On its face, the metatarsal fracture is a simple problem – the bone cracks or breaks and needs to be healed. However, a poor healing process could lead to a lifetime of increased risk – and a diminished ability to enjoy sports. Before we look at the best way to treat this fracture, let’s take a look at what causes this problem, the symptoms, and general treatment information.
A metatarsal fracture is a break in one of the long bones found in the middle of the foot. The metatarsals run from about the mid-point of your arch to the balls of your feet (which are a particularly padded area of the sole, located just under the heads of the metatarsals). Most people only fracture one metatarsal, but it is possible for more of them to be damaged by the same event.
This injury is classified in two ways: Open/Closed and Displaced/Not Displaced.
- Open fractures involve a break in the skin, which causes blood loss and provides a route for infections to enter the body. Also, the damage to the tissues around the metatarsals makes treatment longer and more difficult.
- Closed fractures do not break the skin. There may still be some damage to the tissues around the bone – in fact, it’s unusual for there to be no damage after a break – but the lesser amount of damage means healing is easier.
- Displaced fractures involve the bone slipping out of alignment. These are more common with open fractures, where the bone has more room to move, and require additional work to put back into place.
- Not Displaced fractures remain in their original place. This is – unsurprisingly – better than having the bones moving around.
Unfortunately, healing from a metatarsal fracture isn’t much easier if you have a Closed/Not Displaced version. Surgical treatment is usually necessary and involves cutting through the tissues to reach and repair the bone – which, of course, means those tissues will need to heal afterward.
These fractures are usually caused by:
- Sporting injuries
- Dropping heavy objects onto the foot
- Kicking a particularly hard object
Metatarsal fractures are particularly common in Soccer, which accounts for roughly three-in-four of all sport-related injuries of this type. The fifth metatarsal (which is on the outside, connecting to the smallest toe) is the most frequently broken.
In addition to sudden breaks from sports, metatarsal fractures can also develop over time as stress fractures. These develop when stress is regularly placed on the foot, and causes can include:
- Running in poor footwear
- Doing heavy exercise in shoes that haven’t been broken in
- Suddenly increasing the distance or intensity of running
- Carrying heavy loads over long distances
Stress fractures can develop in people who play almost any sport, as well as those engaged in similar, physically-intensive activities like gymnastics or ballet. These fractures are most common in the second and third metatarsals.
It’s not possible to prevent all metatarsal fractures. However, there are a few strategies you can use to minimize your risk. These include:
- Gradually breaking in new exercise shoes (rather than a sudden shift from one pair to the other)
- Ceasing to exercise when your feet begin hurting
- Wearing extra padding around your feet
- Wearing harder, more-protective shoes
The main symptoms of an acute (sudden/broken) metatarsal fracture include pain, tenderness around the break, bruising, bleeding, and potential infections. Notably, the pain tends to subside over the course of a few hours, although it won’t completely go away for some time.
Most people who have a fracture cannot walk on the foot until it’s healed. Now, this doesn’t mean that you can’t walk on it at all – in fact, you may have to. However, walking on the fracture tends to make it worse – it’s better to put as little pressure on the foot as possible until your doctor says otherwise.
Stress fractures have different symptoms. An early sign is pain in the foot that stops after rest, eventually progressing to a continuous feeling of pain throughout the foot. As the break continues to develop, the pain becomes more and more localized. Swelling is common, but bruising is rare. If left untreated, stress fractures can develop into full-blown breaks.
Most symptoms of a break are healed within six to eight weeks of when treatment begins.
Most acute metatarsal injuries are easily diagnosed by an X-ray scan. In rare cases, doctors may order other imaging tests (typically an MRI or CT scan) to rule out other problems or check for complications.
Aside from determining whether you have an injury or not, the scan is used to determine the correct course of treatment. Most people with a full fracture need to have the bones realigned during surgery.
On the other hand, stress fractures may not be visible on an X-ray. Since they develop over time, the bone doesn’t react as strongly as it does to full breaks. Your doctor may order an MRI or Bone Scan to check for stress fractures.
If you have a broken metatarsal, your doctor’s first goal is to make sure it doesn’t get any worse. In the broad sense, this means elevating the foot, keeping swelling down, and ensuring no additional pressure is put on the bones. From there, treatment varies. There are three major considerations, including:
- Which Bone Is Fractured: It’s easier to adjust the first and fifth metatarsals (the ‘outside’ ones) than the interior ones.
- Location of Break: Another major consideration is the actual location of the break. An injury in the middle of the bone may be easier to treat than damage around the head.
- Severity of Damage: Not every break is complete, especially if the damage is caught before it progresses too far.
After considering these three things, as well as the Open/Closed and Displaced/Non Displaced factors, your doctor will review your treatment options and help you decide on a course of action.
Common Elements of Treatment
The following are the most common things suggested for a metatarsal stress fracture or acute break.
These are particularly common during treatment, with options like ibuprofen or paracetamol preferred in most cases. Most painkillers doctors prescribe for this condition have anti-inflammatory properties, and these are used to lessen the damage to the foot and promote faster healing.
The injured area should be iced as soon as possible after the injury. Make sure to ice it for at least 20 minutes, and don’t keep the ice on for more than half an hour. (Leaving the ice on too long can damage the skin or, worse, the muscles beneath the skin. Needless to say, that’s not going to speed the healing process. For this reason, you should also avoid using ice while sleeping.)
Ice should be reapplied on a regular basis – one session every two hours during the day over the first three days is appropriate for most breaks, but your doctor may suggest icing it for a shorter or longer period.
Elevation helps to reduce the flow of blood to the foot and limit swelling. The foot should be elevated at all times – whether you’re walking around, sitting, or lying down in bed.
In some cases, rest and elevation are the only treatments necessary (aside, perhaps, from pushing the bone back into place from the outside).
For serious cases, your doctor may recommend a foot stress fracture boot. These medical boots help to elevate the foot and prevent the weight of your body from further damaging the injured area.
Finally, for particularly bad cases, surgery may be needed to get everything back into alignment.
Surgery is not needed for most metatarsal fractures. Depending on the location of the break, nonsurgical nonunion cases (where the bone doesn’t properly fuse back together) can be as low as 0.5%. That said, if the bone doesn’t properly fuse back together, surgery may become necessary.
Surgery is more common when multiple metatarsals are broken by the same event. This is because anything damaging enough to break several bones at once usually badly damages them and pushes them out of their original place, making surgery the only truly effective way of getting them back into position.
Note For Athletes: Surgery may or may not be more effective than allowing your injury to heal on its own. If you’re looking for the best possible result – being able to play on that foot again without worrying about another break – talk to your doctor about the most effective treatment for your particular injury.
Only your doctor can determine the best approach for your case. Remember, what worked for someone else isn’t necessarily appropriate for you, so don’t pay too much attention to treatments recommended online. Be sure to ask about supplements, exercises, and treatments that can strengthen your bones after a break.