Pathological functional restructuring of the bones of the foot

Description of injury

The metatarsus is called the midfoot. These are five tubular bones connecting the tarsus and phalanges of the fingers. The metatarsus is involved in the formation of the arches of the foot and is responsible for the shock-absorbing function, ensuring the correct biomechanics of the foot during jumping, running, and fast walking.

Violation of the integrity of one or more bones leads to difficulty in supporting the injured leg and moving independently. And in the absence of proper treatment, the patient may subsequently develop post-traumatic flatfoot.

In traumatology, there is a classification of fractures of the metatarsal bone of the foot. If the fracture occurred as a result of injury, the fracture is considered traumatic. If the provocateur is regular intense stress and bruises, it is called fatigue.

Depending on the location of the damage, the following types are distinguished:

1. Jones fracture - affects the fifth bone, the damage to which requires long-term treatment.
2. Avulsion - appears when the foot is subluxated, accompanied by sprained ligaments and an ankle fracture.
3. Subcapital – when the necks of the bones are broken.

Sometimes the middle part or directly the heads of the metatarsal bones are damaged. If the integrity of the skin is broken and an exposed bone fragment is visible through the open wound, this is an open fracture. A closed injury is one that is localized in the thickness of the soft tissue without damaging the surface layers.

According to the relationship of bone fragments, there is a fracture without displacement and with displacement. A single metatarsal fracture is rarely displaced. When one bone is damaged, nearby formations begin to act as a splint, holding the fragments in the correct position.

Fifth metatarsal fracture

The fifth metatarsal bone is located at the outer edge of the foot. Its location makes it most vulnerable to damage caused by external mechanical influence. Even poor positioning of the foot when running, or turning it in, leads to damage to this bone.

The fifth metatarsal bone is characterized by avulsion fractures. They are located at the base of the fifth metatarsal bone at the insertion of the peroneus brevis tendon and the plantar fascia. The second name for such a fracture is a “dancer’s fracture”, or Jones’ fracture. The name is associated with the name of orthopedist Robert Jones and is due to the mechanics of the injury: an unsuccessful landing after a jump or a twisted foot after a jump. The ankle joint becomes excessively twisted and at the same time the peroneus brevis muscle contracts. As a result, the base of the fifth metatarsal bone is torn off. However, most Jones fractures are stress fractures that occur due to repetitive stress.

Symptoms

A fracture of the metatarsal bone of the foot is accompanied by a clinical picture, the severity and characteristics of which depend on the type of fracture. When one metatarsal bone is damaged:

• pain intensifies when trying to lean on the foot or when palpating the damaged area;
• the foot swells locally over the broken bone on the dorsal and plantar side;
• subcutaneous hemorrhages may not appear immediately, but after a few hours, as a rule, they are not extensive;
• When palpated, crepitation (crunching) is heard.

The foot is deformed, the toes may be visually shortened.

If the fracture is multiple, the following appears:

• severe swelling covering the entire surface of the foot;
• pronounced extensive subcutaneous hematomas;
• the foot hurts a lot, it hurts to touch it;
• it is impossible to lean on the injured leg;
• the foot is deformed.

If the fracture is open, the injury is complicated by bleeding and traumatic shock. The condition is characterized by pale skin, increased or slow heart rate, and a sharp decrease in blood pressure. Some victims may develop fainting.

Causes

A fracture of the metatarsal bone of the foot can occur for traumatic and pathological reasons.

Mechanical damage is caused by:

• a strong direct blow to the foot from above;
• dropping a heavy object onto your foot:
• compression of the foot from above and below;
• load at the moment of rotational movement.

Often such fractures appear after road accidents. Running over a leg with a vehicle causes a crack in the bone or a complete fracture.

Pathological causes include:

• decreased bone density due to osteoporosis;
• leaching of calcium salts from a person taking diuretics for a long time;
• excess load in obesity.

Fractures are more common among older people and professional athletes. Constant intense loads, which are accompanied by regular minor injuries - subluxation, bruise, are a predisposing factor in the subsequent violation of bone integrity.

