Traumatic fractures (also known as acute fractures) are caused by the sudden application of force or trauma. This can be an impact such as a direct blow—like forcefully stubbing your toe. A metatarsal fracture is a crack or break in one of the five metatarsal bones across the top of the foot and ball of the foot. When evaluating traumatic fractures it is important for your doctor to determine whether the broken bone is displaced or nondisplaced. In displaced fractures, the bone is not only broken, but it is also moved out of alignment. In this case, it is said to be dislocated. Treatment of these types of fractures depends on the extent of injury, the amount of displacement, and whether or not the joint surface is involved. Surgery is sometimes required to put the bone back into proper position and stabilize it so it can heal.
• You heard a sound like a crack or pop at the time of injury to the foot. • “Pinpoint tenderness” (pain or tenderness at the precise location of injury) at the time the fracture occurs and perhaps for a few hours later. This can be deceiving, because sometimes, the pain goes away after several hours. • Deviation or mal-alignment (crooked, misshapen or abnormal appearance) of the foot or toe joints. • Bruising and swelling that starts to appear within 48 hours of the injury. • It is absolutely not true that “if you can walk on it, it can’t be broken.” We see people walking into our office with fractures on a regular basis. Because of this, if you suspect you have a fracture, you should get in for an evaluation as soon as possible. We reserve slots for emergency appointments every day so you won’t have to wait to get taken care of.
We often see people in the office who will say “I thought that there isn’t anything that can be done for a broken bone in the foot.” This is false. In fact, if a fractured phalanx bone in the toe or a metatarsal bone in the foot is not treated correctly, you can develop serious problems. For example: • A permanent deformity in the bone alignment and structure can develop and limit the ability to walk on the foot or fit into shoes • Arthritis is often caused by an untreated fracture that involves a break in the joint surface. In some cases, when the bone isn’t realigned, an angular deformity develops and causes problems. • Chronic foot pain and long-term difficulties with walking• Non-union,or failure of the broken bone to heal, can lead to a need for surgery or suffering from chronic pain.
Metatarsal fractures caused by trauma (a whole lot of force applied all at once) need to treated correctly. If the bone is displaced, the fracture must be reduced (sometimes referred to as “setting the broken bone”). The risk for long-term problems after a metatarsal fracture depends on which of the five metatarsal is broken, where the break occurs and how bad the fracture is. For example, a break in the first metatarsal bone (the one behind the big toe joint) can lead to painful stiffness and arthritis. The big toe is used frequently and the big toe joint carries about half of all of the force on the forefoot when you walk. If you develop arthritis in the big toe joint, it can become painful to walk, bend, orjust stand on the foot. There is another worrisome injury called a Jones fracture, which involves the base of the fifth metatarsal bone (the one behind the little toe joint). Jones fractures are often misdiagnosed as an ankle sprain. A misdiagnosis and lack of proper treatment can lead to serious problems since sprains and fractures are treated differently. Make sure you see an expert. The best treatment of a traumatic metatarsal fracture will depend on the specifics of the fracture, but may include: • Rest. Sometimes rest is all that is needed to promote healing of a stress fracture of a metatarsal bone. • Avoid the activity that led to the fracture. It is important to make sure that you don’t injure the area further. If running caused the fracture, stop running until you get an evaluation. Don’t make it worse. Sometimes you might have to stay off the foot entirely with the help of crutches of a wheelchair in order to allow it to heal. • Immobilization, casting, or stiff shoe. A cast, stiff shoe or fracture walking boot might be needed to protect and stabilize the fractured bone while it is healing. • Bone Stimulator. A bone stimulator is a non-painful device that uses ultrasound or electromagnetic energy to stimulate bone healing. Bone stimulators can help a metatarsal fracture heal as fast as possible. They also can be helpful after surgery to lower the risk of a non-union (where the two fractured pieces of bone fail to heal together).• Surgery. Depending upon the extent of the injury, some metatarsal fractures will heal much better with surgery to re-align and stabilize the bone. In some cases the fracture can be stabilized and secured with very small metal plates and screws to stabilize it while it heals. This can make the bone heal faster. • Follow-up treatment. You will receive very particular instructions for treatment after both surgical and non-surgical metatarsal fracture treatment. Physical therapy, strengthening exercises and rehabilitation will help get you back to your athletic activities as quickly as possible.
