Types Of Metatarsal Fractures:
The metatarsal bones are some of the most commonly fractured (broken) bones in the foot. There are two main types of metatarsal fractures:
- Acute fractures - due to an acute (sudden) injury to the foot (commonly dropping a heavy object onto the foot, a fall, or a sporting injury)
- Stress fractures - due to overuse, or repetitive, injury to a normal metatarsal bone
The fifth metatarsal bone is the most common metatarsal bone that is fractured in acute (sudden) injury to the foot. However, other metatarsal bones may also be broken. The first, second and fifth metatarsals are the most commonly injured in sport. Several English footballers including David Beckham and Wayne Rooney have had metatarsal fractures in recent years.
The fifth metatarsal bone may be broken at various points along its length, depending on the mechanism of injury causing the fracture. Briefly, the fifth metatarsal bone has a base (nearest to the heel of the foot), a tuberosity (a bony prominence that protrudes from the base), a shaft (the main body of the bone), a neck and a head.
Acute metatarsal fractures can also be displaced or nondisplaced. If the fracture is displaced, the bone is broken in such a way that it has changed, or moved, its position
Symptoms Of Acute Metatarsal Fracture:
- Acute pain at the point of trauma.
- Rapid swelling.
- Inability to weight bear.
- There may be deformity in the foot.
- Bruising will usually develop within 24 hours.
A stress fracture is a type of incomplete fracture in a bone. Stress fractures tend to occur as a result of overuse and are known as 'overuse injuries'. A metatarsal stress fracture is a stress fracture in one of the metatarsal bones in the foot. Historically, a metatarsal stress fracture has been called a march fracture because it was seen in soldiers who were marching for long periods of time. However, metatarsal stress fractures are not only seen in military recruits. They are commonly seen in athletes (especially runners), ballet dancers and gymnasts. Metatarsal stress fractures can affect anyone: not just olympic athletes. They are seen in runners of all levels.
Causes Of Stress Fractures
- Too much training, too soon without enough rest!
- They are common in army recruits (often called a march fracture), runners, ballet dancers and gymnasts.
- Foot metatarsal pain which comes on gradually.
- Pain is located towards the mid/front of the foot.
- Pain is aggravated by weight bearing activities such as walking, running or dancing.
- Pain to touch the bone at the point it is broken.
- Swelling is often present.
- An X-ray will often not show the fracture until two or three weeks after it has started to heal.
X-rays will be taken of the foot to confirm a fracture.
Treatment Protocol For Metatarsal Fracture
- Rest from weight bearing activities as much as possible.
- For those whose job requires them to weight bear, a walking boot may be used.
- The rest period should normally be around 4 weeks to allow sufficient healing.
- Recommence activities only once all pain on touch and walking have cleared.
- Start with a very slow return to activity and a gradual build of duration and intensity.
- If the stress fracture may have been caused by abnormal foot mechanics such as overpronation or oversupination then orthotics may be required to correct this.
Ankle range of motion
Start by moving the ankle through its full range of motion, you can do this using ankle circles or by writing the alphabet with your toes! Try to practice doing this on a regular basis to help reduce stiffness and also to ease swelling and increase blood flow to the injury.
Toe range of motion
Point your toes up and then down as far as possible. Hold each position for a few seconds and then reverse. Try to spread your toes apart as far as possible and then to scrunch them up as well. Hold for a few seconds, before reversing the movement.
It is common for the calf muscles to tighten up after any injury, especially if a period of immobilisation or reduced weight bearing is required. Stretch both calf muscles regularly every day:
To stretch the Gastrocnemius, stand with a wide stance, with the leg to be stretched at the back. Keep the heel on the floor and the knee straight as you lean forwards. When you feel a stretch in the calf, hold this position for 20-30 seconds. If the stretch fades in this time, then lean a little further forwards until you can feel it again,
To stretch the Soleus muscle, Stand with a narrower stance, still with the leg to be stretched at the back and the heel down. This time, bend both knees as if trying to squat down, you should feel a stretch lower down the calf, around the achilles tendon. Again hold for 20-30 seconds and maintain that stretching feeling.
Repeat both stretches 2-3 times and several times a day.