METATARSAL FRACTURE VARIATIONS
A. Metatarsal Base Fractures
B. Jones/5th Metatarsal StressFractures
C. Lis Franc Fracture Dislocations
D. Metatarsal Neck/Shaft Fractures
E. Metatarsal Stress Fractures
A.Metatarsal Base Fractures
The metatarsal base is the back end of the metatarsal bone away from the ball of the foot. Fractures in this area can be stress related (stress fracture) or can occur from a traumatic event. They can also be associated with Lisfranc injuries. One or more of the metatarsals may be fractured at the same time.
They are more common in sports activities such as football. They can also occur in dances who are unconditioned and develop stress to the base of the bone, which causes a small fracture.
These base fractures are most often nondisplaced and can be treated conservatively with a cast or boot. Patients are going to remain nonweightbearing until the fracture heals. When displaced, surgery may be necessary to help realign the bone and put it in its proper position. Surgery can be done with small percutaneous pins placed directly through the skin so that the fracture does not have to be open. If the fractures are more moderate or severely displaced, an open reduction and internal fixation with pins, small plates and screws may be needed. The most critical metatarsal fracture is usually the second metatarsal.
Signs and Symptoms of these fractures are usually swelling over the top of the foot and difficulty weightbearing. If swelling and discoloraiton extend to the arch, then multiple fractures or a Lisfranc injury may be suspected. X-rays are taken to evaluate the fracture. If the fracture extends into the joint, CT scans may be needed to fully evaluate the injury. If a fracture is not obvious on an x-ray, then an MRI may be needed to evaluate the injury.
Non-Union 5th Metatarsal Base Fracture Treated with Removal of Fracture Fragment and Anchoring of Peroneus Brevis
B.Jones/5th Met Stress Fractures
Jones fractures are fractures of the fifth metatarsal that occur in an area of the fifth metatarsal that has a poor blood supply. Jones fractures are more common in active people and are very common in football, basketball and soccer players. These fractures have often been described as excessive stress to the fifth metatarsal, especially with the foot pointed in a down position in which the ankle also rolls to the outside. This is also commonly seen in athletes that have a high arch foot or ones that have the front part of the foot turned in relative to the back part of the foot (met adductus).
Pain in the fifth metatarsal in an athletic person should often be evaluated relatively quickly after it is felt. Stress to the fifth metatarsal may weaken the bone, predisposing it to more simple trauma that can break the bone in an area with poor circulation. Initial x-rays may be necessary but if the clinical exam is consistent with an injury, MRIs may be necessary to further evaluate the injury. If MRLs do show that there is bone marrow edema then this injury should be treated with a period of immobilization to allow the area to heal. Failure to address this when it is in a pre-fracture stage may predispose the athlete to further injury.
If the x-ray does show that the bone has fractured in the region with poor circulation, conservative and surgical treatment options are offered. Conservative care includes a nonweightbearing cast for eight weeks. A return to sports may be 3-4 months. There is a high risk of refracture to this area in athletes with a high arch foot. In those patients, surgical treatment may be performed initially to allow the fracture to heal more rapidly and return the athlete back to their sporting activity. This would require nonweightbearing for six weeks in a boot. Athletes can usually return to activity following the use of screw fixation in approximately 10-12 weeks. If the foot has an excessively high arched posture in which the heel bone is turned under, surgery in the rearfoot may also be necessary at the same time to get the heel bone straight and take stress off of the outside of the foot. A procedure on the heel bone usually recovers more quickly than the procedure on the metatarsal.
