Non-fifth metatarsal fracture

Background

Bones of the foot.

• Must rule-out associated Lisfranc Injury

Clinical Features

• Foot pain
• Often unable to bear weight

Differential Diagnosis

Foot and Toe Fracture Types

Hindfoot

• Talus fracture
• Calcaneus fracture

Midfoot

• Lisfranc injury
• Navicular fracture
• Cuboid fracture
• Cuneiform fracture

Forefoot

• Fifth metatarsal fracture
• Non-fifth metatarsal fracture
• Toe fracture

Evaluation

Radiography of left foot showing fracture of the first metatarsal (arrow).

Workup

• Plain x-rays

Diagnosis

• Typically on plain x-rays

Management

General Fracture Management

• Acute pain management
• Open fractures require immediate IV antibiotics and urgent surgical washout
• Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
• Consider risk for compartment syndrome

Specific Management

• Hard-sole shoe or walking boot for:
  • Non-displaced 1st metatarsal fracture
  • Isolated, non-displaced central (2nd-4th) metatarsal fracture

Otherwise:

• Posterior ankle splint
• Non-weight bearing

Disposition

• Discharge with ortho follow-up in 2-3 days

See Also

• Foot and toe fractures
• Foot diagnoses
• Fifth metatarsal fracture