TOE AND METATARSAL FRACTURES he structure of your foot is com- •Pain that goes away when resting T plex, consisting of bones, muscles, and then returns when standing tendons, and other soft tissues. Of the or during activity 26 bones in your foot, 19 are toe bones •“Pinpoint pain” (pain at the site (phalanges) and metatarsal bones (the of the fracture) when touched long bones in the midfoot). Fractures •Swelling, but no bruising of the toe and metatarsal bones are common and require evaluation by a Sprains and fractures have similar specialist. A podiatric foot and ankle symptoms, although sometimes with surgeon should be seen for proper a sprain, the whole area hurts rather diagnosis and treatment, even if than just one point. Your podiatric initial treatment has been received surgeon will be able to diagnose in an emergency room. which you have and provide appro- priate treatment. Certain sprains or What Is a Fracture? dislocations can be severely disabling. Afracture is a break in the bone. Without proper treatment they can Fractures can be divided into two lead to crippling arthritis. categories: traumatic fractures and stress fractures. •Deviation (misshapen or abnormal Consequences of Traumatic fractures (also called appearance) of the toe. Improper Treatment acute fractures) are caused by a •Bruising and swelling the next day. Some people say that “the doctor direct blow or impact—like seriously •It is not true that “if you can walk can’t do anything for a broken stubbing your toe. Traumatic fractures on it,it’s not broken.” Evaluation bone in the foot.”This is usually can be displaced or nondisplaced. If the by the podiatric surgeon is always not true. In fact, if a fractured toe fracture is displaced, the bone is broken recommended. or metatarsal bone is not treated in such a way that it has changed in correctly, s e rious complications position (dislocated). Treatment of a Stress fractures are tiny,hairline may develop. For example: traumatic fracture depends on the breaks that are usually caused by •Adeformity in the bony architec- location and extent of the break and repetitive stress. Stress fractures often ture which may limit the ability to whether it is displaced. Surgery is afflict athletes who, for example, too move the foot or cause difficulty sometimes required. rapidly increase their running in fitting shoes Signs and symptoms of a traumatic mileage. Or they may be caused by an •Arthritis, which may be caused by fracture include: abnormal foot structure, deformities, a fracture in a joint (the juncture •You may hear a sound at the time or osteoporosis. Improper footwear where two bones meet), or may be of the break. may also lead to stress fractures. a result of angular deformities •“Pinpoint pain” (pain at the place Stress fractures should not be that develop when a displaced of impact) at the time the fracture ignored, because they will come back fracture is severe or hasn’t been occurs and perhaps for a few unless properly treated. Symptoms properly corrected hours later, but often the pain of stress fractures include: • Chronic pain and long-term goes away after several hours. •Pain with or after normal activity dysfunction •Non-union, or failure to heal, can Tr ea t ment of • Rest. Sometimes rest is the only lead to subsequent surgery or Metatarsal Fractures treatment needed to promote chronic pain. Breaks in the metatarsal bones healing of a stress or traumatic may be either stress or traumatic fracture of a metatarsal bone. Tr ea t ment of Toe Fractures fractures. Certain kinds of fractures • Avoid the offending activity. Fractures of the toe bones are almost of the metatarsal bones present Because stress fractures result from always traumatic fractures. Treatment unique challenges. repetitive stress, it is important to for traumatic fractures depends on For example, sometimes a avoid the activity that led to the the break itself and may include fracture of the first metatarsal bone fracture. Crutches or a wheel- these options: (behind the big toe) can lead to chair are sometimes required to • Rest. Sometimes rest is all that is arthritis. Since the big toe is used so offload weight from the foot to needed to treat a traumatic fracture frequently and bears more weight give it time to heal. of the toe. than other toes, arthritis in that area • Immobilization, casting, or rigid • Splinting. The toe may be fitted can make it painful to walk, bend, or shoe. Astiff-soled shoe or other with a splint to keep it in a fixed even stand. form of immobilization may be position. Another type of break, called a used to protect the fractured bone • Rigid or stiff-soled shoe. Wearing Jones fracture, occurs at the base of while it is healing. a stiff-soled shoe protects the the fifth metatarsal bone (behind the • Surgery. Some traumatic fractures toe and helps keep it properly little toe). It is often misdiagnosed as of the metatarsal bones require positioned. an ankle sprain, and misdiagnosis can surgery, especially if the break is • “Buddy taping” the fractured toe have serious consequences since badly displaced. to another toe is sometimes sprains and fractures require different • Follow-up care. Yo ur podiatric appropriate, but in other cases it treatments. Your podiatric surgeon is foot and ankle surgeon will may be harmful. an expert in correctly identifying provide instructions for care • Surgery. If the break is badly these conditions as well as other following surgical or non-surgical displaced or if the joint is affected, problems of the foot. treatment. Physical therapy, surgery may be necessary. Surgery Treatment of metatarsal fractures exercises and rehabilitation may often involves the use of fixation depends on the type and extent of be included in a schedule for devices, such as pins. the fracture, and may include: return to normal activities. ▲ This information has been prepared by the Consumer Education Committee of the American College of Foot and Ankle Surgeons, a professional society of 5,700 podiatric foot and ankle surgeons. Members of the College are Doctors of Podiatric Medicine who have received additional training through surgical residency programs. The mission of the College is to promote superior care of foot and ankle surgical patients through education, research and the promotion of the highest professional standards. Copyright © 2004, American College of Foot and Ankle Surgeons • www.acfas.org.