■ ■ ■ Description

Metatarsal fracture is a broken bone (fracture) in the middle of the foot. The mid-foot bones are of key importance in maintaining the arch of the foot. Three particular patterns are (1) stress fractures (not discussed here), (2) Jones fractures, and (3) dancer’s fractures. These last two fractures involve the upper part of the fifth metatarsal (outer part of the foot).Dancer’s fracture is an avulsion-type fracture in which a tendon pulls off some of the bone from the metatarsal near the joint with the mid-foot; these fractures heal well. Jones fracture, on the other hand, involves the shaft of the fifth metatarsal and has a propensity to not heal.

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■ ■ ■ Common Signs and Symptoms

• Sharp pain, especially with standing or walking

• Tenderness, swelling, and later bruising of the foot

• Numbness or paralysis from swelling in the foot, causing pressure on the blood vessels or nerves (uncommon)

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■ ■ ■ Causes

• Direct blow, twisting injury to the foot or ankle, or landing wrong on the foot and ankle

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■ ■ ■ Risk Increases With

• Participation in contact sports, sports that require jumping and landing (basketball, volleyball), or sports in which cleats are worn on shoes and sliding occurs

• Previous foot or ankle sprains or dislocations

• Repeated injury to any joint in the foot

• Poor physical conditioning (strength and flexibility)

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■ ■ ■ Preventive Measures

• Appropriately warm up and stretch before practice or competition.

• Maintain appropriate conditioning:

  • Cardiovascular fitness

  • Foot and ankle strength

  • Flexibility and endurance

• For participation in jumping (basketball, volleyball) or contact sports, protect vulnerable joints with supportive devices, such as wrapped elastic bandages, tape, braces, or high-top athletic shoes.

• Wear proper protective equipment and ensure correct fit.

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■ ■ ■ Expected Outcome

With appropriate treatment and normal alignment of the bones, healing can be expected. The only exception to this is a higher risk of not healing (nonunion) with Jones fractures. Occasionally, surgery is necessary for healing of Jones fractures.

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■ ■ ■ Possible Complications

• Nonunion (fracture does not heal, particularly Jones fractures) or malunion (heals in a bad position)

• Chronic pain, stiffness, or swelling of the foot

• Excessive bleeding in the foot or at the dislocation site, causing pressure and injury to nerves and blood vessels (rare)

• Unstable or arthritic joint following repeated injury or delayed treatment

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■ ■ ■ General Treatment Considerations

If the bones are in appropriate alignment (position), the initial treatment consists of ice and elevation of the injured foot and ankle at or above heart level to reduce swelling. Crutches and medications help to relieve pain. Immobilization by splinting, bandaging, casting, or bracing for 6 or more weeks is usually recommended to protect the bones while they heal. Walking on the foot with a cast, brace, or wood-bottomed shoe may be recommended, especially if only one metatarsal is involved, the alignment is normal, and the fracture is not a Jones type. If the fracture is a Jones type, keeping strictly off your injured foot until the bone heals is mandatory. Severe fractures, fractures that are displaced (not in appropriate alignment), Jones fractures, and multiple metatarsal fractures may require surgery restore and maintain the joint to its normal position. After immobilization (with or without surgery), stretching and strengthening of the injured and weakened joint and surrounding muscles (due to immobilization and the injury) are necessary. These may be done with or without the assistance of a physical therapist or athletic trainer. Also, a stiff-soled shoe and arch support (orthotic) may be required when initially returning to sports.

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■ ■ ■ Medication

• Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Strong pain relievers may be prescribed as necessary. Use only as directed and only as much as you need.

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■ ■ ■ Cold Therapy

• Cold is used to relieve pain and reduce inflammation. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain. Use ice packs or an ice massage.

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■ ■ ■ Notify Our Office If

• Pain, tenderness, or swelling worsens despite treatment

• You experience pain, numbness, or coldness in the foot

• Blue, gray, or dusky color appears in the toenails

• Any of the following occur after surgery: fever, increased pain, swelling, redness, drainage, or bleeding in the surgical area

• New, unexplained symptoms develop (drugs used in treatment may produce side effects)