Surgery when performed is done on an outpatient basis under a twilight anesthetic. An incision approximately 1/4" is placed on the side of the foot. Through this incision a small pin is placed into the bone. A screw is then applied over the pin to compress the fracture and allow it to heal more rapidly. The size of the screw depends on the size of the bone. We usually employ a 4.5 mm titanium screw in females. In athletic males who have a much larger bone screws that are 5.5 mm to 7.0 mm may be necessary. In athletes we prefer solid screws over partially threaded screws. We have had great long-term success in healing patients with these fractures. Patients are typically allowed to bathe 2-4 days after the procedure, as only one stitch is used. Although they are nonweightbearing they can get into the gym very quickly and work their upper body. Leg extensions and leg curls can also be performed. We have found a period of nonweightbearing for six weeks is typically best. However, x-rays and clinical exams are important to assess how the patients are healing. A return to walking in a boot is usually performed at week 7 or 8. If the fracture is healing as expected sneakers and an orthotic device in their shoes utilized in running can begin between 8 and 12 weeks depending on the clinical exam and x-rays. A return to active sports may take 10 or more weeks. We typically do not allow athletes to return sooner fear of reinjury to the bone or fracturing the screw.
Jones fractures can often go on to delayed union. This means that the fracture is not healing inthe expected time. In those cases bone stimulators may be used to help accelerate the healing process. In some cases this fracture may go on to a nonunion. Nonunions of the fifth metatarsal can become very painful and cause a disability in a running athlete. It will most often require surgery to remove the areas of the bone that are devoid of blood supply. A bone graft is then applied to the fracture and a small plate or screw is utilized to stabilize the fractured area. Nonweightbearing for 8-12 weeks would be mandatory. Long-term prognosis is excellent. If thereis a foot deformity that predisposes the patient to increased stress to the fifth metatarsal, surgery would be necessary in these other areas to unload the fifth metatarsal more permanently.
Jones Fracture Pre and Post Percutaneous Screw Fixation on a23 year old Professional Soccer Player (Below)
Jones Fracture Status Post Percutaneous Screw Fixation
Jones fractures are specific in that they occur at the base of the 5th metatarsal occurring away from the articular surface, and are a common injury in certain sports such as basketball. These fractures are precarious in their character in that the area of the bone in question where the fracture takes place which has less blood supply than the remainder of the bone, therefore compromising healing potential of this area.
Preop and Postop Metaphyseal Diaphyseal Stress Fracture Fifth Metatarsal Percutaneous Screw Fixation
Preop Photos of Jones Fracture prior to fixation
These X-rays of the foot after surgical repair of the Jones Fracture which is important to stabilize this fracture not only for adequate healing but also because of soft tissue structures such as ligament and tendon that attach to the base of the 5th metatarsal.
Preop and Postop Percutaneous Fixation Jones Fracture
Preop and Postop X-rays of a Jones Fracture.
The first two images are prior to percutaneous screw fixation
The following two images are after percutaneous screw fixation
Diaphyseal stress fractures before and after percutaneous screw fixation
Preop and Postop Jones Fracture Repair
Series of Jones repair with Percutaneous Screw
Pics of the Fracture prior to repair
Intraop pics after percutaneous screw fixation
Intraop pics of 5th metatarsal metaphyseal-diaphyseal stress fracture during repair. We clean out the nonunion fracture and then applied bone graft from the patient's heel into the void to stimulate healing. A screw is then placed across the fracture site.
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FAQs
Do you need physical therapy after broken metatarsal? ›
You may be wondering why physical therapy is necessary if the fracture has healed. When you fracture a bone, you will need to rest the area in order for the bone to heal. During this time, you will likely lose strength, mobility, and flexibility in the area. Physical therapy will help you regain these abilities.
How long should a broken metatarsal take to heal? ›A metatarsal fracture may take from 6 weeks to several months to heal. It is important to give your foot time to heal completely, so that you do not hurt it again. Do not return to your usual activities until your doctor says you can.
How long do you wear a boot for a metatarsal fracture? ›This is a common fracture. You will be given a removable boot to wear to support your foot; this should be used for two to six weeks to enable you to walk more comfortably whilst the injury heals. You only need to wear this when standing or walking, you can remove it at rest, at night and when bathing or showering.
