Metatarsal fracture

Dr. med. Mira Seidel is a freelance writer for the medical team.

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In the case of a metatarsal fracture, the metatarsal bones (ossa metatarsalia) are broken. The cause is usually direct violence. Sometimes it is also a fatigue fracture. Typical symptoms of a metatarsal fracture are swelling in the affected area and stress pain. In most cases, conservative treatment with a cast is sufficient. However, if the metatarsal fracture is severely displaced, an operation must be performed. You can find out more about the metatarsal fracture here!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. S92

Metatarsal fracture: description

The metatarsal fracture makes up about a third of all foot fractures, and mostly athletes are affected. Most often, the fifth metatarsal is broken. Doctors call this type of metatarsal fracture the Jones fracture - after the surgeon Sir Robert Jones (1857 to 1933). Several metatarsal bones are often affected by the injury.

The five metatarsals

The metatarsals are systematically numbered from the inside out (metatarsals I to V):

The first metatarsal bone (first metatarsal) is connected to the big toe. It is shorter, wider and more flexible than its neighbors and, under normal conditions, carries around half the body weight. If the first metatarsus was broken, the force was usually so great that the surrounding soft tissues were also damaged. In addition, other metatarsal bones are usually also affected by the fracture - an isolated metatarsal fracture of the first metatarsal bone is rare.

The middle metatarsals (metatarsals II to IV) are particularly responsible for the transmission of force when walking.

The long fibula muscle (Musculus fibularis longus) attaches to the fifth metatarsal bone. This serves to move the metatarsal bone in the direction of the sole surface of the foot.

Together with the tarsal bones, the five metatarsals form the arch of the foot. The outer metatarsal bones (1st and 5th metatarsal rays) are particularly important for stability.

The Lisfranc joint forms the border between the tarsus and the metatarsus. It is part of the longitudinal and transverse arches of the foot and is therefore exposed to considerable dynamic and static loads.

Metatarsal fracture: symptoms

Typical symptoms of a metatarsal fracture are pain in the metatarsal area. The exact location of the pain depends on the type of fracture. With a Jones fracture, for example, more central pain occurs in the area of ​​the lateral edge of the foot. Pressure pain can also be felt over the affected metatarsal bone.

Because of the pain, the broken foot can hardly bear any weight. It is also swollen in the metatarsal region. Often a hematoma (bruise) forms in the metatarsus, which often extends to the toes. Sometimes the longitudinal arch of the foot is flattened and an incorrect load often occurs when rolling. Warning: If the ankle is broken, similar symptoms can occur.

With such symptoms, it is advisable to see a doctor immediately - a metatarsal fracture is often diagnosed too late and not diagnosed until months after the injury. Early diagnosis and treatment are important so that the foot can heal painlessly and post-traumatic osteoarthritis does not develop.

Metatarsal fracture: causes and risk factors

A metatarsal fracture is usually caused by direct force acting on the foot, for example when a heavy object falls on the foot. A bruise can also be responsible for a metatarsal fracture - for example, if a car drives over the foot.

Other causes are less common: For example, a metatarsal fracture can turn out to be a stress fracture (fatigue fracture, marching fracture). This happens especially with people who put intense strain on their feet, for example through aerobics, ballet or dancing. Very often runners also suffer a stress fracture if they increase their training schedule too quickly. In such an overuse-related metatarsal fracture, the second to fifth metatarsal bones are usually broken.

In the case of a metatarsal fracture, various sections can be affected by the injury, which often allows conclusions to be drawn about the mechanism of the accident:

Metatarsal fracture: head

The heads of the metatarsals are adjacent to the toes. If the metatarsus is broken in this area, direct force is usually responsible. One sees a shortening, often with an axis deviation or rotation. If the injury is due to the foot getting stuck somewhere or bumping into an object, the metatarsophalangeal joint may also be dislocated.

Metatarsal fracture: subcapital

Neck or subcapital fractures in metatarsal bones are often displaced, usually towards the sole of the foot or to the side. The cause is usually a lateral shear mechanism or an oblique direct force.

Metatarsal fracture: shaft

If the shaft of a metatarsal bone is broken, it is often an oblique fracture. The mechanism of an accident can be a direct or indirect force or a crush.

Metatarsal fracture: base

The base fracture usually arises as a result of direct application of force. It is often part of a Lisfranc dislocation fracture (see below).

With a simple metatarsal fracture, the base of the fifth metatarsal is usually broken. The fragments often shift as the tendon of the long fibula pulls the upper piece of bone upwards.

Metatarsal fracture V: avulsion fracture

A so-called avulsion fracture (avulsion fracture) can occur in the fifth metatarsal bone. It is usually the result of an ankle trauma (inversion trauma), since the tendon of the long fibula muscle pulls on the fifth metatarsal bone and thereby triggers a break at the base. The avulsion fracture often results from a sports injury in younger patients and from a fall in older patients.

Metatarsal fracture V: Jones fracture

A Jones fracture can also occur on the fifth metatarsal bone - a break at the transition between the diaphysis and metaphysis: the diaphysis is the bone shaft, the metaphysis is the narrow area between the bone shaft and the end of the bone (epiphysis). A Jones fracture can occur, for example, when the foot is twisted in and bent over while tiptoeing.

Lisfranc dislocation fracture

The Lisfranc dislocation fracture is often a closed injury (no bone parts are visible from the outside) in victims of a car accident. It is caused by direct force, in which the second metatarsal bone shifts backwards and tears the ligaments.

