Metatarsal fracture

Clinical evaluation

Metatarsal fractures often result from crush injury or twisting injury with forefoot fixed.

The severity of injury can range from simple single metatarsal fracture to multiple fractures.

Clinically, check particularly for open injuries, compartment syndrome, and lis franc injuries.

Investigate with AP, lateral and oblique foot x rays (ideally these should be weight-bearing x rays to detect fracture stability)

Simple metatarsal fractures

These include:

• undisplaced 1st metatarsal fractures

• undisplaced / minimally displaced isolated 2-4th metatarsal fractures

• stress fractures

A&E management include

1. walking boot

2. weight bearing as tolerated

3. offer crutches if required

4. advise patient to ice and elevate foot when not mobilising

5. online referral to VFC

Complex metatarsal fractures

These include:

• open fractures

• displaced 1st metatarsal fractures

• displaced intra-articular fractures

• multiple displaced 2-4th metatarsal shaft fractures

• Lis-franc injuries

A&E management include

1. walking boot

2. non-weight bearing

3. VTE prophylaxis

4. refer to ortho oncall