What are the metatarsals?
The metatarsal is composed of five metatarsal bones, which are numbered from the medial aspect of the foot located on the tarsus.
The metatarsals are long bones formed by a triangular prismatic body with three faces, superior and lateral, and two ends, anterior and posterior, the latter with five faces, three of which are articular (except 1 and 5, which only have two).
Function of the metatarsals
The metatarsal bones are the long bones of the foot that connect the ankle to the toes and help with balance in standing and walking.
The fracture of the fifth metatarsal is very frequent in sports.
Pathologies that can suffer the metatarsals
These are the main pathologies that the metatarsal bones can suffer:
- Metatarsalgia: is an injury that affects the sole of the foot near the beginning of the toes, specifically the metatarsal bones, resulting in severe pain and even making the person limp and unable to walk. This is a very common problem, especially affecting women and athletes, with the metatarsal of the second toe being the most affected.
- Fracture of the fifth metatarsal: The fifth metatarsal is a bone located on the outer edge of the foot. It has clinical importance because many fractures occur in this bone. Its fracture is very frequent in sports, especially in those sports that require jumping and displacement actions, with changes of rhythm and direction (soccer and basketball).
We can distinguish three types:- Metatarsal stress fracture: It occurs after prolonged exercise such as a march or marathon, very frequent in military personnel.
- Jones fracture: It occurs at the base of the 5th metatarsal and is usually suffered in numerous activities, both daily and sports, however, in the practice of soccer it has more incidence. In addition, this area of the bone has low blood flow, which makes healing difficult.
Jones fracture can be produced- By stress: as a consequence of repeated impacts a small fissure is produced.
- Acute: a sudden fracture occurs.
- Avulsion fracture: A small portion of bone is torn away by a tendon or ligament. This type of break is often the result of an ankle sprain. They occur due to traction on the fifth metatarsal by the peroneals during forced inversion.
Treatments for metatarsal pathologies
The treatment for a metatarsalgia depends on its cause. Some basic advice is a change of footwear, losing weight, eliminating hardness in the foot or the use of customized insoles to eliminate maximum pressure points. A biomechanical study of the footprint can also be useful.
- Conservative treatment to eliminate pain is recommended physiotherapy treatment, with exercises such as:
- Self-massage of the foot with a ball
- Self-massage and separation of the toes.
- Arch stretching of the anterior arch of the foot
- Stretching of the calf and soleus
- Stretching of the anterior musculature of the foot and ankle
- Self-massage and global mobilization of the foot
- Pharmacological therapy is recommended in the most acute phases of pain with the presence of inflammation, often it is sufficient with a non-steroidal anti-inflammatory drugs.
Infiltration with hyaluronic acid is also used to relieve pain and reduce inflammation. - Surgical treatment: It may be advisable in the case of metatarsalgia caused by a foot deformity to try to restore the ideal biomechanics of the forefoot.
- Open surgery: Shortening and/or elevation osteotomies of the metatarsals are performed by means of open surgery, placing and fixing them in the situation considered optimal.
- Percutaneous surgery: Through incisions of approximately 3 mm on the bone and soft tissues, an attempt is made to correct the foot deformity. This minimally invasive treatment corrects the deformity causing the pain.
Metatarsal fractures generally respond well to conservative treatment. Immobilization with a cast or splint is usually applied, and with the assistance of crutches to prevent loading on the affected foot. In addition, the application of local cold is recommended during the first 48 hours after the fracture to combat inflammation and pain.
Surgical treatment for metatarsal fracture is indicated only in those cases in which there is a comminuted fracture, complete fracture with displacement of the bone fragment or in cases in which, after a period of immobilization, the fracture has not consolidated adequately and surgical intervention with Kirschner pin fixation is necessary.
The application of ultrasound and magnetic therapy will help bone regeneration and the rapid formation of bone callus.
Specialist who treats the pathologies of the metatarsals
The traumatologist is the one who works in the prevention, diagnosis and treatment of diseases and injuries of the musculoskeletal system. The purpose of the traumatologist is to surgically and orthopedically treat injuries or fractures of bones, muscles, joints and ligaments.