There are three types of metatarsal fracture (MF), and affected individuals may provide the following anamnestic data:

• Acute or traumatic MF is the result of a traumatic impact on either of the metatarsal bones. In such cases, mechanical forces sustained during motor vehicle accidents or falls have exceeded the maximal resistance of the respective bone(s) and led to MF. Patients presenting with traumatic MF thus generally report to have been involved in such accidents. Of note, these patients may suffer from polytrauma and life-threatening injuries unrelated to MF. A thorough clinical examination is required to identify possible damage to internal organs and vascular structures.
• Stress fractures of the metatarsal bones may be seen in patients who pursue high load-bearing activities associated with repetitive impacts on their feet, e.g., runners, soccer and tennis players, among others [1] [2] [3]. It has been shown that individuals suffering from pes cavus are predisposed for MF [4].
• Systemic pathologies such as osteopenia and osteoporosis or rheumatoid arthritis may predispose for pathological MF [5] [6]. These entities may or may not have been diagnosed previously, and affected individuals may report bone pain (including but not limited to the affected foot), prior pathological fractures, or morning stiffness and joint disease, respectively.

Intense foot pain predominates the clinical picture. Foot pain generally aggravates during weight bearing activities but may be present at rest. Furthermore, surrounding soft tissues are tender and contact or slight pressure may elicit pain. Pressure pain is most severe at the site of the fracture. Focal swelling is often noted [1].

• Pain

  Initially, pain occurs only with activity. [aafp.org]

  She is active in ballet and her pain is exacerbated with push-off and en pointe maneuvers. A radiograph, bone scan, and MRI are found in Figures A-C, respectively. [orthobullets.com]

  Ice therapy can be effective to help control the pain of a Metatarsal fracture, although pain medication is frequently prescribed. [tsrinjurylaw.com]

• Falling

  Case 2 This 48 year old male presented to the Emergency Department following a fall. His left foot was painful and he was unable to weightbear. He was referred for right foot radiography. [wikiradiography.net]

  A Lisfranc fracture-dislocation (see the image below) is caused by falling from a height, falling down stairs, or stepping off a curb. [10] Lisfranc fracture-displacements are relatively rare, with a reported incidence of one per 55,000 people in the [emedicine.medscape.com]

  Orthopedic injuries are common in Parkinson's disease, but they are usually secondary to falls. [ncbi.nlm.nih.gov]

  Causes & Triggers Falls Impact from heavy objects or crushing Sports, particularly for the fifth metatarsal Twists Signs & Symptoms Difficulty walking Pain Swelling Tips & Treatments The bone connected to the big toe is called the first metatarsal and [orthopedicone.com]

• Fever

  When to call your healthcare provider Call your healthcare provider right away if you have any of these: Fever of 100.4°F (38°C) or higher, or as directed Symptoms that don’t get better, or get worse Numbness or coldness in your foot Toe nails that turn [saintlukeskc.org]

  […] your cast removed Start doing your normal activities again When to Call the Doctor Call your provider if you have any of these symptoms: Swelling, pain, numbness, or tingling in your leg, ankle, or foot that becomes worse Your leg or foot turns purple Fever [stlukes-stl.com]

  Stop using crutches Have your cast removed Start doing your normal activities again Call your provider if you have any of these symptoms: Swelling, pain, numbness, or tingling in your leg, ankle, or foot that becomes worse Your leg or foot turns purple Fever [medlineplus.gov]

• Asymptomatic

  Tuberosity fractures of the fifth metatarsal are treated with a boot until the player is asymptomatic. Supportive taping and/or a cuboid pad can be used to relieve the pressure from the fracture site. [fifamedicalnetwork.com]

  Three months after the injury (C), the patient was clinically asymptomatic. [mdedge.com]

  […] there were six treatment failures: four refractures and two symptomatic nonunions; - mean time to full activity was 6.8 weeks for the patients with failure compared with 9 weeks for patients who did not have complications; - although all patients were asymptomatic [wheelessonline.com]

  Metatarsal stress fractures at more proximal locations in the metatarsal tend to take longer to heal and can take up to 8-12 months to become asymptomatic. [myfootshop.com]

• Pallor

  Late signs include pallor, paresthesias, and tense swelling–but don't wait for them to appear. [orthopaedicsone.com]

• Vascular Disease

  “Sensation changes in the foot can also be caused by vascular diseases, metabolic diseases, and from irritated nerve roots at the level of the spine, so you should still see a doctor just in case.” [runnersworld.com]

  disease) Site of surgery Metabolic bone disease (for example thyroid problems) CT of the foot demonstrating non union of a 5th metatarsal bone fracture Non-Operative Treatment Options Zone 1: Avulsion 5th metatarsal base fracture Protected weight bearing [lfaclinic.co.uk]

• Foot Pain

  Foot Pain Foot pain can sometimes be a sign of an underlying condition that requires medical attention. Find out when to see your doctor, and much more. Orthotics Many people use orthotics to improve the function and stability of their feet. [footvitals.com]

