INJURIES TO THE TOES AND METATARSALS
Section snippets
FRACTURE OF METATARSAL BASE
Injuries to the base of the metatarsal occur primarily through the metaphyseal bone. Most fractures heal rapidly within 6 weeks. Oblique injuries heal more rapidly than transverse or comminuted ones. Lisfranc variant–type injuries must be ruled out, especially when multiple metatarsals are fractured. Treatment of base fractures consists of immobilization with a cast or cam walking boot, with progressively increasing weight bearing as tolerated. There is less risk of displacement of fractures of
FRACTURE OF METATARSAL SHAFT
Injuries to the metatarsal shaft are relatively more common than injuries to the base. Stress fractures are common. Treatment consists of early suspicion, even with nondiagnostic radiographs, and alleviation of aggravating factors, followed sequentially by rigid-soled wooden shoes and limited weight bearing. Subtle radiographic findings may consist of longitudinal cortical hypertrophy, narrowing of the medullary canal, and periosteal lucency. Subtle transverse lines of sclerosis may represent
FRACTURE OF METATARSAL NECK
Fractures of the neck of the metatarsals are treated similarly to fractures of the shaft. Isolated injuries require only symptomatic treatment with a postoperative shoe; multiple fractures may require surgical stabilization to prevent rotational deformities and the development of painful plantar callus from a prominent condyle. Fractures of the metatarsal heads are the result of shearing forces creating an entirely intra-articular fragment devoid of any capsular attachments. The distal fragment
FRACTURE OF FIFTH METATARSAL
Fractures of the fifth metatarsal deserve special attention their prevalence and their because of historical incidence of delayed union. Jones15a in 1902 is credited with the first description of 4 cases of injury to the base of the fifth metatarsal, including his own, sustained while dancing. Jones15a was the first to recognize that these injuries can occur without direct trauma. It is important to understand the anatomy of the lateral border of the foot to appreciate the uniqueness of these
JONES FRACTURE
Jones fractures are defined as a fracture 1.5 to 2.0 cm distal to the tip of the tuberosity at the metaphyseal-diaphyseal junction. Anatomically, this is the region between the insertion of the peroneus tertius and peroneus brevis tendons. The physiologic mobility of the lateral rays occurs in the sagittal plane of dorsiflexion and plantar flexion. The mechanism of injury for Jones fractures is with the foot in plantar flexion and subjected to forceful adduction, which causes sudden
METATARSO PHALANGEAL JOINT INJURIES
The metatarsophalangeal (MTP) articulations are complex structures that are prone to sprains, subluxations, and dislocations. The MTP joint is formed by the oval concave surface of the base of the proximal phalanx articulating with the corresponding convex metatarsal head. The capsule is supported medially and laterally by the collateral ligaments; plantarly, by the thick fibrocartilaginous plate and flexor tendons; and dorsally, by the thin expansion of the extensor tendons. The plantar plate
SUMMARY
Traumatic injuries to the toes and metatarsals are common injuries affecting nearly every individual. Injuries may be precipitated by industrial accidents or simple bumps in the night. They can produce a wide spectrum of consequences ranging from permanent disability to asymptomatic deformities. With appropriate treatment, most individuals should have the capacity to return to their preinjury functional status.
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Address reprint requests to Osep E. Armagan, MD, Neurology-Orthopaedic Center (MC 699), University of Illinois at Chicago, 1801 West Taylor Street, Room 2A, Chicago, IL 60612