The metatarsals are five long bones in the foot that connect the toes to the middle part of the foot.
With trauma, even just a simple twisting injury, the metatarsals can be fractured. A fracture is another word for a broken bone. Fractures can be classified as non-displaced or displaced.
In a non-displaced fracture, the pieces of the broken bone have not shifted and are in their normal position. Most often these types of fractures can be treated without surgery. Sometimes a boot or cast may be required, depending on the specific fracture type.
With a displaced fracture, the pieces of the broken bone have shifted. Some displaced fractures can still be treated without surgery if the amount of displacement is small and will not have significant impact. In other instances, however, surgery may be necessary to realign the bones so that they heal in a better position. It is important to understand that the goal of surgery is not to speed up the healing time. Rather, the goal of surgery is to improve the alignment and position of the broken bones while they heal. Having surgery does not mean that the fracture is healed; the bones are simply in better position while the body heals them.
Certain metatarsal fractures deserve special attention. The fifth metatarsal, on the outer border of the foot, can be broken in several different locations. Fifth metatarsal base fractures occur in the proximal portion of the bone, towards the ankle. These injuries typically heal well. However, certain fracture patterns need to be specially treated and may sometimes even need surgery. A “Jones fracture” is one such injury and is localized to the region where the shaft of the bone meets the flare at the base of the bone.
Lisfranc injuries are another subset of metatarsal fractures that deserve special attention. These are injuries in which the bases of the metatarsal bones are broken and the fracture extends into the joints of the midfoot. If these fractures are significantly displaced, they usually need surgery to improve alignment and decrease the chance that post-traumatic arthritis develops. An interesting historical side note is that Lisfranc was the surgeon for Napoleon’s army. Napoleon’s army was the first to use stirrups on their horses. When soldiers were thrown from their horses, their foot remained in the stirrup resulting in injures that now bear Lisfranc’s name.
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