Metatarsal fracture management

Abstract

Metatarsal fractures represent a significant proportion of all foot injuries. Patients present with pain and difficulty with ambulation either after a traumatic insult or an increase in activity level. Diagnosis requires a foot X-ray series and tarsometatarsal injuries may need to be excluded with a CT. Management is determined by patient factors and fracture pattern. The aim of treatment is to preserve the longitudinal and transverse arches of the forefoot and restore the alignment of the metatarsals to achieve normal weight distribution. Open fractures, fractures with sagittal plane displacement more than 10° or with 3–4 mm displacement in any other plane may benefit from surgical intervention. The majority are minimally displaced and can be treated with a walking boot or hard-soled shoe with arch support or non-weight bearing in a short leg cast for 6–8 weeks. Any suggestion of instability or displacement for the first metatatarsal will require surgical treatment. Proximal fifth metatarsal fractures have differing treatments depending on the location of the fracture.