Our metatarsal bones are the long bones located in our feet between the tarsal (ankle) bones and the phalanges of the toes. Each foot has five metatarsal bones, which are collectively referred to as the metatarsus, and none of them have individual names. Instead they are numbered, starting with the big toe, which is known as the first, then continuing with the second, third, fourth, and fifth metatarsals (the fifth is the pinky toe). Our metatarsal bones bear much of our weight when we are standing, walking, or running. Metatarsal fractures do not discriminate based on age, race, or gender—they can happen to anyone at any time.
Each metatarsal is broken down into segments: the head, neck, shaft, and base. Treatment of a metatarsal fracture depends heavily on which bone is fractured. Injuries to the metatarsal bones are very common and can happen in a number of ways, but most commonly occur when a heavy object falls on them or when they are twisted during a fall.
Injuring the Metatarsal
There are two types of metatarsal fractures: acute and stress fractures. Acute fractures, also called traumatic fractures, happen instantaneously and are caused by an impact, such as when a heavy object falls on the bones. Stress fractures are caused by repetitive actions or impacts to the bones. They worsen over time and are sometimes not evident on x-rays until the bone has started to heal. The second, third, and fourth metatarsals are most prone to stress fractures. In fact, they are second only to the tibia, which is the most common place for a stress fracture. Stress fractures can happen to the first and fifth metatarsals, but it is not as common.
The two other common types of fractures are avulsion fractures and Jones fractures, which are associated with the fifth metatarsal. Avulsion fractures are commonly seen coupled with ankle injuries. Unfortunately, this type of fracture is often overlooked because of the ankle injury. This fracture occurs when a small piece of bone is pulled off the main portion of the bone by a tendon or ligament. Jones fractures are less common than avulsion fractures and they are more difficult to treat due to their location in the small area of the fifth metatarsal base, which receives less blood supply.
Symptoms of an Injured Metatarsal
You may not notice right away if you have injured one of your metatarsal bones, but there are symptoms to watch for. Stress fracture symptoms include:
- Pain that progresses gradually
- Pain in the mid/front of the foot
- Pain worsens when walking or standing
- Swelling and redness over a bony area
- Painful when touched, which may indicate a broken bone
Something to keep in mind is that most stress fractures do not show up on x-rays until two or three weeks after the healing process has begun.
Acute fracture symptoms include:
- Pain at the point of trauma
- Instant and abundant swelling
- Inability to walk or stand
- Bruising within twenty-four hours
What Causes an Injury to the Metatarsal Bones?
Here is a brief look at some of the causes of stress fractures to these bones:
- Not enough rest
- Repetitive activities such as walking, running, jumping, etc.
- Abnormal weight transfer
Here is a look at some of the causes of an acute fracture to these bones:
- Heavy object falling on foot
- Violent impact to foot
- Sprained ankle
When Should I See a Doctor?
If you are experiencing intense pain, swelling, discoloration, or an inability to walk, stand or move, you should contact your doctor immediately. If you are unsure about the severity of the injury and still have function in your foot, call your doctor or a doctor at the emergency room for advice. He or she will ask you about your symptoms and assess whether medical treatment is needed immediately. If your doctor is unable to see you that day, he or she may recommend that you go to the emergency room. You should never try to drive with a fractured metatarsal. If no one is present at the time of the injury and you must get to a doctor, call 911 for an ambulance or call someone for a ride.
Diagnosing Metatarsal Fractures
If you feel you have fractured a metatarsal bone, you should seek medical attention for a proper diagnosis. If your doctor is unavailable, go to the emergency room, where a doctor can confirm a diagnosis by using imaging tests such as x-rays or bone scans. Your doctor may also want to know about the activities you are involved with, which may offer a possible explanation for the injury. You will also be given a physical exam to check for obvious signs of injury. MRIs and CT scans are seldom used in these cases since they are more useful when looking for injuries to ligaments and other soft tissue structures. However, they may be ordered if the circumstances in your case require deeper investigation, or if the x-rays and bone scanners do not detect any obvious injury.
Treating the Metatarsal Bones
It’s important to know that treatment methods differ for each metatarsal. If you have injured the second, third, or fourth metatarsal, you will need to get plenty of rest and allow yourself to become immobile for a while. Recovery periods range from four to eight weeks, depending on the severity of the fracture or break. The most commonly injured metatarsals are the second and the fifth—the one that leads up to the pinky toe.
Your foot doctor will more than likely prescribe you plenty of rest and immobility. He or she may also advise you to practice the RICE method. Rest, Ice, Compression, and Elevation are very important when healing bones in the foot and lower leg. If you cannot stay off your feet for the period recommended, your doctor may be able to fit you with a walking cast or brace to enable mobility. Stiff-soled shoes and/or crutches may also be beneficial to your situation. If these methods fail, surgery may be considered. If your injury involves multiple breaks or a displaced bone, or if the healing process is not moving forward, your doctor may perform a surgical procedure to fix your metatarsal.
Preventing Metatarsal Fractures
Preventing metatarsal fractures can be tricky, especially if you’re involved in high-impact activities such as sports. If you play football or soccer, foot injuries may be inevitable. However, you can still do things to prevent a significant injury, such as:
- Wear the proper type of footwear; this footwear should protect and support your feet.
- Limit activities during your recovery to prevent further problems.
- At the first sign of injury, have your foot looked at by a medical professional.
- Treat underlying conditions that may cause problems with your feet before an injury occurs.
Talking to Your Doctor
Here are some questions to ask your doctor if you have a fractured metatarsal bone:
- What are the chances of this injury happening again?
- Other than calcium-rich foods, what can I eat to strengthen my bones?
- If the symptoms subside, when can I resume normal activities?
- Now that I have fractured a metatarsal, will it be vulnerable to future injuries?
You may have additional questions for your doctor. If possible, make a list before your first appointment. To talk to a podiatrist via e-mail right now, visit the American Podiatric Medical Association web site at http://www.apma.org