  Lots of people associate tendonitis (a.k.a. an inflamed tendon) with knee pain, but it’s also a common cause of top-of-foot pain. [runnersworld.com]

  Intense foot pain predominates the clinical picture. Foot pain generally aggravates during weight bearing activities but may be present at rest. Furthermore, surrounding soft tissues are tender and contact or slight pressure may elicit pain. [symptoma.com]

• Arthritis

  Achilles Tendonitis Corns Posterior Tibial Tendonitis Runner's Toe Morton's Neuroma Foot Pathologies Bunion Metatarsalgia Flat Foot (Pes Planus) High Arches (Pes Cavus) Supination Hallux Rigidus Hammer Toe Pronation Foot Diseases Diabetic Neuropathy Arthritis [wherefeetloveus.com]

  For instance, arthritis may be developed from a fracture in the first metatarsal bone, behind the big toe. [feetfixer.com]

  For example, sometimes a fracture of the first metatarsal bone (behind the big toe) can lead to arthritis. [foothealthfacts.org]

• Metatarsalgia

  […] outcomes limited information available in literature Complications Malunion may lead to transfer metatarsalgia or plantar keratosis treat with osteotomy to correct deformity Please rate topic. [orthobullets.com]

  Pedorthists Foot Scans Custom Orthoses Depth Footwear Foot Shapes High Arch Flat Foot Fitting Advice Foot Injuries Plantar Fasciitis Shin Splits Achilles Tendonitis Corns Posterior Tibial Tendonitis Runner's Toe Morton's Neuroma Foot Pathologies Bunion Metatarsalgia [wherefeetloveus.com]

  FractureICD-9 825.25 (closed fracture of metatarsal bone) 825.35 (open fracture of metatarsal bone) Metatarsal FractureEtiology / Epidemiology / Natural History Untreated displaced fractures (espcially sagittal plane angulation) can lead to transfer metatarsalgia [eorif.com]

• Bone Disorder

  […] metatarsal bone and/or tarsal bone (& one or more), fracture of one or more tarsal and metatarsal bones (diagnosis), Fracture of one or more tarsal and metatarsal bones (disorder) Dutch fractuur van een of meer tarsalia en metatarsalia French Fracture [fpnotebook.com]

  Third, patient specific factors such as intrinsic bone disorders or metabolic disorders were not assessed. Fourth, despite a mean follow-up of almost 2 years, refractures have been reported to occur even after that time range [38]. [bmcmusculoskeletdisord.biomedcentral.com]

• Swelling of Foot

  C ompression: An elastic wrap should be used to control swelling. E levation: The foot should be raised slightly above the level of your heart to reduce swelling. [bigskyfootandankle.com]

  Compression: An elastic wrap should be used to control swelling. Elevation: The foot should be raised slightly above the level of your heart to reduce swelling. [foothealthfacts.org]

  What Are the Signs and Symptoms of a Broken Foot? A common symptom of broken bones in the foot is pain and swelling. The foot pain may be so bad that you may not be able to walk. [emedicinehealth.com]

  In case of severe swelling the foot was immobilized using a walker or a short leg cast for a maximum of 2 weeks. Return to work and sports was encouraged as soon as possible. [bmcmusculoskeletdisord.biomedcentral.com]

• Confusion

  Clinical Presentation Quality of Referral Referrals for ankle and foot radiography are often confused. [wikiradiography.net]

  (By Simon Bartold) There has always been confusion about fractures of the base of the 5th MT. [lbgmedical.com]

  However, there are accessory ossicles that are symptomatic, which can confuse the diagnosis. [dynamicchiropractic.com]

  Despite what should be a simple entity, controversy exists, as well as confusion in the literature, with the term Jones fracture sometimes liberally (and incorrectly) applied to this fracture. [radiopaedia.org]

• Seizure

  Other factors reported to be associated with foot fractures are insulin-dependent diabetes, use of seizure medications, history of falls, poor depth perception, hyperthyroidism, and use of benzodiazepines. 18-20 Diabetes may be related to foot fractures [lermagazine.com]

Plain radiography is the mainstay of MF diagnosis. In order to evaluate the condition of the metatarsal bones, anteroposterior and oblique radiographs should be obtained. Fractures of the metatarsal bones appear as radiolucent lines that interrupt the continuity of the physiological osseous structure. Any metatarsal bone may be affected, and patients may present with multiple MFs. Joint involvement should be assessed.

MFs most commonly involve the fifth metatarsal [7]. In this context, incidence rates of tuberosity avulsion fractures are higher than those of Jones fractures and diaphyseal stress fractures. The latter two are easily confounded [8]. They are, however, associated with different therapeutic regimens and prognoses and thus require a thorough workup. According to Lawrence and Botte, Jones fractures occur at the distal limit of the joint between the fourth and the fifth metatarsal. Diaphyseal stress fractures, in contrast, affect the proximal diaphysis [8] [9]. Stress fractures are often associated with intramedullary sclerosis, cortical hypertrophy and periosteal reaction [2].

