Fractures of the Metatarsals
There are five metatarsals in the
foot. The first metatarsal is the most important and fractures of
the first metatarsal usually require surgery. Fractures of the middle
metatarsals (the second, third and fourth) do not require surgery
unless there are significant displacements of the bone.
||The metatarsals of the foot. These are
the bones that connect the toes to the middle bones of the foot.
The first metatarsal (1) connects to the big toe, and the 5th
metatarsal to the baby toe.
Each metatarsal is divided anatomically into different segments
(the head and neck, the shaft, and the base). The treatment of these
fractures depends on where the metatarsal bone is fractured.
||On the left are fractures of the
neck of the metatarsals.
On the right are fractures of the middle or the shaft
of the metatarsals.
Injuries to the metatarsals are sustained in many different ways
ranging from minor twisting to falls and injuries sustained when
heavy objects fall on the foot and literally crush the metatarsals.
Fractures of the fifth metatarsal are quite varied, and the treatment
is determined according to the specific location of the fracture
in this bone. The treatment of the metatarsals varies depending
on the injury. Some patients simply wear a very stiff-soled shoe
or a special type of rigid heeling shoe or a short leg walking cast.
Surgery is reserved for the more serious of these fractures. These
are usually certain types of fractures of the first and fifth metatarsal.
||This fracture of the 5th metatarsal
shaft is a relatively easy one to treat, and usually heals quite
well in a special shoe or boot, without any surgical treatment.
Fractures of the fifth metatarsal are unique in that they commonly
occur associated with sporting activities. There is one type of
fracture in particular, called the Jones fracture, which is a difficult
fracture to get to heal. Because of problems with blood supply to
the bone where the fracture occurs, these fractures are difficult
to heal and often surgery is required.
If surgery is not performed, then a boot or cast is used. It can
take eight to ten weeks for this fracture to heal and it is not
always predictable whether or not full healing will occur. If a
cast or boot is used, no walking on the foot is permitted for about
6 weeks. The results of bone healing are unpredictable. Studies
have shown about 70% heal with cast treatment.
On the other hand, surgery for the Jones fracture has about a 95%
success rate. Therefore, surgery is preferable for most Jones fractures.
In this treatment, a tiny puncture is made in the skin on the outside
of the foot and a screw is inserted. An x-ray monitor is used to
help position the screw. The screw helps speed up the healing process.
Healing occurs quite rapidly and walking on the foot (with a removable
boot) is permitted within a few days after surgery. Typically, bike
exercise can be commenced at about four weeks. Patients may return
to running approximately six weeks after this type of surgery.