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Metatarsal Fractures

Anatomy of the Metatarsals

The structure of the foot is complex, consisting of bones, muscles, tendons, and other soft tissues. There are five metatarsal bones in each foot. They are long, slim bones that run the lengths of the foot to the base of the toes. A metatarsal fracture occurs when one of the long bones of the midfoot is cracked or broken. This may be due to sudden injury (an acute fracture) or repeated stress (a stress fracture). 

Fractures of the Fifth Metatarsal

The fifth metatarsal is the long bone on the outside of the foot that connects to the little toe. The fifth metatarsal bone is the most common to be fractured in sudden (acute) injury to the foot. It may break at various points along its length, depending on the type of injury. The first, second, and fifth metatarsals are the ones most frequently injured in sports. 

Types of Metatarsal Fractures

Acute fractures are caused by a direct blow or impact, while stress fractures occur over a long period of time. An acute metatarsal fracture can be open or closed, and displaced or not displaced. 

Open or closed

An open fracture is when the skin is broken over the fracture so that there is a route of possible infection from the outside into the broken bones. Open fractures cause more damage to the soft tissues around it making treatment and healing more complicated. 

Displaced or not displaced

A displaced fracture is one where, following the break, the bones slip out of line. In order to treat a displaced fracture, the bones need to be lined up and stabilized using some kind of metal pinning or plating.

Common Causes of Metatarsal Fractures

The main causes of a metatarsal fracture include:

  • Direct blow to the foot: when someone steps on or kicks the foot, by dropping something on to the foot, or by falling on to the foot.
  • Ankle twisting: when your ankle twists, it pulls on the ligament that attaches to the base of your fifth metatarsal.
  • Overuse: activities like running and jumping can put repetitive stress on your metatarsal bones and can cause them to crack over time.

Symptoms of a Metatarsal Fracture

Acute Metatarsal Fractures

  • You may hear a sound at the time of the break.
  • Pinpoint pain (pain at the place of impact) at the time the fracture occurs and perhaps for a few hours later, but often the pain goes away after several hours.
  • Bruising and swelling the next day.
  • Limited mobility in the foot

Stress Fractures

  • Pain with or after normal activity
  • Pain that goes away when resting and then returns when standing or during activity
  • Pinpoint pain when touched
  • Swelling but no bruising

How are Metatarsal Fractures Diagnosed?

To diagnose a metatarsal fracture, your Raleigh Orthopaedic physician will ask how the injury occurred and when the pain started. The foot will be examined by gently pressing on different areas of the foot to determine where there is pain. Imaging tests, such as an X-ray, will be ordered to see initial cracks and any irregularities in the bone as it starts to heal and remodel itself. In some cases, a bone scan or MRI may be performed to find stress fractures, since they do not show up easily on X-ray. 

Treatment for Metatarsal Fractures

Treatment will depend on which metatarsal bone is fractured, which part of the metatarsal bone is fractured, how severe the damage is, and whether it is an acute or stress fracture. Stress fractures normally heal without any complications and patients are able to return to their previous activities fully. Most metatarsal fractures do not require surgery, but your Raleigh Orthopaedic physician will determine the right treatment plan to ensure you make a full recovery. 

Non-Surgical Treatment

For mild stress fractures, conservative methods such as rest and anti-inflammatory medication can be used to manage symptoms. Non-surgical treatment for a metatarsal fracture includes:

  • Rest
  • Anti-inflammatory medication. Medications such as ibuprofen and naproxen can be taken to reduce pain and inflammation.
  • Avoid the offending activity. Because stress fractures result from repetitive stress, it is important to avoid the activity that led to the fracture. 
  • Immobilization, casting, or rigid shoe. A stiff-soled shoe or other form of immobilization may be used to protect the fractured bone while it heals. Use of a postoperative shoe or boot walker is also helpful.


Some acute fractures of the metatarsal bones require surgery, especially if the break is badly displaced. A procedure known as internal fixation can be used to repair the damaged bone. This usually involves inserting pins, plates and/or screws to hold your bones in place while they heal. Recovery from an acute metatarsal fracture generally takes around six to eight weeks.

Metatarsal Fractures and Treatment at Raleigh Orthopaedic 

Raleigh Orthopaedic is the number one choice for patients in Wake County seeking expert foot and ankle treatment. Our board-certified, fellowship-trained physicians provide comprehensive care for a wide range of foot and ankle injuries, including metatarsal fractures. We will work to develop a treatment plan tailored specifically to your needs and ensure the most effective recovery for your injury. Contact us today to schedule an appointment at one of our orthopedic clinic locations nearest you. 

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