Metatarsal fracture: examinations and diagnosis

Accident victims usually suffer from several different injuries, which is why a metatarsal fracture is often overlooked. The foot injury is sometimes discovered by chance years after the accident. This is precisely why you should consult a doctor for orthopedics and trauma surgery at the slightest suspicion of a metatarsal fracture.

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In order to diagnose a metatarsal fracture, the doctor will first ask you exactly how the accident happened and your medical history. Possible questions are:

• What is the exact course of the accident?
• Do you have pain?
• Does the pain occur during exercise?
• Did you already have symptoms before you broke your foot (e.g. pain or restricted movement in the foot area)?

Physical examination

Immediately after the accident, a metatarsal fracture can be determined based on the clear misalignment. At a later point in time, however, the often massive swelling can complicate the diagnosis. During the examination, the doctor also pays attention to possible accompanying injuries to the soft tissues, nerves and tendons on the foot.

Imaging procedures

Imaging procedures are necessary for a reliable diagnosis of a metatarsal fracture. In any case, this includes an X-ray examination, whereby images are taken in three planes: from the back of the foot to the sole of the foot (dorsoplantar), strictly to the side and oblique images with the outer edge of the foot raised.

If the x-rays are not informative enough, the doctor will also order magnetic resonance imaging (MRI, also called magnetic resonance imaging) and / or computed tomography (CT) or scintigraphy (a nuclear medicine examination).

The doctor will also order an MRI, a scintigraphy and / or a vascular X-ray (angiography) if the metatarsal fracture is due to fatigue (stress fracture) or due to illness. The latter can be the case with bone tumors or with so-called Charcot's foot (also: diabetic neuropathic osteoarthropathy, DNOAP).

In the case of a fatigue fracture, diagnosis is often difficult initially because no fracture gap is visible. Only later, when the bone reacts to the break and forms a callus (consisting of newly formed bone tissue), can the break be localized. With the help of an additional MRI image of the foot, an earlier diagnosis is easier.

Metatarsal fracture: treatment

If the metatarsus is broken, the aim of the treatment is to get the foot back pain-free and fully resilient as soon as possible. It is not necessary to have an operation for this. Surgery is only recommended if the fracture is very displaced.

Conservative metatarsal fracture treatment

A fracture of the foot that is not or only slightly displaced and is not shortened can be treated conservatively. To do this, the affected person is not allowed to move his foot for a long time and has to relieve it, otherwise the risk of a renewed fracture or osteoarthritis is too high.

The foot is first stabilized from the outside with hard soles, soft cast (a support bandage) and tape bandages. The cast must be worn for about six weeks. Depending on the type of fracture, the foot can be loaded after about four weeks. The doctor controls the healing process with regular x-ray examinations.

In the case of a metatarsal fracture V in the form of an avulsion fracture, it is sufficient if the person concerned wears a so-called stable shoe or a firm shoe sole in order to protect the foot.

If the Jones fracture is only minimally displaced, the foot can initially be immobilized in a cast shoe for six weeks. The patient is allowed to put full weight on the foot as the cast shoe is very stable and the upper ankle remains freely movable. Then the foot can be provided with fixing bandages until it is functional again.

Most stress fractures can be treated conservatively. The foot should be immobilized in the cast shoe for about six weeks.

Surgical metatarsal fracture treatment

If the fracture fragments are displaced too much, surgery is necessary. The bone fragments are aligned and stabilized with the help of screws or plates. Usually only two days of hospitalization are necessary for the procedure. Regular x-ray controls show when the foot can be put under increased stress again.

If the metatarsal fracture in a Jones fracture is displaced by more than five millimeters, it is treated with a lag screw or a tension strap. This operation is particularly recommended for athletes. A firm sole should be worn in the shoe after the operation.

In the event of a fracture of the remaining metatarsal bones, the closed bone is realigned and fixed under the skin with so-called spike wires (Kirschner wires). If the bone fragments cannot be aligned in this way, open surgery must be carried out. Since the first metatarsal bone stabilizes the foot in particular, it must be fixed particularly early and well in the event of a fracture.

Lisfranc dislocation fracture

If the Lisfranc joint fractures, the fracture must be realigned in an open position. The break point here is usually at the base of the second metatarsal bone. This is then aligned and provided with two spiked wires from the side for stabilization. The bases of the metatarsals are then supplied with the tarsal row with screws.

If there is severe soft tissue damage, a so-called "external fixator" is used. The Schanz screws are inserted into the first and fourth metatarsal bones and the tibia.

Metatarsal fracture: disease course and prognosis

The healing process can be very different for a metatarsal fracture. The duration and course depend on the type of break. Whether or not soft tissues were also damaged also plays an important role.

The prognosis for an isolated metatarsal fracture of the shaft of the first and fifth metatarsal bones is good - provided the fragments have been aligned anatomically. If there are no complications in the further course, it usually takes about eight weeks for the bone to heal completely.

Metatarsal fracture: complications

A post-traumatic splayfoot and flat foot can develop in the event of a comminuted fracture or if several metatarsal bones are broken that could not be properly realigned.

If cartilage was also damaged in the metatarsal fracture, osteoarthritis can develop despite good treatment.If there is a Jones fracture, pseudoarthroses can occasionally occur, which means that the bone fragments do not grow back together completely.

In the case of open fractures, osteitis (inflammation of the bone) can develop as a complication. If the metatarsal fracture is accompanied by crush injuries, there is also the risk of a compartment syndrome.

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