Edit concept Question Editor Create issue ticket

Metatarsal Fracture

Metatarsal Fractures

Metatarsal fracture refers to the disruption of the physical integrity of any one or multiple of the five metatarsal bones. The metatarsal fracture may result from blunt trauma, possibly sustained in motor vehicle accidents. Stress fractures of the metatarsal bones are increasingly seen in athletes who subject their feet to repetitive, heavy impacts. Fractures of the metatarsal bones may also be related to systemic diseases like osteopenia and osteoporosis.


Presentation

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].

Gangrene
  • Compartment syndrome Complex regional pain syndrome (CRPS or RSD) Nerve injury Numbness Weakness Loss of muscle control Tendon injury or disruption of tendon function Circulation disturbance of soft tissues or bone (including avascular necrosis of bone) Gangrene[thrive.kaiserpermanente.org]
Aspiration
  • […] fractures at the diaphysis (diaphyseal stress fractures). 1 O’Malley and colleagues published the largest review of Zone 2 and 3 fractures in NBA players. 2 The review consisted of 10 players with seven having percutaneous internal fixation with bone marrow aspirate[podiatrytoday.com]
  • In the meantime the Dallas offense will have to make due without a key piece of their aerial attack as a team with title aspirations looks to make a run at Super Bowl 50.[instreetclothes.com]
  • The effect of concentrated bone marrow aspirate in operative treatment of fifth metatarsal stress fractures; a double-blind randomized controlled trial. BMC Musculoskelet Disord. 2015 Aug 20. 16:211. [Medline].[emedicine.medscape.com]
Ulcer
  • Charcot neuroarthropathy is a progressive, noninfective, inflammatory destruction of bones and joints leading to foot deformities and plantar ulceration.[ncbi.nlm.nih.gov]
  • Talk with your health care provider before using these medicines if you have heart disease, high blood pressure, kidney disease, liver disease, or have had stomach ulcers or internal bleeding in the past.[nlm.nih.gov]
Foot Pain
  • 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]
  • 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]
Metatarsalgia
  • 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]
  • […] 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]
  • Chou, “Surgical Management for Intractable Metatarsalgia,” Foot and Ankle International, Vol. 16, No. 6, 1995, pp. 322-327. [ 3 ] A. E. Sanchez, C. V. Vicent, P. Alcantara and A. J.[dx.doi.org]
  • 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
  • […] bones, Fracture metatarsal bone and/or tarsal bone (& one or more) (disorder), Fracture 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[fpnotebook.com]
  • , Fracture metatarsal bone and/or tarsal bone (& one or more) (disorder) , Fracture 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[fpnotebook.com]
Osteopenia
  • Fractures of the metatarsal bones may also be related to systemic diseases like osteopenia and osteoporosis.[symptoma.com]
  • Lack of bone accretion and amenorrhea: evidence for a relative osteopenia in weight-bearing bones. J Clin Endocrinol Metab 1991;72:847–53. PubMed Google Scholar 8. Seeley DG, Kelsey J, Jergas M, Nevitt MC.[link.springer.com]
Bone Disorder
  • […] bones, Fracture metatarsal bone and/or tarsal bone (& one or more) (disorder), Fracture 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[fpnotebook.com]
  • , Fracture metatarsal bone and/or tarsal bone (& one or more) (disorder) , Fracture 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[fpnotebook.com]
Irritability
  • A "high and inside" approach that remains superior to the superior border of the PBT is anatomically safe and may decrease the chance of intraoperative nerve injury and irritation postoperatively.[ncbi.nlm.nih.gov]
  • Vamp disease is a colloquial term for irritation over the top of the foot, and it sometimes happens when runners wear sneakers that are too tight.[runnersworld.com]
  • Corrective exercises and strengthening can then be prescribed to prevent further irritation.[physioroom.com]
Dystonia
  • Abstract We report a 45-year-old man with a 4-year history of Parkinson's disease complicated by the development of left-foot dystonia resulting in a fracture of the fifth metatarsal.[ncbi.nlm.nih.gov]

Workup

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.

