What You Need to Know About Second Metatarsal Fractures

A second metatarsal fracture refers to a break or crack in the second metatarsal bone of the foot. The metatarsals are the long bones that connect the toes to the midfoot. The second metatarsal is the one that corresponds to the second toe and is the bone most commonly injured.

Medical Illustration of Metatarsal Bones

What causes a 2nd metatarsal fracture?

It is usually caused by trauma to the foot, repetitive stress or overuse. Activities that involve running, jumping, or sudden changes in direction can put excessive stress on the second metatarsal, leading to a stress fracture; or a sudden impact or crushing force to the foot, such as dropping a heavy object on the foot or getting it caught in a door, or being involved in an accident can cause an acute fracture in the second metatarsal.

foot of runner at starting line

What are the types of 2nd metatarsal fractures?

The fracture may be open or closed, and displaced or not displaced:

Open Fractures

An open fracture is one where the skin is broken over the fracture so that there is a route of possible infection from the outside into the broken bones. This is a more serious type of fracture, with more damage to the soft tissues around it making treatment and healing more complicated. Specialist assessment is needed.

Displaced Fractures

A displaced fracture is one where, following the break, the bones have slipped out of line. A displaced fracture needs specialist care, as the bones will need to be properly lined up and stabilized. This may involve an anesthetic and some kind of metal pinning or plating to the bones.

What is a stress fracture?

A stress fracture is a hairline break in a bone, which goes only partway through the bone. There may be a single split in the bone, or multiple small splits. The hairline break or breaks do not go through the full thickness of the bone, so stress fractures are not generally displaced. However, several small stress fractures can develop around the same area, over time.

What is an acute metatarsal fracture?

Acute metatarsal fractures are usually caused by direct injury to the foot, for example, by someone stepping on or kicking the foot, by dropping something on to the foot or by falling on to the foot. An acute metatarsal fracture may make an audible sound at the time of the break and you will usually have immediate pain and tenderness around the area of the fracture. The pain is often called ‘pinpoint pain’ as it is quite well localized at the site of impact to the bone.

What are the symptoms of a 2nd metatarsal fracture?

A second metatarsal fracture will cause pain and tenderness over the top or over the ball of the foot, towards the middle or front of the foot, specifically around the base of the second toe. Broken bones bleed, so swelling and bruising may occur around the affected area and there will be difficulty bearing weight on the foot due to pain. There may be a limited range of motion in the toes and foot.

Stress Fracture Image

What happens if a metatarsal fracture is left untreated?

If a 2nd metatarsal fracture is left untreated, it can lead to several potential complications and negative outcomes, similar to the consequences of leaving any metatarsal fracture untreated. The 2nd metatarsal is one of the longer metatarsal bones in the foot, and fractures in this bone are relatively common. Here are some possible consequences of not treating a 2nd metatarsal fracture:

Malunion

Without proper treatment, the fractured bone segments may heal in a misaligned position, leading to malunion. Malunion can cause foot deformities, altered gait (walking pattern), and chronic pain.

Nonunion

If the fractured bones fail to heal together, a nonunion can occur. Nonunion refers to a condition where the bone does not unite during the natural healing process. This can result in persistent pain and instability in the foot.

Chronic Pain and Discomfort

An untreated 2nd metatarsal fracture can lead to long-term pain and discomfort. The pain may worsen with activity or pressure on the affected foot.

Delayed Healing

Without proper medical attention, the healing process can be significantly delayed, prolonging the time it takes for the fracture to mend.

Changes in foot biomechanics

Untreated fractures can alter the biomechanics of the foot, affecting how weight is distributed and how the foot functions during movement. This can lead to secondary problems, such as overuse injuries or pain in other parts of the foot.

Risk of Arthritis

Improperly healed fractures can increase the risk of developing post-traumatic arthritis in the affected joint. The abnormal joint surfaces and misalignment can accelerate wear and tear on the cartilage, leading to joint pain and stiffness over time.

Soft Tissue Damage

Fractures can cause damage to surrounding soft tissues, including tendons, ligaments, and muscles. If not appropriately addressed, these soft tissue injuries may not heal correctly, leading to chronic pain and decreased foot function.

Open Fractures and Infection

If the 2nd metatarsal fracture is open (where the broken bone pierces through the skin), there is an increased risk of infection if left untreated. Infections can be severe and may require aggressive treatment, including surgery and antibiotics.

Remember, timely and appropriate medical care is crucial for any bone injury, including 2nd metatarsal fractures. If you suspect you have a fracture in your foot, seek medical attention promptly. Treatment may involve immobilization with a cast, boot, or splint, rest, pain management, and in some cases, surgery to ensure proper alignment and healing. A doctor is able to determine the best course of action - not only to make things better as quickly as possible, but also to prevent making things worse.

What can I do before I see a doctor if I suspect I have a 2nd metatarsal fracture?

It is important to avoid putting weight on the injured foot as much as possible to allow the bone to heal and to prevent further injury. And, depending on the severity of the fracture, a physician may recommend wearing a walking boot, cast, or using crutches to protect and immobilize the foot during the healing process.

There are some things you can do immediately to relieve pain and swelling such as, applying ice packs to the affected area for 15-20 minutes several times a day, which can help reduce swelling and alleviate pain. Elevating the foot above heart level when resting can also reduce swelling. Over-the-counter pain relievers can be used to manage pain and inflammation as advised by a healthcare professional.

Do metatarsal fractures show up on X-rays?

Your doctor is likely to suggest an X-ray of your foot if they suspect an acute metatarsal fracture. A medical professional will need to determine if the fracture is displaced, which may mean that the bones need to be re-aligned and held in place. This is quite common in acute metatarsal fractures, as the weight of your body tends to push down on the broken bone, and this can force the two broken ends slightly apart. If the fracture is displaced or severe, surgery may be necessary to realign the bones and stabilize the fracture site with pins, screws, or plates. Most fractures can be seen easily on an X-ray, and after a few days they can also see irregularities in the bone as it starts to heal and remodel itself. Computerized tomography (CT) scanning or magnetic resonance imaging (MRI) scanning is also occasionally needed.

Stress fractures do not show up as easily on an X-ray, particularly not at first. Half of them never show up on a normal X-ray. There can be multiple, very tiny fractures and splits in the bone, or just one fine crack which doesn't go right through the bone. A specialized ultrasound scan may show a fracture that can't be seen on an X-ray. Metatarsal stress fractures can usually be seen by using a bone scan or MRI scanning.

How long does a 2nd metatarsal fracture take to heal?

The long-term prognosis for a second metatarsal fracture is generally good with appropriate treatment and compliance. It can take several weeks to a few months for the fracture to heal completely, depending on the severity of the injury and the individual's age and physical condition. Displaced or complex fractures may take longer to heal and might have a slightly higher risk of complications; and certain medical conditions, such as osteoporosis, can slow down the healing process. Younger individuals tend to heal faster than older individuals. Appropriate exercises are essential for regaining strength, flexibility, and functionality in the foot after the healing process is complete. Adhering to the prescribed treatment plan, including physical therapy, rest and rehabilitation is crucial for optimal healing.

In most cases, once the fracture has healed, and the individual has regained strength and mobility, they can resume their regular activities without significant long-term consequences. However, it's essential to follow up with a healthcare professional regularly to monitor the healing progress and ensure there are no lingering issues or complications. 

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