Fracture of the 1st metatarsal

What is a first metatarsal fracture?

A fracture of the first metatarsal is a break in the continuity of the bone located at the base of the big toe. The shape and length of the 1st metatarsal provide the propulsion strength of the hallux for walking, balance, and sports activities.

Identifying the symptoms of a first metatarsal fracture

The symptoms of a first metatarsal fracture include intense pain in the foot, particularly around and at the base of the big toe, which may worsen when walking or upon palpation. Swelling, bruising, hematoma, and a deformity of the toe may be observed. The pain can be severe, preventing the wearing of regular shoes, greatly limiting mobility, and generally preventing weight-bearing.

Causes of first metatarsal fracture

The causes of a metatarsal fracture are varied; they can be traumatic or due to bone insufficiency, including direct trauma to the foot in road accidents or sports accidents, as well as stress fractures caused by overuse.

Any fracture of the first metatarsal should prompt investigation for associated bone and ligament injuries within the broader context of Lisfranc lesions.

Diagnosis and first aid

How to Diagnose a Fracture of the 1st Metatarsal

When sharp pain occurs in the foot, following a direct impact or a twisting mechanism, it is necessary to consult in order to obtain a diagnosis. To confirm this hypothesis, several steps are essential:

• Clinical examination: This makes it possible to assess pain, swelling, and functional impairment. It seeks for injuries associated with the suspected fracture of the first metatarsal according to the suspected injury mechanism.
• Medical imaging tests: X-rays are performed as a first-line investigation, allowing confirmation of the fracture diagnosis. In case of articular fracture or suspected associated injuries, a CT scan will also be performed. In the particular case of stress or insufficiency fractures, MRI is the most effective imaging test.

First Aid to Administer

While waiting for a medical consultation, simple actions can be performed to reduce complications and relieve pain:

• Immobilization: Avoid putting weight on the injured foot. Using crutches may be necessary to move around without putting strain on the foot.
• Ice application: To reduce swelling, apply ice wrapped in a cloth to the painful area for 10 minutes several times a day.
• Elevation: Keep the foot elevated to decrease swelling.
• Compression: Use a compression bandage to support the foot and limit swelling.

Once at the doctor’s office, an appropriate treatment plan will be established, which may include wearing a splint, a walking boot, an orthopedic shoe, or even a cast. In cases of displaced fracture, articular fracture, or fracture-dislocation of the first metatarsal, surgery is generally necessary.

Possible treatments for a first metatarsal fracture

Non-surgical treatments

When it comes to treating a first metatarsal fracture without surgery, several options can be considered depending on the severity and type of fracture. Here are the main non-surgical approaches:

• Immobilization: Using a splint or cast may be necessary to keep the metatarsal in position and promote bone healing without secondary displacement of the bones.
• Rest: Taking the weight off the fractured foot by using crutches may be recommended to relieve pain and reduce the risk of secondary displacement.
• Painkillers: Pain and inflammation can be managed with non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics.
• Physical therapy: Once bone healing has sufficiently progressed, rehabilitation exercises guided by a physiotherapist can help restore strength and mobility to the foot.

These methods are generally preferred for simple, extra-articular, non-displaced fractures of the first metatarsal.

Surgical treatments

In cases where the fracture is complex, displaced, or articular, surgical treatments may be necessary to ensure optimal recovery. Surgical procedures may include:

• Open reduction and internal fixation: This surgical procedure involves making an incision to correctly reposition the bones, then fixing them in place with screws or plates.
• Osteotomy: Correction of bone alignment may be needed in cases where the bones have healed incorrectly, which involves cutting and repositioning the bone by performing an osteotomy.
• Foot arthrodesis: In some cases, particularly with complex and comminuted articular fractures, fusing the affected joint as a first-line treatment may be the best surgical option to stabilize the foot and provide long-term pain relief.

For these procedures, it is best to consult a foot specialist surgeon who will assess your situation and can recommend the most appropriate surgical treatment.

Prevention and tips to avoid metatarsal fractures

Prevention Tips

To effectively prevent metatarsal fractures, it is essential to adopt appropriate behaviors and practices. Here are some practical tips: 

• Maintain good physical condition : Regular physical exercise strengthens the muscles that support the metatarsals, thereby reducing the risk of injuries.
• Warm-up and stretching : Before any physical activity, take the time to warm up properly, and after exertion, make sure to stretch to relieve your feet and avoid unnecessary tension.
• Gradual increase of activity : Avoid overloading your feet by increasing the intensity of your physical activities too quickly. A gradual progression helps prevent stress fractures.
• Footwear for two-wheelers : It is essential to wear appropriate shoes when traveling on two-wheelers, as this helps reduce the risk of breaking bones in the ankle and foot, which are often difficult to repair and carry a high risk of significant aftereffects due to the limited effectiveness of both surgical repairs and even reconstruction.

Importance of suitable equipment

The use of fracture prevention equipment is crucial for protecting your feet. Investing in good sports shoes, specifically designed for your chosen activity, can greatly reduce your risk of metatarsal fractures. Here is why and how to choose: 

• Choice of footwear : Choose shoes that offer good support and adequate protection. They should fit well—not too tight nor too loose—to avoid any excessive pressure on the metatarsals.
• Orthopedic insoles : In some cases, using orthopedic insoles may be recommended to better distribute pressure on the foot.
• Regular replacement : Sports shoes lose their effectiveness with time and wear. Replace them regularly to maintain optimal protection.