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Broken Metatarsals
















What is a metatarsal?

A metatarsal is one of the bones of the foot. There are five metatarsals in each foot, and they span from the ankle bones to the toe bones. They can be easily felt by firmly feeling the top of your foot.


How is a metatarsal broken?

Common causes of a broken metatarsal are inward rolling of the ankle or landing awkwardly after a jump. The metatarsal can also be broken from a direct blow to the foot, as can happen in football, rugby or basketball. Occasionally metatarsals can be broken by repetitive stress during running (metatarsal stress fracture), or in major trauma such as car accidents. Of all the metatarsal bones, the 5th metatarsal is most prone to being broken - this is the metatarsal on the outer edge of the foot.


What are the symptoms of a broken metatarsal?

The most common symptom of a broken metatarsal is intense pain at the site of the break, with swelling and bruising soon after. It may be difficult to walk on the foot due to the pain, and pressing on the break site will usually be very painful. Occasionally, in a severely broken metatarsal, there may be a visible deformity of the foot.


Is an X-ray needed for a suspected broken metatarsal?

Yes, usually an x-ray will be needed to diagnose the broken bone. Occasionally further tests may be needed such as CT or MRI scans.


What treatment is needed for broken metatarsals?

For tiny breaks or stress fractures, rest is often all that is needed and a support stocking may be of help. Larger breaks may need immobilisation, either with a stiff shoe, boot, or plaster cast. Crutches may be helpful to keep the weight off the foot while the bone heals.

Some broken metatarsals will need surgery, especially if the metatarsal break is displaced.


What operations may be needed for broken metatarsals?

  • K-wires - Kirschner, or 'K' wires are thin metal rods that are passed across the broken area. These hold the break in place until it is healed, usually three weeks later. The wires are usually left with a short length exposed at the skin, and can be removed with very little discomfort by simply pulling them out with special pliers. The wires need to be kept clean while they are in place, as bacteria could otherwise track to the fracture site to cause a bone infection - this is very hard to then treat and could lead to serious consequences

  • Plate fixation - small metal plates are used to span the break site, being held in place with small screws. The plates are often left in place permanently, often un-noticed.

  • External fixation - complex metatarsal breaks may need this form of fixation to hold fragments in place while they heal. Usually, a thick pin is placed through the skin into the bone either side of the break. A metal bar then spans between the pins, keeping them and therefore the bones still. This is kept in place until the fracture is healed, usually three to four weeks.


Often after surgery, a plaster cast will be used to keep the break area protected. This may be made from plaster of Paris or lightweight plastic. You will usually need to keep weight off the break area while it heals, and may need crutches for a few weeks. Depending on your break type, special boots may be provided allowing you to walk with or without crutches.



What can go wrong with broken metatarsals?

  • Delayed union - this is where the metatarsal break takes longer to heal than expected. Whilst this can be an inconvenience, it still results in a fixed bone

  • Mal-union - the broken bones heal in a poor position. If this causes problems with foot function, then further procedures may be needed

  • Non-union - the break does not heal, even after many weeks. Further procedures may be needed

  • Infection - infected bone is called osteomyelitis, and can be extremely hard to treat. A lengthy course of antibiotics or further surgery can clear the infection, although occasionally the infection does not clear and can even, in a worst case scenario, lead to amputation

  • Stiffness - this is a common result of having a broken metatarsal, due to a combination of splinting and the break itself. Physiotherapy exercises may help to reduce this risk

  • Pain - well-healed breaks often cause little problem, although it is quite common to get 'niggling' aches and pains in the fracture area, especially during cold weather or when walking long distances. Occasionally, severe pain may require further procedures for improvement


You may also want to read : Stubbed toes, broken toes or how to choose a surgeon


Any procedure involving skin incision can also result in unfavourable scarring, wound infection, or bleeding. This list of risks is not exhaustive, and you should discuss possible complications with your specialist. Whilst these risks will seem very worrysome, and indeed can be serious, it should also be borne in mind that many people have no postoperative problems whatsoever.

The information provided is as a guide only and you should discuss matters fully with your specialist before deciding the right procedure for you. Please also read our disclaimer


Read our guide on broken toes



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