Introduction

Metatarsal fractures are relatively common. Fractures can be limited to one metatarsal or can affect multiple ones e.g. by direct trauma or crush injuries. When a fracture occurs due to repeated mechanical stress, this is termed a stress fracture. The metatarsals are the most common site of stress fractures.

Epidemiology

  • Incidence: 100.00 cases per 100,000 person-years
  • Peak incidence: 60-70 years
  • Sex ratio: 1:1
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Clinical features

5th metatarsal fractures:
  • Proximal avulsion fractures (pseudo-Jones fractures): most common type. Occurs at the proximal tuberosity. Usually associated with a lateral ankle sprain and often follow inversion injuries of the ankle.
  • Jones fractures: much less common. This is a transverse fracture at the metaphyseal-diaphyseal junction.

Metatarsal stress fractures
  • Occurs in otherwise healthy athletes, e.g. runners
  • The most common site of metatarsal stress fractures is the 2nd metatarsal shaft

Features:
  • Pain and bony tenderness
  • Swelling
  • Antalgic gait

Investigations

Investigations:
  • X-rays: distinguishes between displaced and non-displaced fractures. This differentiation guides subsequent management options. Although stress fractures may appear normal on X-ray, sometimes there is a periosteal reaction seen on 2-3 weeks later.
  • Isotope scan or MRI: in the case of stress fractures, X-rays are often normal and may remain normal in up to half of all cases. An isotope bone scan or MRI may help to establish the presence of a stress fracture.