The metatarsals are the long bones in the middle of the foot that end at the bases of the toes. There are five total, just as there are five toes. These bones can be broken in a variety of different ways, and some fractures can be specific to individual bones. For example, the first metatarsal (the one that forms the start of the big toe joint) is very strong, and fractures are uncommon except in a severe crushing or foot flexing injury, where the bone breaks in a splintering pattern. Conversely, the 5th metatarsal (which forms the start of the little toe joint), is commonly fractured in simple twisting injuries of the foot, leading to the infamous Jones fracture at the base of the bone. Fractures of the other metatarsals are very common, and can occur at many points along the bone. Overall, metatarsals can break at their bases in the middle of the foot, in the middle of their shaft, or at the neck and head of the bone where it meets the initial toe bone.

Metatarsals can break when a heavy crushing object drops on to or compresses the foot. They can also break when the ball of the foot is forced upward or downward, or when the foot is subjected to a twisting force. Kicking a hard object can break both the toes and the metatarsals, and the metatarsals can also fracture after being subjected to continuous stressful injury from job or sports related activity. Metatarsal fractures can occur either alone or in multiple numbers, and some injuries can create multiple fractures in a single metatarsal.

The symptoms of a metatarsal fracture follow a definite injury (unless it is a repetitive stress fracture), and usually include pain, swelling, bruising, and warmth in the foot. The foot will be painful to walk or stand on, and may be painful to move. In some cases, the symptoms may be minimal and difficult to notice initially, with more pain in the weeks following the actual injury.

Treating metatarsal fractures varies by which metatarsal is fractured, whether the fracture has moved the bone out of alignment, or how stable the bone is during the healing process. Many metatarsal fractures can be easily healed by limiting weight bearing pressure using a walking fracture boot. Our practice generally prefers this to a hard sole shoe dispensed by emergency rooms as the boot provides better support and limitation of pressure to the metatarsal. The healing process is usually six weeks, but may be longer in smokers or those with poor bone density. More unstable fractures or multiple metatarsal fractures require the use of a cast and crutches for support and complete limitation of weight bearing. If the fracture has moved out of place, it must be returned to a proper position by either externally manipulating the fracture back to a proper position, or by surgically repairing the fracture and securing the bone with medical hardware. Surgery is often necessary for unstable Jones fractures, first metatarsal fractures, or severe fractures involving a change in the alignment of the joints at the end of the metatarsal. If the bones are allowed to heal in an abnormal position, the result could be long-term discomfort, joint arthritis, and painful callus formation due to abnormal pressure under the metatarsals from the deformity.