A similar picture is observed among army recruits due to the increased load on the foot.

Consequences and possible complications of a metatarsal fracture

Many victims experience pain after the injury has healed and do not consider it necessary to consult a specialist for this discomfort.

Ignoring pain can cause serious complications. These include:

• changes in the structure of bone tissue;
• limitation of the range of motion of the foot;
• intra-articular changes;
• formation of flat feet;
• arthrosis;
• improper healing of the fracture;
• chronic pain;
• inability to withstand prolonged loads: walking, standing in one position, running, as pain, fatigue, tingling in the foot occur.

Conclusion

The metatarsus is located between the phalanges of the fingers and the tarsal part of the foot. Metatarsal fracture is a relatively common injury. It accounts for 2.5% of all skeletal bone fractures, and among foot fractures – 25-45%. A fracture requires immediate medical intervention. Treatment tactics are determined based on the examination results. If the doctor's instructions are fully followed, a favorable prognosis is given. If a person neglects some of the specialist’s recommendations or puts excessive stress on the leg prematurely, he may become lame or lose the ability to move normally.

Treatment

Therapeutic measures begin even before qualified assistance is provided. It is important to take the correct pre-medical actions at the scene of the incident:

1. Provide rest to the victim and do not allow him to stand up or move the injured leg.
2. If possible, remove your shoes; if this requires effort, then there is no need to do so.
3. Apply cold to the fracture site: frozen foods wrapped in cloth, a hypothermic “Snowball” bag. The duration of exposure should not exceed 15 minutes to avoid local hypothermia.
4. Immobilize the foot by applying a splint, or fix it between two flat planks.
5. In case of severe pain, you can take a painkiller - Baralgin, Ketanov.

The victim should be taken to a doctor immediately. Any delay may result in the development of unwanted complications.

A traumatologist treats a fracture of the metatarsal bone of the foot. Before prescribing therapeutic procedures, a diagnosis is carried out. In addition to a visual examination and listening to the patient’s complaints, the doctor records the time and details of the injury, and prescribes an x-ray examination. The picture is taken in 2-3 projections, depending on the type of fracture. After confirmation of the diagnosis, treatment tactics are drawn up.

Types of therapy:

1. For a simple fracture without displacement, a plaster splint is applied for 1 month. The duration of fusion may increase if the patient has a calcium deficiency in the body. To speed up regeneration, calcium preparations are prescribed - Kalcemin, Calcium D3 Nycomed. The plaster cast is removed only after a control x-ray, which confirms the formation of callus.
2. When the ends of the damaged bone are displaced, closed or open reposition (comparison) of the fragments is performed. If the operation is performed using the open method, it is necessary to fasten the bone parts with special staples and pins. In some cases, skeletal traction is indicated. In this case, the cast will have to be worn for about 12 weeks.

During the treatment period, the patient is required to exclude any load on the injured foot. You should only move around with the help of crutches. After removing the cast, it is recommended to wear a medium-fixation bandage, which is eventually replaced with an elastic orthosis. It is necessary to insert orthopedic insoles into shoes to avoid the development of flat feet.

Medicines prescribed:

• NSAIDs for relieving pain and preventing an inflammatory reaction - Ketoprofen, Ketorol, Diclofenac;
• chondroprotectors to speed up bone tissue metabolism - Teraflex, Artra;
• calcium preparations for healing fractures of the metatarsal bones of the foot - Kalcemin Advance.
• diuretics to remove excess fluid - Furosemide, Diuver.

Metatarsal stress fracture

Metatarsal stress fractures typically occur in athletes. Often such injuries go unnoticed. They are visualized on an x-ray 5-6 weeks after the onset of the first symptoms, when a callus is formed. Therefore, for timely diagnosis, it is recommended to do an MRI or scintigraphy.

Stress fractures of the second and third metatarsals usually occur at the level of the diaphysis or neck. As a rule, such damage is facilitated by a sharp increase in loads. The fracture is also called a “marching” fracture because it often occurs in army recruits due to long marches. Stress fractures of the base of the second metatarsal are common among ballet dancers. A stress or fatigue fracture is accompanied by:

• pain while walking and running;
• pain that disappears during rest and returns during movement;
• “point” pain at the fracture site, which is felt upon palpation;
• swelling.

