Do I need to see a doctor if I suspect metatarsal fracture?
You should seek medical advice if you suspect that you have a metatarsal fracture. A doctor is able to do tests, including imaging, which will suggest the best course of action - not only to make things better as quickly as possible, but also to prevent making things worse.
How are acute metatarsal fractures treated?
This depends on:
- Which metatarsal bone is broken (fractured).
- Which part of the metatarsal bone is broken.
- How severe the damage is.
It also depends on:
- Whether the fractured bone is displaced or non-displaced (see above).
- Whether the tissues of the foot around the break are also badly injured causing the fracture to be an open fracture.
The basic principles of treating metatarsal fractures are as follows.
Applying ice to your foot can also be helpful as pain relief. Ice should be applied as soon as possible after injury, for 10-30 minutes. (Less than 10 minutes has little effect. More than 30 minutes may damage the skin.) Make an ice pack by wrapping ice cubes in a plastic bag or towel, or by using a bag of frozen peas. Do not put ice directly next to skin, as it may cause ice burn. Gently press the ice pack on to the injured part. The cold is thought to reduce blood flow to the damaged area. This may limit pain, inflammation and bruising. Some doctors recommend re-applying for 15 minutes every two hours (during daytime) for the first 48-72 hours. Do not leave ice on while asleep.
Rest and elevate
Elevation initially aims to limit and reduce any swelling. For example, keep the foot up on a chair to at least hip level when you are sitting. When you are in bed, put your foot on a pillow. Sometimes rest is the only treatment that is needed, even in traumatic fracture.
Stop stressing the foot
Avoiding the offending activity is important for healing. This may mean using crutches or even a wheelchair.
Some fractures just need support to help healing. For example, a supportive Tubigrip®-type dressing with a supportive, rigid shoe or boot. Progressive weight-bearing on the foot can then follow as pain allows. Other fractures may need treatment with a below-the-knee plaster cast.
Very occasionally, surgery may be necessary - for example, to re-align any part of the bone that has moved out of position.
Physiotherapy and a gradual return to exercise are a part of good follow-up care.
When can I return to activity after metatarsal fracture?
Acute metatarsal fractures generally take around six to eight weeks to heal. However, it may be longer than this before a sportsperson is fully back in action.
How are metatarsal stress fractures treated?
The principles of treatment are the same as for acute metatarsal fractures (see above).
The most important treatment is to rest your foot. This means avoiding any exercise or activity that may have caused your stress fracture. It is particularly true in the case of stress fractures, because these result from repetitive overuse.
Special shoes are available to help to immobilise the fracture and support the foot so that you are able to walk. If pain is severe, your doctor may suggest a below-the-knee plaster cast until the fracture has healed.
Surgery is not needed for metatarsal stress fractures.
When can I return to activity after metatarsal stress fracture?
Stress fractures normally heal without any complications and, in time, people are able to return to their previous activities fully. You can return to your activities when you can perform them without pain. This will typically take six to twelve weeks. When you do start exercising again, you should gradually build up your activity levels. A sudden return to high-intensity exercise after a break may cause a repeat or a new stress fracture, or other injury.
What if the pain gets again worse?
If the pain gets worse then you should seek medical advice. The expected pattern of healing, in bony injuries of any kind, is that they should gradually hurt less as healing occurs, and that any gradual worsening of pain suggests that the injury is also getting worse, or that you have a fresh injury.
If your foot pain is increasing over time then your activity may be making an existing problem worse. In the case of a stress fracture this may mean progression to an acute fracture. In the case of an acute fracture it may be worsening displacement of the bones and preventing the two ends of the bone from knitting together. Always return to your doctor or health professional for further advice if you have gradually worsening symptoms.
Further reading and references
Fredericson M, Jennings F, Beaulieu C, et al; Stress fractures in athletes. Top Magn Reson Imaging. 2006 Oct17(5):309-25.
I broke 2nd, 3rd & 4th metatarsels, non displaced. I was told it's really bad injury. in week 6 the cast was removed and the doctor at the clinic gave me a long boot and told me to gradually begin...CatNip1uk
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