When can you start walking after a metatarsal fracture? ›As you recover, your provider will instruct you to begin moving your foot. This may be as soon as 3 weeks or as long 8 weeks after your injury. When you restart an activity after a fracture, build up slowly. If your foot begins to hurt, stop and rest.
How can I speed up the healing of a broken metatarsal? ›- Elevating your foot while seated.
- Icing your foot for 20 minutes a day as needed, after your injury and before treatment.
- Keeping weight off your foot for the time recommended by your provider.
- Quitting smoking and/or using tobacco products which can help speed your healing time.
In general, a fracture should be healed by about eight weeks after the injury with adequate physical therapy 5. However, a patient's rehabilitation timeline will vary depending on the type of fracture and a patient's age and fitness level, among other factors.
Should I keep my walking boot on all day? ›If supplied, wear the boot for comfort and use crutches when walking. It is ok to take the boot off at night, when resting at home and to wash. Regularly perform the exercises below to get your movement back.
What are the side effects of wearing a walking boot? ›Moisture can collect under the boot and cause skin irritation and itching. If you have a wound or have had surgery, moisture under the boot can increase the risk of infection. If your doctor says to keep your boot on to shower, protect it so that it won't get wet.
Is it OK to walk on a broken metatarsal? ›A patient with a broken metatarsal may be able to walk, depending on how painful the injury is. Despite this, the patient with a metatarsal fracture is advised to avoid excessive walking, especially on uneven ground, to eliminate the risk of displacement.
Is a walking boot weight bearing? ›Physicians routinely prescribe partial weight bearing in a walking boot following fractures of the lower limbs in order to produce the needed mechanical environment to facilitate healing. Plantar pressure measurements can provide key information regarding the mechanical environment experienced by lower limb bones.
Can you wear walking boot for 5th metatarsal fracture? ›
You should remain immobilized in a walking boot/post-op shoe until 4 weeks from the initial injury. You are allowed to fully weight bear as tolerated in the walking boot/post-op shoe.
How long should you stay off a fractured foot? ›| Healing: | This injury normally takes 6 weeks to heal. |
|---|---|
| Pain and Swelling: | The swelling is often worse at the end of the day and elevating your foot will help. Take pain killers as prescribed. |
Metatarsalgia can have a number of different causes, including wearing unsupportive footwear, conditions such as arthritis, and doing high-impact sports. It can be very uncomfortable and interfere with your normal activities, but will often improve with some simple self-help measures.
What are the best shoes to wear after a broken foot? ›What shoes do orthopedic surgeons recommend? An orthopedic surgeon would highly recommend post-op shoes such as United Ortho Short Air Walker Fracture Boot or BraceAbility Closed Toe Medical Walking Shoe for a foot injury or Kefit Fracture Boot for an ankle injury.
What do doctors do for a broken metatarsal? ›Definitive Treatment
Most nondisplaced metatarsal shaft fractures require only a soft elastic dressing or firm, supportive shoe and progressive weight bearing. A postoperative shoe or cast boot may be necessary if the foot is too swollen for ordinary shoes.
It is commonly believed that the only nutrients needed for healthy bones and, therefore, the only ones that can enhance the fracture healing process are vitamin D and calcium [58].
How do I know my fracture is healing? ›When you touch the fractured area, the pain will lessen as the fracture gets more solid. So, one way to tell if the broken bone is healed is for the doctor to examine you – if the bone doesn't hurt when he touches it, and it's been about six weeks since you broke it, the bone is most likely healed.
What slows down bone healing? ›Smoking and high glucose levels interfere with bone healing. For all patients with fractured bones, immobilization is a critical part of treatment because any movement of bone fragments slows down the initial healing process.
When should you stop physical therapy? ›In general, you should attend physical therapy until you reach your PT goals or until your therapist—and you—decide that your condition is severe enough that your goals need to be re-evaluated. Typically, it takes about 6 to 8 weeks for soft tissue to heal, so your course of PT may last about that long.
