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Metatarsal Fractures

The Metatarsals are 5 long bones in the foot that are just behind each toe. Breaks in the metatarsal bones may be either stress fractures  or traumatic fractures. Certain kinds of fractures of the metatarsal bones present unique challenges.

Stress fractures are tiny hairline breaks usually caused by repetitive stress. Stress fractures often afflict athletes who, for example, too rapidly increase their running mileage. They can also be caused by an abnormal foot structure, deformities or osteoporosis. Improper footwear may also lead to stress fractures. Stress fractures should not be ignored. They require proper medical attention to heal correctly.

Symptoms of stress fractures include:

  • Pain with or after normal activity
  • Pain that goes away when resting and then returns when standing or during activity
  • Pinpoint pain (pain at the site of the fracture) when touched
  • Swelling but no bruising

Traumatic fractures (also called acute fractures) are caused by a direct blow or impact, such as seriously stubbing your toe. Traumatic fractures can be displaced or nondisplaced. If the fracture is displaced, the bone is broken in such a way that it has changed in position (malpositioned). Depending on the amount of malposition, or if the fracture extends into a joint,  surgical correction may be necessary.

Signs and symptoms of a traumatic fracture include:

  • You may hear a sound at the time of the break.
  • Pinpoint pain (pain at the place of impact) at the time the fracture occurs and perhaps for a few hours later, but often the pain goes away after several hours.
  • Crooked or abnormal appearance of the toe.
  • Bruising, swelling and difficulty bearing weight.

Diagnosis:

Your doctor will first ask you questions about your pain and level of activity to evaluate you for the risk factors discussed above.

Next, he or she will examine you and order X-rays for the area where you experience pain. When a stress fracture is present, it is actually not uncommon for the X-rays to appear normal and show no break in the bone. This is because sometimes the bone reacts and grows new bone to heal the crack. (However, the injured bone is still vulnerable to being rebroken.) When new bone grows, the final step is for it to calcify. The physician often confirms the stress fracture diagnosis by seeing the calcification of new bone growth on your X-ray.

In certain cases your doctor may order a bone scan or MRI to provide more information than does a standard X-ray. However, these more expensive tests are not routinely needed to diagnose a stress fracture.

Treatment

Most stress fractures will heal on their own if you reduce your level of activity and wear protective footwear for a period of time. You should stop all high-impact activity for a time, typically for about six weeks.

Icing and elevating the affected leg immediately following a stress fracture can help decrease swelling and pain. As for pain, it is best to take acetaminophen (Tylenol) instead of nonsteroidal anti-inflammatory drugs (NSAIDs), which includes ibuprofen (Advil) and naproxen (Aleve). This is because some data suggests that taking NSAIDs can reduce the ability of bone to heal.

Your doctor may recommend that you wear a stiff-soled shoe, a wooden-soled sandal, or a removable “walking boot,” also known as a short leg-fracture brace shoe.

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