Of note, stress fractures may not be depictable using plain radiography. A strong suspicion of MF despite the absence of radiographic anomalies thus justifies magnetic resonance imaging or scintigraphic examinations [10]. Due to radiation exposure, computed tomography scans should be reserved for specific indications. Sonography may be of use if the examiner has sufficient experience [11]. In any case, imaging studies lay the foundation for treatment planning [12].

Further diagnostic measures may be indicated to identify underlying systemic disorders, e.g., laboratory analysis of blood samples, bone density measurements, and additional diagnostic imaging.

The patient had minimal symptoms and declined further treatment. Fractures of the proximal fifth metatarsal that are distal to the tuberosity require more aggressive treatment. [aafp.org]

In the literature you find many different methods of functional treatment. [ediss.uni-goettingen.de]

Treatment options and Outcomes The goal of treatment is to restore alignment of the 5 metatarsals to preserve the arches of the foot and allow normal weight distribution over the metatarsal heads. [orthopaedicsone.com]

Surgical versus nonsurgical treatment. Jones' fractures and related fractures of the proximal fifth metatarsal. Proximal diaphyseal fractures of the fifth metatarsal--treatment of the fractures and their complications in athletes. [wheelessonline.com]

Treatment and prognosis In general, these fractures can be treated conservatively, and heal well 2. For large or very displaced fragments with intra-articular extension then operative fixation may be indicated. [radiopaedia.org]

Answer Explanation Fractures of the fifth metatarsal are the most common of all foot fractures. 1 Emergency physicians must understand the different types of fractures as management and prognosis differs widely. [aliem.com]

Most metatarsal fractures have a good prognosis; however, Jones fractures have a high rate of nonunion and Lisfranc injuries can result in chronic symptoms. [accessmedicine.mhmedical.com]

Etiology Zone 1 fractures are tuberosity avulsion fractures, also called pseudo-Jones fractures, and occur when the hindfoot gets forced into inversion during plantarflexion.[3] This acute injury pattern may occur after an athlete lands awkwardly after [ncbi.nlm.nih.gov]

Various studies have evaluated the etiology of each type of proximal fifth metatarsal fracture as well as the best therapeutic options. [podiatrytoday.com]

Epidemiology/ Etiology 5 to 6% of all fractures treated in primary care are metatarsal fractures. It are the most common injuries of the foot. [physio-pedia.com]

BACKGROUND: A paucity of data exists studying the epidemiology of fifth metatarsal fractures. [ncbi.nlm.nih.gov]

Several previous studies have looked at the epidemiology of all metatarsal fractures, but few have examined the epidemiology of all types of fifth metatarsal fractures in the general US population. [lermagazine.com]

[…] subsequent encounter for fracture with nonunion P- subsequent encounter for fracture with malunion S- sequela Metatarsal FractureICD-9 825.25 (closed fracture of metatarsal bone) 825.35 (open fracture of metatarsal bone) Metatarsal FractureEtiology / Epidemiology [eorif.com]

Athletics Epidemiology Foot Injuries Soccer Stress Fracture View Full Text Statistics from Altmetric.com Request Permissions If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center [bjsm.bmj.com]

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Jones fractures: pathophysiology and treatment. JBJS Rev. 2015;3(7):00100. doi:10.2106/JBJS.RVW.N.00100 Baumbach SF, Prall WC, Kramer M, Braunstein M, Böcker W, Polzer H. [verywellhealth.com]

Pathophysiology As in all metatarsal fractures, first and central metatarsal fractures occur with either direct or indirect trauma.21,28 Rarely, crush injuries may cause these fractures and are often associated with soft-tissue and other bony injury.28,31 [journals.sagepub.com]

Epidemiology incidence frequent injury encountered in primary care setting base of 5th metatarsal fractures account for 25% of all metatarsal fractures of which, 90% are zone 1 fractures demographics athletes, military recruits, and manual laborers Pathophysiology [orthobullets.com]

Clin Orthop Relat Res 466:1444–1448 Lareau CR, Anderson RB (2015) Jones fractures pathophysiology and treatment. JBJS Rev 3(7):e4 Lawrence SJ, Botte MJ (1993) Jones’ fractures and related fractures of the proximal fifth metatarsal. [jeo-esska.springeropen.com]

The removable cast allows for physiotherapy treatment, which is aimed at preventing stiffness in the ankle joint. The foot will have to be in the non-weight bearing cast for 6-8 weeks. [tsrinjurylaw.com]

It is not the fractured area immobilised, but the causal movement of the mechanism of injury (usually inversion) is prevented. [ediss.uni-goettingen.de]

Because of the swollen foot and fracture comminution, an operation using the Ilizarov mini external fixator was performed to prevent further damage to the soft tissue. [ncbi.nlm.nih.gov]

Risk factors and prevention Not much can be done to prevent an injury to the metatarsal if a large force is applied to the foot in a traumatic incident. However, wearing the appropriate footwear can provide some protection. [orthopaedicsone.com]

How can I help prevent a fifth metatarsal fracture? Most foot fractures are caused by accidents that are not easy to prevent. However, shoes that fit well and give good support can help prevent injury. Developed by RelayHealth. [summitmedicalgroup.com]

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