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Metatarsal Fracture

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Other Names

  • Met Fracture
  • Metatarsal Fracture
  • Metatarsal stress fracture
  • 1st metatarsal fracture
  • Central metatarsal fracture (CMF)




  • Prevalence
    • Represent about 88% of all fractures involving the foot and ankle[1]
    • Represent 35% of all foot fractures[2]
    • 5% - 7% of musculoskeletal injuries[3]
    • 1.2% are open fractures
  • Incidence
    • Approximately 6.7 per 10,000 people[4]
  • Demographics
    • Among non athletes, the average age is 42 and female
    • Among athletes, the average age is 26 and male
  • Pediatric considerations[5]
    • Under 5: 1st metatarsal is most commonly fractured
    • Over 5: 5th metatarsal is most commonly fractured
    • Account for 61% of all fractures of the foot[6]


  • General
    • Occur as a result of direct trauma to forefoot
    • Central metatarsals include the 2nd, 3rd, and 4th


  • Generally occur due to low energy trauma
  • Fall from standing height
  • Twisting injury with a static forefoot

Fracture Patterns

  • Location
    • 5th metatarsal is most common, followed by 3rd metatarsal[7]
    • Contiguous metatarsal fractures occur in 9% of all metatarsal fractures
    • 60% of middle metatarsal fractures associated with neighboring metatarsal injury[4]
    • 1st metatarsal fractures are the least common, representing only 1.5% of metatarsal fractures

Associated Conditions


  • Metatarsal Bones
    • Skeletal component of the foot between the tarsus and the foot phalanges
    • Numbered 1 to 5 from medial to lateral

Risk Factors

  • Unknown

Differential Diagnosis

Clinical Features

  • History
    • Characterized by pain, swelling and trouble weight bearing
    • Deformities are typically absent unless there are more significant injuries present
  • Physical Exam: Physical Exam Foot
    • Bruising and swelling
    • Tenderness to metatarsal
    • Pain with axial loading of the forefoot
  • Special Tests




  • Only recommended for occupt fractures, or suspected stress fracture


  • Useful to
    • Assess the degree of intra-articular involvement, comminution
    • Evaluate integrity of lisfranc joint
    • Surgical planning when appropriate


AO-ICI (Integral classification of injuries)

  • Type A: extra-articular fractures[8]
    • Subdivided into metaphyseal, diaphyseal, and distal metaphyseal fractures
  • Type B: intra-articular fracture
    • subdivided into proximal partial articular, meta-diaphyseal wedge, and distal partial articular
  • Type C: fracture-dislocations
    • subdivided into proximal complete articular, meta-diaphyseal communition, and distal complete articular
  • Type D: pure metatarsal dislocation or ‘floating metatarsal.’


  • Objectives
    • Restore the alignment of all metatarsals
    • Maintain the arches of the forefoot
    • Normal distribution of weight under the head of metatarsals


1st Metatarsal

  • Indications
    • Nondisplaced, stable fractures
    • Isolated avulsion fractures
  • Serial radiographs
    • close radiographic monitoring for callous formation
  • Immobilization/ Protection
  • Weightbearing status
    • Non-weight bearing for at least 3 weeks
    • Progression to a walking cast for another 3 weeks

Central Metatarsals

  • Indications
    • Nondisplaced or minimally displaced
    • Nondisplaced or minimally displaced neck fractures
    • Less than 10° sagittal angulation, 3 - 4 mm displacement in any plane
  • Immobilization/ Protection
  • Weight bearing status
    • Weight bearing as tolerated


1st Metatarsal

  • Indications
    • Unstable closed fractures
    • Intra-articular fracture
    • Open fractures
    • Polytrauma
  • Technique
    • Open reduction, internal fixation
    • K-wire fixation
    • Plate osteosynthesis
    • Reconstruction of the TMTJ, MTPJ

Central Metatarsals

  • Indications
    • Displacement > 2 mm
    • More than 10° sagittal angulation, 3 - 4 mm displacement in any plane
    • Displaced metatarsal neck fractures
  • Technique
    • K-wire fixation

Rehab and Return to Play


  • Needs to be updated

Return to Play/ Work

  • Needs to be updated

Complications and Prognosis


  • Patient predictors of poor outcome[10]
  • Injury predictors of poor outcome
    • Open fractures[11]
    • Planatarly displaced fracture


See Also


  1. Cakir H, Van Vliet-Koppert ST, Van Lieshout EM, De Vries MR, Van Der Elst M, Schepers T. Demographics and outcome of metatarsal fractures. Arch Orthop Trauma Surg. 2011;131:241–5.
  2. Vuori JP and AroHT. Lisfranc joint injuries: traumamechanisms and associated injuries. J Trauma 1993; 35: 40–45.
  3. Urteaga A and Lynch M. Fractures of the central metatarsals. Clin Podiatry Med Surg 1995; 12: 759–762.
  4. 4.0 4.1 Petrisor BA, Ekrol I and Court-Brown C. The epidemiology of metatarsal fractures. Foot Ankle Int 2006; 27: 172–174.
  5. Singer G, Cichocki M, Schalamon J, et al. A study of metatarsal fractures in children. J Bone Joint Surg Am 2008; 90: 772–776.
  6. Zwipp H, Ranft T. Malunited juvenile fractures in the foot region. Orthopaede. 1991;20(6):374–80.
  7. Johnson VS. In: Bateman JE (ed.) Treatment of fractures of the forefoot in industryFoot Science. Philadelphia, PA: WB Saunders, 1976.
  8. Zwipp H, Baumgart F, Cronier P, et al. Integral classification of injuries (ICI) to the bones, joints, and ligaments– application to injuries of the foot. Injury 2004; 35: SB3–SB9.
  9. Zenios M, Kim WY, Sampath J, Muddu BN. Functional treatment of acute metatarsal fractures. A prospective randomised comparison of management in a cast versus elasticated support bandage. Injury. 2005 Jul;36(7):832–5.
  10. Cakir H, Van Vliet-Koppert ST, Van Lieshout EM, et al. Demographics and outcome of metatarsal fractures. Arch Orthop Trauma Surg 2011; 131: 241–245.
  11. 11.0 11.1 Sánchez Alepuz E, Vicent Carsi V, Alcántara P, Llabrés AJ. Fractures of the central metatarsal. Foot Ankle Int. 1996;17(4):200–3.
  12. 12.0 12.1 Stavlas P, Roberts CS, Xypnitos FN, et al. The role of reduction and internal fixation of Lisfranc fracture dislocations: a systematic review of the literature. Int Orthop 2010; 34: 1083–1091.
  13. Murphy GA. Operative treatment of stress fractures of the metatarsals. Oper Tech Sports Med 2006; 14: 239–247.
  14. Jameson SS, Augustine A, James P, et al. Venous thromboembolic events following foot and ankle surgery in the English National Health Service. J Bone Joint Surg Br 2011; 93: 490–497.
Created by:
John Kiel on 25 October 2021 15:35:20
Last edited:
4 October 2022 12:35:47
Lower Extremity | Trauma | Foot | Fractures | Acute