Broken metatarsal

A broken metatarsal is a fracture in one or more metatarsal bones. The medical term for a fracture of one of the metatarsals is metatarsal fracture.

The foot consists of three parts. Starting at the ankle, there are first the tarsal bones, then the metatarsal bones, and finally the toes. In total, there are five metatarsal bones per foot. The medical term is metatarsals. Below, we describe how a fracture can occur and what treatment options are available.

How does a metatarsal fracture occur?

Repeated or prolonged loading of the foot, for example during long hikes, can lead to a stress fracture of one of the metatarsals. Traditionally, this fracture is also called a stress fracture or march fracture. This name refers to the fracture that can occur in soldiers after a long period of marching. Zo’n stress fracture in the foot most often occurs in the middle of the second or third metatarsal.

A hard collision of the forefoot or an object falling on the foot can also lead to a fracture. Other possible (medical) causes that increase the risk of a broken metatarsal are a congenital foot abnormality, rheumatism, or bone loss. Finally, poor or worn-out shoes and improper foot roll-off during walking also increase the risk of a fracture.

Characteristics of a broken metatarsal

The most common characteristic of a broken metatarsal due to a stress fracture is a hard-to-describe pain in the forefoot. This is usually a dull pain. This pain is usually felt suddenly while walking. The foot may turn red, swell, and feel warm at the level of the fracture.

The pain worsens with lots of walking or standing or by pressing on the painful spot. Wearing sturdy shoes may reduce the pain somewhat.

The pain often leads to a different foot roll-off during walking. This increases muscle tension and may cause muscle pain in the lower leg.

How is a broken metatarsal diagnosed?

The patient's history, combined with a physical examination by the general practitioner or physical therapist, may point to a broken metatarsal. The fracture should then always be examined by a specialist.

It is important to know that a broken metatarsal is not always visible on an röntgenfoto. In many cases, the fracture only becomes visible as it heals or when it worsens. Although a röntgenfoto is still used first to examine a fracture, a broken metatarsal can therefore sometimes be missed during the initial examination.

The specialist may choose to perform further investigations using ultrasound or a CT scan and, in the case of persistent symptoms, an MRI scan.

Treatment of a broken metatarsal

Unlike other fractures in the body, a broken metatarsal is not always put in a cast. Often a supportive insole or splint is sufficient to allow pain-free walking. It is strongly advised to rest the foot as much as possible during the first six weeks. This allows the fracture to heal as well as possible.

In rare cases, it is necessary to treat the fracture surgically. If the röntgenfoto shows that the bone fragments are misaligned, surgery will be necessary to straighten them. The surgeon fixes the bone fragments together with metal plates and screws.

After the rest period, it is important to restore foot mobility and rebuild muscle strength and fitness. A physical therapist helps with this. The therapy focuses on improving foot roll-off and foot muscle strength. Common treatment methods include mobilizations, exercise therapy, medical taping, and, if necessary, massage of the shin and calf muscles.

Finally, it is important to identify the cause so that recurrence can be prevented. This may involve adjusting footwear, gait pattern, and training progression.