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1. TOE AND METATARSAL
FRACTURES
T he structure of your foot is com-
plex, consisting of bones, muscles,
tendons, and other soft tissues. Of the
• Pain that goes away when resting
and then returns when standing
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.
A fracture 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, serious 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 • A deformity 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

2. • Non-union, or failure to heal, can Treatment 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.
Treatment 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. A stiff-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. Your 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