The five metatarsal bones (Ossa metatarsalia) connect the tarsal with the toes and are numbered 1-5 from the inside to the outside. Pain in the metatarsals can have a variety of causes. A doctor’s consultation (anamnesis), a clinical examination, the quality and exact localization of the pain or an imaging procedure can help to clarify the cause.
Traumatic midfoot pain
Pain in the metatarsals is often traumatic, i.e. it is caused by damage to the structures of the metatarsus through direct or indirect violence. This can be the case, for example, when heavy objects fall on the foot or due to a sports injury, as well as when the foot is twisted. Depending on the cause of the accident, different injury patterns occur, all of which are associated with pain in the midfoot.
On the one hand, ligament structures can tear or be compressed and small vessels can burst, resulting in bleeding into the tissue (haematoma), which often causes pain and swelling. In addition, bones can also be directly compressed or broken, which leads to stronger pain in the area of the metatarsus, especially when occurring, as well as swelling and bruising. The course of the accident already gives the doctor important information about the type of injury.
He will then take a close look at the foot and look for signs of injury such as bruises, swelling or malpositioning. If the following palpation of the metatarsus causes severe pain or the bones are displaced against each other, this is a sign of a fracture. If a fracture is suspected, an X-ray of the foot is taken.
If the suspicion is confirmed, a CT scan may have to be carried out in the case of complicated fractures in order to determine the extent of the injury accurately and to be able to plan the therapy precisely. In rare cases of injuries to soft tissue (tendons, ligaments, etc.) it may be necessary to take an MRI image.
The therapy depends on the injury pattern and in the case of simple ligament or tendon injuries, as well as compressions or contusions, usually consists of cooling, elevation and relief, sometimes the patient wears an orthosis for a few days/weeks. Simple bone fractures can also be treated conservatively by putting a plaster cast on the foot, which can be fully loaded again after about 6-8 weeks. However, if the fracture is displaced or if several metatarsals are affected, surgery is necessary.
The metatarsal bones are fixed together with wires (so-called Kirschner wires) and the foot may only be partially loaded for the following weeks until the fracture has completely healed after about 2 to 3 months. A special form of metatarsal fracture is the load fracture, which does not occur as a result of a sudden violent impact, but after long lasting strong load. This can be the case, for example, with competitive athletes such as runners, so the common term “marching fracture” is also appropriate. Marching fractures are a form of fatigue fracture of the metatarsus.
