​ASKPHYSIO

• Metatarsals are the long bones in the feet.  1st ray is the metatarsal in line with the big toe.  The 5th metatarsal is the metatarsal in line with the little toe.

• Fractures of the metatarsals can be stress fractures or related to a single traumatic incident.

Stress fractures:

• Gradual onset of pain

• Local tenderness specific to the metatarsal

• Pain which over time worsens with activity

• 2nd metatarsal most commonly affected

Traumatic incident fracture:

• Sudden pain

• Audible snap or crack

• Related to traumatic accident

• Inability to weight bear

• Swelling

• Excessive pronation

• Shorter 1st ray compared to 2nd metatarsal

• Trauma such as an ankle sprain

• Sports including ballet, running

• R.I.C.E. protocol

• Seek an assessment and diagnosis, as rest from activity may be required

• Rest from aggravating activities (4-6 weeks)

• X-ray, bone scan, or MRI are the optimal investigations for a suspected metatarsal fracture

• Surgery and immobilisation may be required for an unstable traumatic fracture (especially for the 2nd and 5th metatarsals).

• Assessment of the metatarsals for bony damage

• Biomechanical review of the foot and lower limb

• Prescribe an individualised plan of management

• Acupuncture

• Referral for investigation (x-ray, bone scan, MRI) scan for confirmation of diagnosis

• Referral to an orthopaedic specialist for advice on management

• Prescribe use of an aircast to reduce pain initially

• Referral to a podiatrist for biomechanical review and orthotic prescription