Broken metatarsal

A broken metatarsal is a fracture of one or more metatarsal bones. The medical term for a fracture of one of the metatarsals is metatarsal fracture.

The foot consists of no fewer than 28 bones. From the ankle there are first the tarsal bones, then the metatarsal bones and finally the toes. There are five metatarsal bones in each foot. The medical term is metatarsalia. Below we describe how a fracture can occur and which treatment options there are.

How does a broken metatarsal occur?

Repeated or prolonged loading of the foot, for example during long hikes, can lead to a stress fracture of one of the metatarsals. Traditionally this fracture is also called a stress or march fracture. This name refers to the fracture that can occur in soldiers after marching for a long time. Such a stress fracture in the foot most often occurs in the middle of the second or third metatarsal.

A hard collision of the forefoot or an object that falls on the foot can also lead to a fracture. Other possible (medical) causes that increase the risk of a broken metatarsal are a congenital foot deformity, rheumatism or osteoporosis. Finally, poor or worn-out shoes and an incorrect foot roll-off during walking are increased risks of a fracture.

Characteristics of a broken metatarsal

The most common feature of a broken metatarsal due to a stress fracture is a difficult-to-describe pain in the forefoot. This is usually a dull pain. This pain is usually felt suddenly while walking. At the site of the fracture, the foot may redden, swell and feel warm.

The pain complaints worsen with a lot of walking or standing or by pressing on the painful area. Wearing sturdy shoes may reduce the pain somewhat.

The pain often leads to a different foot roll-off while walking. This gives an increased muscle tension and possibly muscle pain in the lower leg.

How is a broken metatarsal diagnosed?

The patient's account, combined with physical examination by the GP or physiotherapist, can point to a broken metatarsal. The fracture must then always be investigated by a specialist.

It is important to know that a broken metatarsal is by no means always visible on an X-ray. In many cases the fracture only becomes visible when it is healing or when the fracture worsens. Even though an X-ray is still used first to investigate a fracture, a broken metatarsal can therefore in some cases be missed during the examination.

The specialist may choose to carry out further examination via ultrasound imaging or a CT scan and, if complaints persist, an MRI scan.

Treatment of a broken metatarsal

Unlike other fractures in the body, a broken metatarsal is by no means always put in plaster. Often a supportive insole or splint is sufficient to walk without pain. Clear advice is given to rest the foot as much as possible in the first six weeks. This enables the fracture to heal as well as possible.

In rare cases it is necessary to treat the fracture surgically. If the X-ray shows that the bone fragments are misaligned, an operation will be necessary to correct this. The surgeon fixes the bone fragments with metal plates and screws.

After the rest period it is important to restore mobility of the foot and to build up muscle strength and conditioning again. A physiotherapist helps with this. They focus the therapy on an improved foot roll-off and muscle strength of the foot. Frequently used treatment forms include mobilisations, exercise therapy, medical taping and, if necessary, massage of the shin and calf muscles.

Finally, it is important to identify the cause so that recurrence can be prevented. For example by adjustments to the shoes, the walking pattern and the training build-up.