Most nondisplaced metatarsal shaft fractures require only a soft elastic dressing or firm, supportive shoe and progressive weight bearing. If there is more than 3 to 4 mm displacement in a dorsal or plantar direction, or if dorsal/plantar angulation exceeds 10 degrees, reduction is usually required.
If radiography reveals a normal position seven to 10 days after injury, progressive weight bearing may be started, and the cast may be removed three to four weeks later.įractures of a single metatarsal with lateral or medial displacement usually heal well without correction and may be managed like nondisplaced fractures. Nondisplaced fractures of the proximal portion of metatarsals 1 through 4 can be managed acutely with a posterior splint followed by a molded, non–weight-bearing, short leg cast. Treatment of fractures distal to the tuberosity should be individualized based on the characteristics of the fracture and patient preference. Radiographs should be carefully examined to distinguish these fractures from tuberosity fractures. Proximal fifth metatarsal fractures that are distal to the tuberosity have a poorer prognosis. Avulsion fractures of the proximal fifth metatarsal tuberosity can usually be managed with a soft dressing. Stress fractures of the first to fourth metatarsal shafts typically heal well with rest alone and usually do not require immobilization. Nondisplaced fractures of the metatarsal shaft usually require only a soft dressing followed by a firm, supportive shoe and progressive weight bearing. Injuries to this ligament require referral or specific treatment based on severity.
If the midfoot is injured, care should be taken to evaluate the Lisfranc ligament. Referral is generally indicated for intra-articular or displaced metatarsal fractures, as well as most fractures that involve the first metatarsal or multiple metatarsals. The fracture should then be characterized and treatment initiated. Initial evaluation should focus on identifying any conditions that require emergent referral, such as neurovascular compromise and open fractures. Patients with metatarsal fractures often present to primary care settings.
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