The following information does not replace a physician’s diagnosis and advice under any circumstances whatsoever.

Metatarsus fracture

Metatarsus fracture: What’s that?

The skeleton of the human foot consists of a total of 26 bones and 2 sesamoid bones. Via the anatomical structure, they form the arch of the foot (longitudinal and transverse arch of the foot) together with muscles and ligaments, which distributes the body weight forces optimally when burdened, e.g. when walking upright. If parts of these anatomical structures are injured, the physiological balance between external load and individual strain of the foot is disturbed. As a consequence, permanent damages to the bone, the muscles and tendon system are incurred. Therefore, it is important to support an injury (e.g. bone fracture) in the foot region as well as possible.

Figure 1: Osseous foot skeleton structures

The osseous foot structures can be split to the following areas:
  • Forefoot
  • Metatarsus
  • Tarsus
  • Talus
  • Calcaneus

Cause of a metatarsus fracture

As for all bone fractures, also metatarsus breaks or metatarsal fractures normally arise from direct or indirect trauma. The ailment osteoporosis can also play a role. In case of exaggerated burdening of the metatarsal, e.g. long walks or high sports burdens, a fatigue fracture may also arise.

The most frequent fractures are incurred on the 5th metatarsus bone and can normally be treated functionally conservatively as isolated fractures with good results.1

Symptoms of a metatarsus fracture

A metatarsus fracture can already be painful when standing upright without any special burdens. To compensate this pain, patients affected normally assume a relieving posture. This can lead to overburdening of further anatomical joint structures, e.g. to pelvic obliquity. Moreover, pressure pain in the metatarsal region as well as swellings and internal bleeding are characteristic. The precise location of the pain depends on the type of the fracture.

Can metatarsal fractures be prevented?

Primarily, the fractures resulting from indirect physical influences can be prevented. Healthy nutrition rich in minerals and vitamins as well as targeted, regular training, such as the BORT ankle joint exercises (german version) strengthen the bones and muscles. Moreover, vibration training can increase the mineral content of the bones. This helps the body to minimise the injury and fracture risk.

Diagnosis of a metatarsal fracture

Your treating physician will initially create a case history (questions regarding the course of the accident) and a physical examination. Depending on the region concerned on the metatarsal, further examinations may provide clarification for confirmation of the diagnosis. They may include imaging procedures such as MRI, CT or scintigraphy.

Therapy of a metatarsus fracture

Metatarsal fractures can be treated both conservatively and operatively.

A conservative therapy (therapy without an operation) is very often applied and is aimed at being able to burden the affected foot pain-free again as soon as possible. Your physician will immobilise the broken foot for approx. 6-8 weeks. This is normally done using a brace, for example the BORT X-Walker short. In order to avoid burdening the foot affected, crutches can additionally be prescribed.

Adapted to the course of therapy, the foot can slowly be burdened again in-part (e.g. up to 20 kg weight) You can practise using the correct partial burden weight, for example, with an analogue pair of bathroom scales. The treating therapeutic team will determine the precise course of this exercise.

If the type of break requires operative intervention, the exact procedure will be discussed with the treating physician. After the operation, your physician will initially immobilise the foot concerned in order to secure the results. Here, either a classical plaster cast or a brace such as the BORT X-Walker short can be used.

Following the healing process, in accordance with the conservative therapy, the foot can be partially burdened. Depending on the extent of the swelling, medical compression stockings such as the BORT AktiVen® medical compression stockings can take effect by reducing pain whilst reducing the thrombosis risk.
In both cases, the treating physician decides on the best individual therapy jointly with the patient and the team of therapists.

1 Reference: Klos, K., Randt, T., Simons, P. & Knobe, M. (2019). Vor- und Mittelfußfrakturen beim Erwachsenen. Orthopädie und Unfallchirurgie up2date, 14(01), 63-89. DOI: 10.1055/s-0044-101766