An Overview of Midfoot InjuriesThe midfoot is marked by something known as the Lisfranc joint complex. In this area, there is a cluster of small bones that form an arch on the top of the foot. This is where the long metatarsal bones begin and extend to the toes. Everything is held in place by ligaments stretching across and down the foot. There are essentially three categories of midfoot injuries:
- Sprains. A sprain in the Lisfranc joint complex happens when a ligament is twisted beyond its intended range of motion. This results in pain and swelling.
- Fractures. Fractures are simply broken bones. There are various ways the bones in the midfoot can become fractured, including direct trauma (like a fall from height).
- Dislocations. Some Lisfranc injuries are ones wherein a metatarsal has become dislocated due to physical trauma.
The Basics of Metatarsal FracturesEach of your feet has 26 bones and five of those are metatarsals. These bones are the long ones that run across the midfoot, connecting the front and back. A fracture is simply another term that means break. There are two main categories when it comes to fractures:
- Traumatic fractures. This is an injury that happens when a bone is subjected to greater force in one moment than it can handle. Events that could cause this include seriously stubbing a toe, dropping a heavy item on your foot, or sustaining an injury while playing baseball or another sport.
- Stress fractures. Unlike a traumatic fracture, this type does not happen from a single event. A stress fracture is a tiny, hairline crack that develops because of repetitive stress. This is thought of as being an “overuse” injury and can be seen in athletes who run great distances.
Causes of Stress Fractures in MetatarsalsWhereas most people understand fractures caused by blunt physical trauma, stress fractures aren’t quite as universally understood. Let’s take a look at these particular fractures that can develop in the bones in your midfoot. Bones undergo a near-constant process of generating and replacing tissue (known as “remodeling”). If activity levels are too great or too frequent, the breakdown of bone outpaces the body’s ability to repair and replace it. This results in weaker bones; ones that are then more vulnerable to stress fractures. A stress fracture is a thin, surface-level crack in a bone caused by overuse (often in conjunction with repetitive motion). The weight-bearing bones in the lower extremities are particularly vulnerable to these common overuse injuries because they absorb repetitive forces during activities like running, jumping, and even simply walking. Metatarsal stress fractures are most likely to develop in either the second or third metatarsals. This can be attributed to the fact they are often longer and thinner than the first metatarsal. This area of the foot sustains the greatest amount of impact whenever you push off the ground while walking or running. Accordingly, the most frequent causes of these stress fractures is a sudden increase in physical activities, either in frequency, duration, or intensity. The activity doesn’t even necessarily need to be particularly “athletic” for this injury to develop. Even excessive walking, if you normally walk on an infrequent basis, can lead to this problem. Some factors that increase the likelihood of a metatarsal stress fracture include:
- Poor conditioning. Instead of jumping into an activity too quickly, take time to gradually build up your body and prepare it ahead of time.
- Improper equipment. Make sure you choose shoes with ample shock-absorbing features and then replace them when they are worn out.
- Bone insufficiency. Consume plenty of calcium and vitamin D in your diet to keep bones strong and dense.
- Change in surface. Going from a soft surface to a harder one can increase your injury risk, so you may need to lower your intensity or duration when doing so.
First Aid and Treatment OptionsUntil you can come and see one of our doctors at Southern Oregon Foot & Ankle, be sure to follow the RICE protocol. Use Rest, Ice, Compression, and Elevation to relieve pain and reduce swelling in the affected area. You may want to also use a nonsteroidal anti-inflammatory drug (like naproxen or ibuprofen), but make sure you check with us for professional dosage recommendations first. In addition to over-the-counter medications and RICE treatment, we might be able to include conservative options in your treatment plan, such as activity modifications, protective footwear, and casting. For expertise and effective treatments, please call us at (541) 776-3338.
Due to the nature of both the injuries themselves and the likely causes behind them, midfoot bone fractures are often treated with surgical procedures. It takes a tremendous amount of physical force to break one of the midfoot bones. When this happens, the bone is more likely to become displaced, which can affect the structure and stability of the foot as a whole. Surgery may be a recommended part of treatment, depending on the severity and nature of the midfoot injury.
The surgeries we perform to repair broken midfoot bones will often entail an incision in the top, but a second may be needed, depending on the extent of the injury. Surgical procedures that might be used include fixation and fusion. When internal fixation is performed, bones are lined up in their proper places and then secured with the use of screws and/or plates. After about 3 to 5 months, the screws and/or plates will be removed to allow for increased movement.
Fusion is an option that is more commonly used for severe cases that are damaged beyond other means of repair. This procedure will fuse damaged bones together, and they will heal into a single, solid piece. In the event that screws or plates are used for fusion, they will not likely be removed. How long it takes for a metatarsal fracture to heal entirely depends on how serious the break is and how well you take care of it. Your full recovery may range from several weeks to several months. The more serious the injury is—cracks in multiple places, broken ends that don’t align, pieces that have to be surgically held together—the longer it will take. Failing to treat it correctly lengthens healing time.
Whether it’s a simple or more complicated injury, the recovery process follows roughly the same pattern. First, you’ll spend a few weeks in a cast or special boot to immobilize your foot. You must minimize or completely avoid putting weight on the affected limb during this time. If your fracture required surgery, the immobilization period may last a couple months. After your bones show signs of healing, you’ll slowly begin putting weight on that foot again. You’ll move to wearing stiff-soled and then more comfortable shoes as you recondition your feet for activity.