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Toe and Metatarsal Fractures

By October 4, 2012No Comments

Foot and Ankle Anatomy

The foot is made up of 26 bones, 19 are located in the toes (phalanges), 5 are the long bones of the foot (metatarsals).  The midfoot has several small bones that form the medial and lateral arches.  The rearfoot consist of the heel bone (calcaneus) and ankle joint bone (talus).

The ankle joint, or mortise, consists of the tibia and fibula.  Each of these bones has corresponding ligaments that attach the foot to the ankle.

What is a Fracture? 
A fracture is defined as a break in the bone. Fractures can be divided into two categories: traumatic fractures and stress fractures.

Traumatic Fractures 
Traumatic fractures are caused by a direct injury to a bone and are classified as either displaced or non-displaced. If a bone breaks but is in good anatomic alignment, often casting, and not surgery, is the recommended treatment.  However, if the fracture is displaced, the bone is broken in such a way that it has changed in position (dislocated). Treatment of a traumatic fracture depends on the location and extent of the break and whether it is displaced. Surgery is sometimes required.

Signs and symptoms of a traumatic fracture include:

  • Swelling and bruising which often increases the day after an injury.
  • Pain at one specific location which is often intense and may lessen after a period  of time.
  • You may hear a sound at the time of the break.
  • Sometimes after stubbing a toe, the toe will change direction often indicative of a fracture.

Incorrect Myth: “if you can walk on it, it’s not broken.” Evaluation by the foot and ankle surgeon is always recommended.

Stress Fractures 
Stress fractures are tiny, hairline breaks that are usually caused by repetitive stress. Stress fractures often afflict athletes who, for example, too rapidly increase their running mileage. Or they may be caused by an abnormal foot structure, deformities, or osteoporosis. Improper footwear may also lead to stress fractures. Stress fractures should not be ignored, because they will come back unless properly treated.

Symptoms of stress fractures include:

  • Pain with or after normal activity
  • Pain that goes away when resting and then returns when standing or during activity
  • “Pinpoint pain” (pain at the site of the fracture) when touched
  • Swelling, but no bruising

Is it a Fracture, or a Sprain? 
Sprains and fractures have similar symptoms, although sometimes with a sprain, the whole area hurts rather than just one point. Your foot and ankle surgeon will be able to diagnose which you have and provide appropriate treatment. Certain sprains or dislocations can be severely disabling. Without proper treatment they can lead to crippling arthritis.

Consequences of Improper Treatment 
Some people say that “the doctor can”t do anything for a broken bone in the foot.” This is usually not true. In fact, if a fractured toe or metatarsal bone is not treated correctly, serious complications may develop. For example:

  • A deformity in the bony architecture which may limit the ability to move the foot or cause difficulty in fitting shoes.
  • Arthritis, which may be caused by a fracture in a joint (the juncture where two bones meet), or may be a result of angular deformities that develop when a displaced fracture is severe or hasn”t been properly corrected.
  • Chronic pain and long-term dysfunction.
  • Non-union, or failure to heal, can lead to subsequent surgery or chronic pain.

Treatment of Toe Fractures 
Fractures of the toe bones are almost always traumatic fractures. Treatment for traumatic fractures depends on the break itself.

Treatment of Metatarsal Fractures 
Breaks in the metatarsal bones may be either stress or traumatic fractures. Certain kinds of fractures of the metatarsal bones present unique challenges.