Pain and symptoms
The main symptom of a metatarsal fracture is severe pain when it occurs, which usually makes any kind of locomotion impossible. On the one hand, this is due to the fact that the entire body weight is always on the foot. On the other hand, the body always reacts very sensitively to further strain in the case of bone fractures.
This is a signal to prevent us from further, damaging movements. With every further movement of the metatarsus, the broken bone bumps against and through the periosteum. This is highly sensitive because it is pervaded by a tight network of nerves.
This immediately sends strong pain impulses to the brain as soon as we continue to strain the foot. The pain usually subsides at rest. Other symptoms of a fracture, in addition to pain, are generally restricted mobility, crunching noises when moving, and swelling. Usually, vessels that bleed into the foot and cause hematomas are also affected.
Diagnosis of metatarsal fracture
The diagnosis of a metatarsal fracture is based – taking into account the severe pain – on the clinical examination in combination with an X-ray examination. During the clinical examination, the physician asks about the course of the accident and can already form a relatively accurate picture based on the position of the foot, painful pressure points and possible malpositioning of the foot. However, an X-ray examination always follows, as this is the only way to diagnose the exact extent and type of fracture. If the bone has broken through smoothly and is not displaced, it is an uncomplicated fracture that can be treated conservatively. Fractures with multiple fracture fragments and obvious misalignment are considered complicated and require surgical treatment.
Therapy
The first priority is to combat the severe pain. For this purpose, the doctor has analgesics – i.e. painkillers – at his disposal. In principle, according to a step-by-step scheme prescribed by the WHO (World Health Organization), “non-opioid analgesics” are used first, i.e. commercially available painkillers such as ibuprofen or paracetamol.
Only when these are not sufficient are low-potency opioids such as tilidine used. However, the pain is rarely so severe that these are used. As soon as the pain has been combated, the actual treatment of the fracture can begin.The fracture – if displaced – is reduced, i.e. the bone is brought back into its original position and immobilized in a plaster splint.
The immobilization takes place for 6-8 weeks. Since the foot cannot be loaded during this time, additional support is provided with crutches. In predisposed patients, thrombosis prophylaxis must also be performed to prevent thrombosis.
For more complicated fractures, there is no way around surgery. Since a “crooked” coalescence of the bones leads in the long run to an incorrect loading of the entire foot, joints and muscles can degenerate over the years. In order to prevent this, the fracture is then treated minimally invasively through a small skin incision with a screw.
The screw pulls the separated bone pieces together again and exerts pressure on them. The pressure accelerates healing. In comminuted fractures, the individual bone fragments must be fixed to a plate.
For this purpose, each bone piece is individually fixed on a so-called osteosynthesis plate. Here it is important to bring the bone pieces back into the correct anatomical position. The bone pieces then grow together within 6-8 weeks.
A plaster cast must also be worn during this time. Within the following 2-3 weeks, the foot can be increasingly loaded until full weight-bearing is possible again after a good 10 weeks. The healing time depends on the age and constitution of the patient.
After the swelling around the metatarsal fracture has subsided, the pain should also disappear. The swollen tissue presses on the surrounding nerve fibers for a while until the pressure slowly subsides and the pain subsides. If the pain remains unchanged after one week, there may be a nerve contusion or damage. This can also be accompanied by numbness and should definitely be clarified early.
