Fractures of the metatarsal bones account for 35% of all foot fractures (1).
In most cases, surgery isn’t necessary and treatment involves wearing a cast, boot, or special shoe and resting the injury. If left untreated, the fracture can get worse and may cause long term problems so it’s important to get your injury properly diagnosed. This article explains more about the causes of metatarsal fractures, symptoms, treatment options, and recovery time.
The metatarsal bone is the long bone that runs the length of your foot, from the ankle to the toes. There are five in each foot and when one of them breaks or cracks, it is known as a metatarsal fracture. Any of the five bones can break but the fifth metatarsal, which is the one that runs along the outer part of your foot and connects to your little toe, is the most susceptible in adults. It accounts for 68% of all metatarsal fractures (2). When the fracture occurs at the base of the fifth metatarsal, it’s known as Jones fracture. In children the most commonly fractured metatarsal is the first one.
The metatarsal bones have a big job to do. They help to share the load of the body and will move position to cope with uneven ground. This can leave them prone to injury. There are two types of fracture. An acute metatarsal fracture is caused by a sudden injury, whereas a stress fracture happens slowly over a period of time. Both types of fractures of the metatarsal bones are common, especially among athletes who do a lot of running and jumping. The ‘metatarsal curse’ is particularly known to strike among top soccer players.
Metatarsal fractures are more common in younger people because they’re more likely to do the types of sports and activities that can cause the injury. However, they also occur in older people, particularly if the bones are weakened by a condition like osteoporosis.
Symptoms of a metatarsal fracture will depend on whether it’s an acute or stress fracture. In an acute fracture you may hear an audible crack and you’ll probably feel immediate pain in your foot at the location of the injury. You may develop bruising and swelling and have trouble putting weight on your foot. Some people find they can’t walk at all whereas others can tolerate a bit of weight – it depends on where and how severe the break is.
With a stress fracture, the symptoms are unlikely to come on as suddenly. You may start to notice some pain when exercising, which goes away when you stop. If left untreated, the pain will gradually get worse and become more persistent. You may notice some swelling. Eventually the stress fracture may develop into a complete break in the bone.
If you suspect that you may have a metatarsal fracture, get it checked out by a doctor. A fracture left untreated can get worse, potentially causing long term problems. The doctor will examine your foot and if they suspect a metatarsal fracture, will most likely send you for X-rays. Sometimes they will suggest a more sensitive imaging test like an MRI or CT scan – this is because small stress fractures don’t always show up in an X-ray..
While you’re waiting to see a doctor, try to rest as much as possible, using cushions to elevate your foot above your hips, and apply an ice pack or frozen peas wrapped in a towel, for up to 15 minutes every few hours. Make sure the ice doesn’t make direct contact with your skin as this can cause ice burn, and don’t keep it on for any longer than 15 minutes. Over the counter painkillers can help with any pain you’re experiencing.
Treatment for a metatarsal fracture depends on the type, location, and severity of your injury.
Most metatarsal fractures don’t need surgery but you’ll need to follow the treatment plan your doctor gives you to ensure that you make a full recovery. In mild stress fractures, you may only need to take it easy for a few weeks and avoid any activity that causes pain. You may be given a special shoe to wear and you’ll probably still be able to walk around.
For more severe fractures you may need a period of non-weight bearing – where you can’t put any weight on your foot at all – for up to six weeks. This is essential to give the bone a chance to heal so it’s important to stick to the rules. During this time, you may also need to wear a cast or a walking boot to protect your injury and you’ll need to use a mobility device like crutches, a knee scooter or a hands-free crutch.
Once you get the go ahead from your doctor, you’ll be able to start gradually putting weight on your foot again and, over the course of a few weeks, slowly resume normal activities.
If the bone has become displaced or you’ve fractured several metatarsals you may need an operation to fix it. This usually involves inserting pins or plates and screws to hold your bones in place while they heal. This is called internal fixation.
After the surgery you’ll need to wear a cast or walking boot and you’ll probably be non-weight bearing for around six to eight weeks.
Your doctor will tell you whether it’s okay to walk or not, as it will depend on the type and severity of your injury. If you need to be non-weight bearing for a few weeks, it’s normal to feel a little overwhelmed by the prospect of not being able to get around. Fortunately, there are now some great alternatives to crutches which can make this period much easier.
Here are your main mobility options while non-weight bearing:
Crutches are the most common type of mobility device and have been around for thousands of years. They are relatively easy and cheap to get hold of and are used by millions of people each year. However, they can be frustrating as you lose the use of your hands and arms as well as your leg, which makes simple, everyday tasks impossible. They are also extremely tiring to use and this may make you reluctant to move around, adding to the sense of boredom and frustration. They can also cause pain in your back, arms and hands. For all these reasons, non-compliance in remaining non-weight bearing is common with crutches but doing so can result in re-injury and / or a longer recovery period.
Knee scooters are a great alternative to crutches. You can scoot about easily without feeling like you’ve just run a marathon after crossing from one side of a room to the other. Your injured leg rests safely on a padded platform while your other leg helps to propel you. Knee scooters are easy to use but they can only be used on flat, even surfaces so they’re no good for uneven ground, slopes and stairs. You also have to use your arms and hands to steer them so they don’t solve the problem of not being able to carry things.
The iWALK2.0 hands-free crutch allows people to stay active while recovering from lower leg and foot injuries. It functions like a hi-tech pirate-leg and enables you to keep your injured leg elevated, strapped safely to the device, while you walk around completely unaided and with full use of your hands and arms. This means that you can carry on with your everyday life – going to work, pushing a grocery cart or stroller, even going to the gym. A 2019 medical study (3) found that nine out of 10 patients prefer this device to traditional crutches.
The healing time for metatarsal fractures is usually six to eight weeks, although sometimes it can take longer.
Physiotherapy can help to improve mobility and prevent long term problems. You’ll be given some rehabilitation exercises to encourage movement in your foot and ankle. Your doctor will tell you when it’s okay to resume normal activities and return to sports.
Here are some of the most commonly asked questions about metatarsal fractures:
The healing time for metatarsal fractures is usually about six to eight weeks, although in some cases it may take longer. Occasionally it can take a few months. Metatarsal fractures usually heal well and most people are able to return to their previous activities.
It depends on whether it’s an acute fracture, caused by a sudden injury, or a stress fracture, which develops over time. With an acute fracture you’ll probably feel immediate pain at the location of the injury and may even hear a loud crack when it happens. With a stress fracture the pain is usually milder at first and you may only feel it when doing certain activities. Over time though, the pain will probably get worse and become more persistent.
Depending on the type and severity of your injury, you may be able to walk on a broken metatarsal. Some people find that they can’t tolerate any weight at all whereas other people can still walk, especially if it’s a mild fracture. However, it’s better that you don’t walk until you know the extent of the injury to avoid doing any further damage. You may need a period of non-weight bearing to allow the fracture to heal.
Most fractures show up on X-rays. However, stress fractures may not be visible when they first develop because they’re too small. If your doctor suspects a stress fracture they may order an MRI or CT scan instead as these imaging tests are more sensitive.
A metatarsal fracture needs to be seen and treated by a medical professional. While it may not need surgery, you’ll be given a treatment plan to ensure that it heals correctly. This could include wearing a cast or walking boot and keeping weight off it for a few weeks. If left untreated it could get worse and cause the bone to become displaced, which may need surgery. It may also cause long term problems, including foot deformity and arthritis.
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