Metatarsal Fracture

$metatarsal fracture$

From Andrews JR, Harrelson GL, Wilk RE: Physical Rehabilitation
of the Injured Athlete, 2nd ed. Philadelphia, WB Saunders, 1991, p. 320.

Description
Metatarsal fracture is a broken bone (fracture) in the middle of the foot. The mid-foot bones are very important in maintaining the arch 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 usually does not heal well.

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)

Treatment
If the bones are in appropriate position, the 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.

RICE Principle
With all acute injuries, follow the RICE principle to reduce swelling, pain and inflammation.

Rest- Walk with crutches if you cannot bear weight or it is very painful.
Ice- Use an ice pack for 20 minutes every two to three hours during the first 72 hours.
Compression- Use an ace wrap. Start at the toes and wrap up above the ankle.
Elevation- Keep the injured leg above the level of the heart when you are sitting or lying down