The first metatarsal, which connects to the big toe, is the most important and fractures of the first metatarsal usually require surgery. Fractures of the middle metatarsals (the second, third and fourth) do not require surgery unless there are significant displacements of the bone. Fractures of the fifth metatarsal are quite varied and the treatment is determined according to the specific location of the fracture in this bone.
The treatment of the metatarsals varies depending on the injury. Some patients simply wear a very stiff-soled shoe or a special type of rigid heeling shoe or a short leg walking cast. Surgery is reserved for the more serious of these fractures. These are usually certain types of fractures of the first and fifth metatarsal.
Fractures of the fifth metatarsal are unique in that they commonly occur associated with sporting activities. There is one type of fracture in particular, called the Jones fracture, which is a difficult fracture to get to heal. Because of problems with blood supply to the bone where the fracture occurs, these fractures are difficult to heal and often surgery is required.
If surgery is not performed, then a boot or cast is used. It can take eight to 10 weeks for this fracture to heal and it is not always predictable whether or not full healing will occur. If a cast or boot is used, no walking on the foot is permitted for about six weeks. The results of bone healing are unpredictable. Studies have shown about 70% heal with cast treatment.
On the other hand, surgery for the Jones fracture has about a 95% success rate. Therefore, surgery is preferable for most Jones fractures. In this treatment, a tiny puncture is made in the skin on the outside of the foot and a screw is inserted. An X-ray monitor is used to help position the screw. The screw helps speed up the healing process.