Fractured Metatarsal

What is a Metatarsal?

A Metatarsal in a small bone in the foot, there are five metatarsal bones in each foot. Metatarsals are technically known as long bones, even though they are relatively short in length. The Metatarsals are located between the 'Tarsal' bones of the hind-foot and the 'Phalanges' bones in the toes.

The foot has two principle functions, which are to propel and support. The Metatarsal bones play a major role in these two functions, as they act like a rigid lever to aid propulsion and act like a flexible structure to aid and support balance.

How does a fractured Metatarsal occur?

Soccer fans all over the world will probably be more than familiar with the infamous Metatarsal injury suffered by David Beckham in the build up to the 2002 World Cup.

Fractures to the Metatarsal bones are usually caused by direct trauma i.e. high impact caused by a player accidentally kicking the sole of an opponent's boot. Other causes can be from an opponent stepping on a player's foot. Sports men and women are obviously at high risk from such injuries, particularly if their injury was also combined with excessive rotational force.

The reason why this area of the foot is susceptible to damage is that there is very little soft tissue to protect the top of the foot and boney injuries, such as a fractured Metatarsal bone are consequently common in high impact activities and sports.

The most common Metatarsals to be fractured by direct impact, are the second, third and fourth Metatarsals. Rotational injuries are more likely to be responsible for a fracture of the fifth Metatarsal (the most outermost Metatarsal). This type of injury usually occurs when the ankle twists and so it is not uncommon for a significant ankle sprain injury to also accompany a fractured fifth metatarsal.

There are two common types of traumatic fracture to the fifth Metatarsal, the 'Jones fracture', which refers to a fracture directly through the Metatarsal bone and an 'Avulsion fracture', which is when a corresponding muscle is pulled so forcefully that it actually shears off a piece of the Metatarsal bone.

Additionally, overuse can cause 'stress fractures' to the Metatarsal bones, where protracted pain is eventually followed by a hair-line crack, which becomes visible on x-ray. These fractures are regularly seen in army recruits, as well as sports men and women and are commonly known as 'March fractures'. The second Metatarsal is the most commonly affected bone with this type of injury.

What are the signs and symptoms of a fractured Metatarsal?

As with all fractures, there is considerable pain and the patient will find it difficult to walk at the time of the injury. Often there will be significant pain if pressure is applied to the fracture site or if the surface of the fracture site is maneuvered in anyway without appropriate support. Although there is usually limited swelling at the time of the injury, swelling and bruising over the outer border of the foot will usually become apparent after the first 48 hours if an injury is left untreated.

How is a fractured Metatarsal treated?

The treatment of a Metatarsal fracture varies depending on the type and location of the fracture.

If the fracture is due to direct trauma and the fracture fragments are not displaced out of their original position, then the treatment of choice is to completely immobilise the foot and ankle in a cast and avoid any weight baring action for 6 - 8 weeks. There are two types of cast commonly used, a traditional plaster cast or a removable plastic pneumatic boot. The removable boot is advantageous for sports men and women, because the boot can be removed temporarily for physiotherapy treatment and swimming pool rehabilitation.

The same treatment is usually employed for 'March' (stress) fractures of the second metatarsal and rotational fractures of the fifth metatarsal. However, stress fractures of the base of the fifth metatarsal sometimes show poor healing capabilities and for this reason, many orthopaedic surgeons favour surgical fixation. In this procedure a small incision is made on the outside border of the foot and a small screw is placed down the middle of the fractured bone to fix it securely in place. This procedure can be performed under General Anaesthetic (you will be asleep) or Regional Anaesthetic (you will be awake). The procedure usually takes only a short amount of time to perform (approximately 30 - 40 minutes).

What is the recovery like following a fractured Metatarsal?

Following a progressive improvement of mobility and pain control, patients are normally discharged home the day of or the day after surgery. By the time the required level of recovery is achieved for discharge, patients are normally walking confidently on crutches to avoid any weight baring on the affected limb and taking only mild analgesia (pain killers) to control any pain.

Over the next 6 weeks patients will be expected to work on improving their own mobility and range of movement through dedicated and progressive physiotherapy and by increasing their activity gradually. Your Consultant Surgeon will assess your condition and progress after 1 week and then again after six weeks to remove the cast and evaluate how successful the fracture repair has been.

Patients who are in employment should not resume work until after their second consultation and dependant on the physical nature of their job may be advised to take longer off work. Patients should expect a continuous and full physical recovery to take up to 4-6 months to achieve.

Are there any risks associated with Metatarsal conditions and treatment?

Although Metatarsal fractures are regularly treated without any long-term complication, it is very important that all candidates are fully aware of both the benefits and risks of undertaking specialist orthopaedic treatment such as this. All treatment and surgery, no mater how expertly or carefully it is performed, carries risks and the importance of a full evaluation and consultation with an expert in sports injuries in relation to these risks cannot be over emphasised.

How do I find out if I need treatment?

Surgical Advisor will be delighted to help you find a leading expert orthopaedic surgeon in foot and ankle sports injury to consult with. Your Orthopaedic Consultant will carry out a thorough evaluation of your condition and provide you with a comprehensive explanation of the most appropriate treatment or surgical solution.
 
Our Expert Consultant Orthopaedic Surgeons are most carefully selected and recommended because they understand the importance of the decision you are making when contemplating sports injury treatment or surgery and because of their specific foot and ankle expertise. Throughout your consultation you will therefore be encouraged to ask as many questions as you wish and to take your time in making a decision to proceed with any recommended treatment.

To ensure that all patients are comfortable with any recommendations or advice given in their consultation, all patients are asked to go away after a consultation and think through all the information they have received. If for whatever reason you are still not sure about the best course of action and wish to have further dialogue with your Consultant, you will not be expected to pay for a second consultation appointment.

How do I make a consultation appointment?

For further advice on how to make an appointment to consult with an expert Consultant Surgeon in sports injury and foot and ankle conditions: 

Please call Surgical Advisor on: 0870 41 41 41 2
Or email us by clicking on: advice@surgicaladvisor.com