Midfoot fracture
A metatarsal fracture is a fracture of one or more metatarsal bones, usually caused by indirect force, such as twisting the foot or a contusion. Even when a large force is applied directly to the metatarsus, for example when a heavy object falls on the foot, a metatarsal fracture can occur. The second metatarsal bone is most often affected.
The symptoms of a metatarsal fracture are usually a distinct pain when the foot is injured, swelling and often bleeding into the surrounding tissue. The metatarsal area is very painful under pressure. However, an x-ray must be taken to establish a definitive diagnosis, as the symptoms are relatively unspecific for the metatarsal fracture.
The therapy of the metatarsal fracture depends on its extent. If only one metatarsal bone is broken, it is often sufficient to immobilize the foot with a cast for about 6-8 weeks and then return to normal weight bearing. However, if the fracture is unstable or the first metatarsal is affected, surgery is often indicated to achieve a good result.
In this procedure, the ends of the fracture are fixed together with so-called Kirschner wires. It usually takes two to three months until the fracture has completely healed and the original resilience is restored. Morton’s neuroma (also called Morton’s neuralgia or Morton’s metatarsalgia) usually develops in people with splayfoot.
This results in a permanent mechanical irritation of the nerves that run between the metatarsals. The splayfoot position compresses the nerves there and they react with thickening and connective tissue changes. It is also called a “neuroma”, since this term refers to a benign growth of nerve tissue.
The symptoms of Morton’s neuroma are sudden shooting pains in the metatarsus, which are accompanied by a pronounced painfulness in this area. The neuroma is usually located between the third and fourth metatarsal bones. In order to be able to make a diagnosis, an ultrasound image or MRI of the foot must be taken, in which the neuromus can be identified and localized.
This is important for the subsequent therapy. If the symptoms are very severe, the Morton’s neuroma can be removed surgically. Otherwise, it may also be sufficient to correct the splayfoot malpositioning, whereby the changes in the nerves can be reduced secondarily as soon as the mechanical irritation ceases. Since the complete removal of the altered nerve has long been considered the standard method, but this often involves complications, nowadays nerve-preserving surgery is increasingly being attempted.