Injuries such as foot sprains and metatarsal fractures have similar symptoms. Even if you can walk, this does not guarantee the absence of a fracture, so it is recommended to consult a specialist to clarify the diagnosis.

Rehabilitation

The speed of recovery after a fracture of the metatarsal bone of the foot depends on various factors:

• severity of injury;
• age of the patient;
• accompanying pathologies.

For example, in patients with diabetes, as well as in older people, tissue regeneration slows down significantly. A history of osteoporosis requires special attention and intensive therapy.

The rehabilitation period includes a set of procedures, the goals of which are to completely restore the functionality of the foot and return the patient to a working condition. For this purpose they prescribe:

• physiotherapy;
• massage;
• a set of therapeutic exercises.

A metatarsal foot fracture will heal faster if the patient undergoes a full course of physical therapy. The recovery method is prescribed by a doctor and is available at home. It could be:

• magnetic therapy;
• electrophoresis;
• Ural Federal District;
• phonophoresis;
• laser therapy.

Mud baths and paraffin applications are useful. Each of these methods increases blood circulation, improves nutrition and regeneration of damaged tissues.

The massage course is aimed at restoring mobility and strengthening the ligamentous apparatus. Sessions should be conducted by a qualified specialist who has the technique of therapeutic massage.

Therapeutic exercises are prescribed after removing the plaster cast. The list of exercises and their frequency are prescribed by the doctor together with the physiotherapist. The first classes are conducted under the guidance of an instructor who teaches the correct technique and teaches how to dose the load. In the future, it is recommended to regularly perform therapeutic exercises at home.

A set of basic exercises:

1. Flexion and extension of the toes on the injured leg.
2. Sitting on a chair, perform heel-to-toe rolls.
3. Bend your foot, stretching the front part of it forward and back, in the opposite direction. In this case, a noticeable tension should be felt.
4. Rotate the foot to the left and right.
5. Rolling a massage roller, a small ball or a bottle filled with water on the floor.
6. Rotate the foot in a circle in different directions.
7. Exercise "scissors" in a lying position - crossing slightly raised legs.

Each movement should be performed slowly and smoothly. In this case, the patient should not experience pain. If pain occurs, exercise should be stopped and your doctor informed.

If you follow all the specialist’s recommendations, it will take from 1.5 to 3 months to restore your ability to work. In most cases, the prognosis is favorable. Impaired functionality may be a consequence of delay in contacting a doctor and attempts at self-medication.

Prevention

A fracture of the metatarsal bone of the foot can be prevented by following simple rules:

• eat right and lead an active lifestyle;
• monitor your weight and prevent the appearance of extra pounds;
• wear comfortable shoes with heels no higher than 4 cm;
• perform feasible physical exercises to strengthen ligaments and muscles;
• go swimming.

If you suspect a fracture, do not try to cure the injury yourself, but immediately contact a medical facility.

Insoles after a metatarsal fracture

The normal foot maintains lateral balance using the first and fifth metatarsals. After a fracture of one of the metatarsal bones, if orthopedic insoles are not used, the bone may move apart under the weight of the body. The result of this process is post-traumatic flatfoot. After an injury, insoles should be used for at least six months, in some cases – 10-12 months, when the bone is completely strengthened.

In order for the use of orthopedic insoles to fulfill its function, you must follow several simple rules. Before purchasing special insoles, it is recommended to consult a podiatrist to find out which insoles are worth purchasing. Those. Is a universal product suitable in your case, or is it better to order the production of orthopedic insoles according to an individual design? The latter option takes into account the dynamics of your foot.

For orthopedic insoles, orthopedists recommend purchasing shoes with a heel of no more than 2-4 cm. Experts recommend not wearing boots or shoes with flat soles (ballet flats, pumps, moccasins, etc.), in which the foot can dangle and spread out. If this happens, then the risk of developing negative processes that can lead to pain when walking increases significantly.