![]() Hence thorough examination and proper evaluation are needed in cases of metatarsal injuries. Sometimes it is hard to differentiate soft tissue injury and fracture of the base of the fifth metatarsal because the pain and swelling for both injuries lie just inferior to the lateral malleolus. Gross deformities are usually seen only with complex injuries, which include multiple fractures and dislocations. Proper history taking in such patients regarding suggestive mechanisms of injury is essential. Clinically, there is tenderness, crepitus, bruising, deformity, and swelling over the forefoot. Patients with such injuries usually complain about difficulty in bearing weight or excruciating pain on ambulation. The fifth metatarsal is the most commonly fractured (23%), followed by the third metatarsal in cases of industrial injuries. Metatarsal fractures consist of 61% of all fractures of the foot in children. Most metatarsal fractures in children occur at the fifth (41%) and the first (19%) ray. The frequency of metatarsal fractures is about ten times compared with that of Lisfranc fracture-dislocations. Metatarsal fractures are one of the most common injuries to the foot. Such injuries are usually seen in osteoporosis patients and postmenopausal women. Insufficiency fractures can also be seen in metatarsal bones, which occur due to normal stress loading over a weakened bone. The other variety of fractures that are commonly seen in metatarsal bones is stress fractures which result from a small amount of repetitive force and are commonly associated with ballet dancers, athletes and soldiers, hence termed “march fracture.” Multiple risk factors associated with stress fractures include hyper load syndrome, Morton’s foot, anorexia nervosa, amenorrhea, and prolonged hypoestrogenism. In the former mechanism, the metatarsal head remains fixed while body weight lies over the hindfoot, especially against the base of metatarsals. The common mechanisms of injury are either longitudinal compression of the foot or rotation around a fixed forefoot. The Lisfranc fracture-dislocation can result due to falling from height or stairs. The Lisfranc joint complex consists of the tarsometatarsal joints. Supination injuries to the foot may result in avulsion fractures of the fifth metatarsal base because of the tension generated over the peroneus brevis tendon and the lateral cord of plantar aponeurosis. Indirect trauma occurs when there is a twisting movement of the hindfoot and leg while the forefoot is fixed. Direct trauma can occur due to the fall of heavy objects on the foot and is usually seen in industrial workers. Such injuries may vary from a simple isolated metatarsal fracture to crush injuries involving multiple fractures and drastic soft tissue compromise. The most common etiology for metatarsal fractures is either direct or indirect trauma. Metatarsalgia is one of the common sequelae in cases with failure in achieving the ascertained goal of management. On the other hand, these injuries may also result in prolonged disability in scenarios of malunion or non-union. If properly managed, these injuries are easy to treat and have a favorable prognosis. ![]() The main goal of treatment is to restore the alignment of all metatarsals, hence maintaining the arches of the forefoot and thereby resulting in the distribution of a normal weight under the head of metatarsals. ![]() Metatarsal fractures are relatively common injuries of the foot.
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