Do you need physical therapy after walking boot? ›Physical therapy will help to strengthen and stabilize your ankle joint after an injury, especially after a period of immobilization. You might notice when you are taken out of a cast or cam boot that your calf is significantly smaller compared to your other leg.
Do I need physical therapy after fracture? ›
Fractures often result in damage to the soft tissues along with the damage to the bone. Even after your bones are healed thanks to the Vibone bone funnel, you will still need to re-strengthen the area through physical therapy. Physical therapy is vital to promoting flexibility and strength where the damage was done.
Do you need to wear a sock with a walking boot? ›Adding a sock to the equation is a good idea for a few reasons: It will help reduce any friction between the brace and your skin, which can help prevent any chafing or blisters. Socks for walker boots can act as a buffer between your foot (and its sweat and dead skin cells) and the brace.
How tight should walking boot be? ›Tighten the straps so they are snug but not too tight. The boot should limit movement but not cut off your blood flow. If your boot has one or more air chambers, pump them up as directed by your healthcare provider.
Should your foot hurt in a walking boot? ›The study found that nearly 70% of patients experienced secondary pain (away from the original injury) after wearing the boot. 1 in 3 patients had continued secondary pain 3 months after the device was removed. The secondary pain from the CAM boot can range from a mere annoyance to a severe pain.
What is the difference between a walking shoe and a walking boot? ›Walking boots are better for uphill walking across more treacherous uneven terrain, as most of them offer waterproof protection, ankle support and grip, whereas walking shoes are lighter shoes and more comfortable to walk in for lengthy distances on a flatter and more even ground.
How far can I walk with a boot? ›How far can you walk in a walking boot? For some injuries, no weight-bearing is allowed with the walking boot (at least at the start of the rehab). But if your injury isn't too bad, you may be allowed to walk as much as you want with the walking boot.
What shoes should I wear with a metatarsal fracture? ›Wear Arch Support Sandals or Slippers
It is a good idea to have arch support most of time to prevent the return of the stress fractures. For patients who don't want to wear a shoe around the house, we suggest they consider Vionic Flip Flop Sandals or Vionic Arch Support Slippers.
There is a minor break at the bottom end of your fifth metatarsal (bone of the foot). This is a common injury to have and will normally heal well in four – six weeks. No routine follow-up appointment is necessary as this injury will usually heal with time alone.
Are metatarsal fractures serious? ›Toe and Metatarsal Fractures (Broken Toes)
Broken toes and broken metatarsal bones can be painful, significant injuries. The structure of the foot is complex, consisting of bones, muscles, tendons and other soft tissues. Of the 28...
Skeletal muscle weakness and atrophy occur following an extended period of decreased use, including space flight and limb unloading. It is also likely that affected muscles will be susceptible to a re-loading injury when they begin return to earth or weight bearing.
Can you walk normally in a walking boot? ›
In general, as long as you have crutches or a knee scooter, you can walk as much as you need to in a walking boot. But your options of where you can walk, and what else you can do while walking, are very limited. This is because your upper body isn't used to carry your body weight.
Can you walk in a non weight bearing boot? ›Non-weight-bearing means that no weight can be placed on the operated leg. This is the most restrictive of all weight-bearing limitations. Since you are not able to bear any weight on the leg, an assistive device, such as a walker or crutches, will be necessary for you to walk.
Should I wear my fracture boot all day? ›It is important to place as much weight as possible through the boot when walking to help the healing process. The boot should be worn when walking but can be taken off when you are: resting.
When can I start walking after 5th metatarsal fracture? ›As you recover, your provider will instruct you to begin moving your foot. This may be as soon as 3 weeks or as long 8 weeks after your injury. When you restart an activity after a fracture, build up slowly. If your foot begins to hurt, stop and rest.
Can you make a foot fracture worse? ›A metatarsal stress fracture can become gradually worse if repeated stress to the bone continues.
How do you help a fractured foot heal faster? ›- Rest: Rest is key. ...
- Ice: Ice the area for 20 minutes at a time to help with swelling and inflammation. ...
