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Metatarsal Fractures

By Danielle Campagne, MD , University of San Francisco - Fresno

Fractures may occur in the long bones in the middle of the foot (metatarsal bones).

There are several different kinds of metatarsal fractures.

Stress Fractures

Stress fractures are incomplete breaks in the bone caused by repeated stress rather than a single injury.

A stress fracture of the metatarsals can occur when people walk or run a long time (see Stress Fractures of the Foot), as when they suddenly start exercising longer or more intensely.

Symptoms

The affected area of the metatarsal bone is tender to the touch. Putting full weight on the foot increases the pain.

Diagnosis

  • X-rays

Stress fractures may not be seen on x-rays if they are small or if the x-rays are taken soon after the fracture occurred (before the bone starts to repair itself).

Treatment

  • Avoidance of activities that aggravate the fracture

  • Crutches

  • Sometimes a protective shoe or boot or a cast

When a developing stress fracture is recognized early, stopping activities that aggravate the fracture and using crutches may be the only treatment necessary.

People may need to wear a special protective walking shoe or boot. Sometimes a cast is necessary.

Lisfranc Fracture-Dislocation

A Lisfranc fracture is a complete break in the 2nd metatarsal bone, which connects the 2nd toe to the bones at the back of the foot. A Lisfranc fracture-dislocation occurs when the broken pieces of bone are separated from each other (dislocated).

In a Lisfranc fracture-dislocation, the 2nd metatarsal bone is fractured at its base, and the broken pieces may be separated from each other (dislocated). Lisfranc fracture-dislocations usually occur when people fall on a foot that is flexed or when the foot is hit with severe force. This injury is common among football players, motorcyclists, and horseback riders.

Fracture of the 2nd Metatarsal Bone

The 2nd metatarsal is broken near its base, and the broken pieces are separated from each other (dislocated). This injury is called Lisfranc fracture-dislocation.

Symptoms

The middle of the foot becomes painful, swollen, and tender. The foot may look short, and the bottom of the foot may be bruised.

Lisfranc fracture-dislocation is serious and can result in permanent pain and arthritis. Compartment syndrome (see Compartment Syndrome) can develop. People may have problems participating in strenuous activities for the rest of their life.

Diagnosis

  • X-rays

  • Usually computed tomography

X-rays are taken, but the injury may be difficult to see. Usually, computed tomography (CT) is also needed. It can provide more detailed, three-dimensional images of the injury.

Treatment

  • Referral to an orthopedic surgeon

  • Surgery to realign the broken bones or fusion of the bone in the foot

People are usually admitted to a hospital and seen by an orthopedic surgeon as soon as possible.

Open reduction and internal fixation (ORIF—see Surgery) or fusion of the bones in the middle of the foot is usually required, but these procedures do not always restore the foot to its previous condition.

Fractures of the 5th Metatarsal Bone

(Jones Fracture; Dancer's Fracture; Pseudo-Jones Fracture)

Fractures of the 5th metatarsal bone occur in the bone that connects the little toe to the bones at the back of foot.

The 5th metatarsal bone is the most commonly fractured bone in the foot. These fractures usually occur

  • At the base of the metatarsal (near the ankle)

  • In its shaft (the long middle part) of the metatarsal

Fractures of the base

The base can be broken when the foot turns inward or is crushed. These fractures are sometimes called dancer's or pseudo-Jones fractures.

The outside edge of the foot is painful, swollen, and tender. A bruise may develop.

If doctors suspect a fracture of the base, they take x-rays from several different angles.

Crutches and a protective hard-soled walking shoe or boot may be needed for a few days. A cast is not usually necessary. People are encouraged to walk as soon as they can tolerate it. Usually, these fractures heal relatively quickly.

Fractures of the shaft

The shaft often fractures near the base. These fractures, called Jones fractures, are less common than fractures of the base.

Jones and Pseudo-Jones Fractures

Because these fractures can disrupt the blood supply to the bone, complications are more likely. For example, the bone may not grow back together (called nonunion), or it may grow back very slowly (called delayed union).

Usually, a short leg cast is applied to immobilize the ankle, and people must use crutches and not put any weight on the foot for 6 weeks. Sometimes surgery is needed, and people are referred to an orthopedic surgeon. Open reduction with internal fixation (ORIF) may be done (see Surgery).

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