A patient with a broken metatarsal may be able to walk, depending on how painful the injury is. Despite this, the patient with a metatarsal fracture is advised to avoid excessive walking, especially on uneven ground, to eliminate the risk of displacement. Displacement means the broken bones shift farther than the natural alignment. This is dangerous because it will cause poor healing, visible foot deformity, and even compromised nerve and blood supply to the foot.
- It is best if the patient avoids putting too much pressure on their foot if they have a serious injury; rest will help aid recovery.
- Many people continue to walk on their injured foot despite having a fracture. This can cause further damage to the foot or toe.
- The patient may have been walking around on a broken bone for weeks. Sometimes, stress fractures don’t show up on X-rays for up to 2 weeks after the injury.
- If the pain is not going away, the patient may need a second X-ray.
- The patient should always get a metatarsal fracture evaluated by a podiatric surgeon. A fracture that doesn't heal correctly can lead to arthritis, making the fractured area painful even after healing.
- Walking on an injured foot with multiple metatarsal fractures is not recommended, and it may cause further displacement of the broken bones and ultimately require surgical intervention.
What are the causes of metatarsal fractures?
- Metatarsal shaft fractures are typically caused during sports.
- An accident such as the drop of a heavy object on the foot or sudden bend of the forefoot (i.e., a trip and fall on uneven ground) may cause a metatarsal fracture.
- Metatarsal shaft fractures can also be caused by direct loading and twisting of the foot.
- Sometimes, an automobile accident can cause an injury and a fracture to the metatarsal.
- If a patient has osteoporosis (fragile bones), it takes minimal impact to cause metatarsal fractures such as a miss-step or a sudden twisting movement.
- In addition to acute fractures of the metatarsals, repetitive intense activity (i.e., military marching) or a change in intensity of a particular activity can lead to a stress fracture of one of the metatarsals.
The symptoms of a broken metatarsal may include:
- Bruising of the foot
- Inability to walk normally or sometimes
- Inability to walk at all
What are the treatment options for metatarsal fractures?
Most metatarsal fractures can be treated non-surgically if the fractured metatarsals are in an acceptable position. The other possible treatment options may include:
- The RICE method (rest, ice, compression, and elevation method)
- Removable/plaster cast
- Using a brace or support
- Rehabilitation exercise
- Surgery (rare cases)
Treatment of a single metatarsal fracture involves protecting the injured foot until the bone is healed. During this time, limited weight bearing in a stiff-soled boot or very stiff-soled shoe is recommended to support the fracture. Multiple metatarsal fractures are rare and normally are treated with restricted weight bearing.
Surgery is required in the following conditions:
- In rare occasions, manipulation of the bone to reposition them in an acceptable position is necessary.
- Occasionally, an “open reduction internal fixation” procedure is required to stabilize the bone. This may involve the placement of small plates and/or screws or using pins to realign the bone.
- Surgery may be indicated in the case of either a significantly displaced metatarsal shaft fracture or in the case of multiple displaced metatarsal shaft fractures.
- It typically takes 6-8 weeks for the bone to heal and get strong enough for the patient to resume full weight bearing in a normal shoe.
- It is often 4-6 months before a full recovery is obtained (return to unrestricted activities such as jumping and sprinting).
- There are some proofs that surgical stabilization for a displaced metatarsal shaft fracture can produce a slightly faster recovery time, albeit with the associated risks of surgery. These risks include infection and residual numbness around the toe or surgical site. In rare cases, excessive scar formation around the surgical site may cause toe deformity in the long term.
- Smoking cessation is recommended to all patients with broken bones.
- Take regular pain relief (acetaminophen and ibuprofen) as needed.
- Elevate the leg while sitting by using pillows or a stool, which will help with swelling and pain.
- The doctor may recommend the patient to take vitamin D and calcium daily.