- Compression: Wrapping the injury helps control swelling.
- Elevation: Keep your foot and ankle raised slightly above the level of your heart to help reduce inflammation.
Central Metatarsal Fractures: i. Non-Displaced: These can be treated in a non-weight bearing cast or CAM walker for 4-6 weeks, followed by progressive weight bearing for another 4-6 weeks. Close radiographic follow up is required at 1 to 2 week intervals in those fractures at risk for displacing.
Is physical therapy required after a broken foot? ›A crucial part of the complete healing process for a broken foot is physical therapy. Exercises to strengthen the muscles in your broken foot are usually started between four to six weeks after the injury. The stages of physical exercise for a broken foot will also include conditioning.
Do you need physical therapy after breaking a bone? ›Fractures often result in damage to the soft tissues along with the damage to the bone. Even after your bones are healed thanks to the Vibone bone funnel, you will still need to re-strengthen the area through physical therapy. Physical therapy is vital to promoting flexibility and strength where the damage was done.
Why is physical therapy necessary after a fracture has healed? ›The goal of physical therapy is to restore full range of motion and functionality. For hairline fractures, physical therapy is a good way to restore strength and flexibility; for more complex injuries physical therapy can be the key to learning how to become mobile again.
Can you make a metatarsal fracture worse? ›
If not recognised and treated then some of these problems can occur: A metatarsal stress fracture can become gradually worse if repeated stress to the bone continues. It can eventually become a full-thickness metatarsal fracture. A fracture of the first metatarsal bone can lead to later arthritis of the big toe joint.
How do I strengthen my metatarsals? ›- Stand at an arm's length away from a wall, placing your hands on it.
- Step forward with one foot, keeping the back heel on the floor with your knee straight.
- Hold the stretch for 30-60 seconds before switching legs.
At the 3-4 week stage the patient will begin to take a more active role in their recovery and begin doing some active assisted exercises and some light strengthening work depending on their pain level. This is to recondition the muscles which will have weakened due to being immobilised.
What happens if you don't do physical therapy after an injury? ›You'll likely experience lingering pain.
Following this treatment plan encourages healing and reduces the risk of chronic pain. If you don't follow through with the PT's recommendations, there's a chance the injury won't heal properly, leaving you with long-lasting aches and extreme pains.
In fact, research shows that being physically active can promote bone healing – and even help you avoid future fractures. Almost 178 million new bone fractures happen worldwide each year.
How do you know if a fracture is fully healed? ›When you touch the fractured area, the pain will lessen as the fracture gets more solid. So, one way to tell if the broken bone is healed is for the doctor to examine you – if the bone doesn't hurt when he touches it, and it's been about six weeks since you broke it, the bone is most likely healed.
Does physical therapy help heal faster? ›Physical therapy for an acute injury can help eliminate pain, assist with the healing, and improve your physical health. This therapy helps heal the injured tissue and facilitates full mobility on its own. In cases where you've already gone through surgery, physiotherapy can help you recover much faster.
Does physical therapy speed up healing? ›Early intervention of physical therapy can speed up the recovery process by decreasing the time the body is able to compensate or perform “bad” movements, leading to increased complications or problems.
What happens if you walk on a fractured metatarsal? ›Walking will be painful if you have a fifth metatarsal fracture. To allow the bone to heal, you shouldn't walk without a cast or a boot and crutches to keep weight off the foot. Walking on a fifth metatarsal fracture could delay or disrupt healing of the bone.
Can you walk with a boot with a metatarsal fracture? ›You will be provided with a removable walking boot. You may walk as much as pain allows. Elbow crutches will be provided if required. Weight bearing through the foot while in the boot improves the rate of healing and reduces your recovery time.
Is compression good for metatarsal fracture? ›
Metatarsalgia and metatarsal stress fractures are best treated by the forefoot compression sleeve. Midfoot pain is best treated by the arch binder or arch binder with metatarsal pad.