Treatment

  • Our results suggest that the Ilizarov mini external fixator should be considered not only for temporary treatment, but also for the entire duration of treatment of first metatarsal fractures associated with severe soft tissue damage.[ncbi.nlm.nih.gov]
  • Although drug-induced dystonia is a common side effect of pharmacological treatment of Parkinson's disease, this is the first report of a fracture related to these abnormal movements.[ncbi.nlm.nih.gov]
  • NEXT: Treatment Options › Treatment Options The first metatarsal, which connects to the big toe, is the most important and fractures of the first metatarsal usually require surgery.[mdmercy.com]
  • A foot and ankle surgeon should be seen for proper diagnosis and treatment, even if initial treatment has been received in an emergency room. What Is a Fracture? A fracture is a break in the bone.[foothealthfacts.org]

Prognosis

  • 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]
  • 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]
  • Anyone else fractured their 5th and if so what was the prognosis and what happened. I guess I am sceptical on the diagnosis and the lack of follow up care and am wondering if I should get a second opinion.[hitched.co.uk]
  • 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]

Etiology

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

Epidemiology

  • BACKGROUND: A paucity of data exists studying the epidemiology of fifth metatarsal fractures.[ncbi.nlm.nih.gov]
  • […] 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]
  • Epidemiology of Lower Extremity Stress Fractures in the United States Military. Mil Med. 2016 Oct. 181 (10):1308-13. [Medline]. Hetsroni I, Nyska M, Ben-Sira D, Mann G, Segal O, Maoz G, et al.[emedicine.medscape.com]
  • Epidemiology of age-related fractures. In: Avioli LD, editor. The osteoporotic syndrome: detection, prevention and treatment. New York: Grune and Stratton, 1983:45–72. Google Scholar 15.[link.springer.com]
Sex distribution
Age distribution

Prevention

  • 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]
  • 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]
  • Prevention of Metatarsal Fractures This type of injury can be very hard to prevent because it is usually caused by sudden direct trauma to the foot.[medic8.com]
  • Metatarsal Fracture Prevention If the force applied to the foot during a traumatic incident is high then there is very little that can be done to prevent a Metatarsal fracture.[physioroom.com]

References

Article

  1. Kahanov L, Eberman LE, Games KE, Wasik M. Diagnosis, treatment, and rehabilitation of stress fractures in the lower extremity in runners. Open Access J Sports Med. 2015; 6:87-95.
  2. Hetsroni I, Nyska M, Ben-Sira D, et al. Analysis of foot structure in athletes sustaining proximal fifth metatarsal stress fracture. Foot Ankle Int. 2010; 31(3):203-211.
  3. Roehrig GJ, McFarland EG, Cosgarea AJ, Martire JR, Farmer KW. Unusual stress fracture of the fifth metatarsal in a basketball player. Clin J Sport Med. 2001; 11(4):271-273.
  4. Lee KT, Kim KC, Park YU, Kim TW, Lee YK. Radiographic evaluation of foot structure following fifth metatarsal stress fracture. Foot Ankle Int. 2011; 32(8):796-801.
  5. Pradhan P, Saxena V, Yadav A, Mehrotra V. Atypical metatarsal fracture in a patient on long term bisphosphonate therapy. Indian J Orthop. 2012; 46(5):589-592.
  6. Tung TS. Metatarsal Shaft Fracture with Associated Metatarsophalangeal Joint Dislocation. Case Rep Orthop. 2016; 2016:9629585.
  7. Ferguson KB, McGlynn J, Jenkins P, Madeley NJ, Kumar CS, Rymaszewski L. Fifth metatarsal fractures - Is routine follow-up necessary? Injury. 2015; 46(8):1664-1668.
  8. Lawrence SJ, Botte MJ. Jones' fractures and related fractures of the proximal fifth metatarsal. Foot Ankle. 1993; 14(6):358-365.
  9. Polzer H, Polzer S, Mutschler W, Prall WC. Acute fractures to the proximal fifth metatarsal bone: development of classification and treatment recommendations based on the current evidence. Injury. 2012; 43(10):1626-1632.
  10. Dobrindt O, Hoffmeyer B, Ruf J, et al. MRI versus bone scintigraphy. Evaluation for diagnosis and grading of stress injuries. Nuklearmedizin. 2012; 51(3):88-94
  11. Moran DS, Evans RK, Hadad E. Imaging of lower extremity stress fracture injuries. Sports Med. 2008; 38(4):345-356..
  12. Ochenjele G, Ho B, Switaj PJ, Fuchs D, Goyal N, Kadakia AR. Radiographic study of the fifth metatarsal for optimal intramedullary screw fixation of Jones fracture. Foot Ankle Int. 2015; 36(3):293-301.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2018-06-22 04:56