FOOT & ANKLE

Toe & Forefoot Fracture

Fractures of the toes and forefoot are quite common. The forefoot is the front of the foot and has 5 metatarsal bones and 14 phalanges (toe bones). Each toe has 3 phalanges, except the first two which usually only has 2. All the bones in the forefoot are designed to work together when you walk. Fractures occurring in this part of the foot are painful but very often not disabling.

Toe and forefoot fractures often result from trauma or direct injury to the bone. Stress fractures can also develop after repetitive activity, rather than a single injury. 


Fractures may either be:

  • Non-displaced, where the bone is cracked but the ends of the bone are together
  • Displaced, where the end of the broken bones have partially or completely separated

They can also be divided into:

  • Closed fractures, where the skin is not broken

Open fractures, where the skin is broken, and the wound extends down to the bone. Immediate treatment is required to prevent infection.

Toe Fractures

May result from direct injury, such as dropping a heavy object on the front of your foot, or from accidentally kicking or running into a hard object. A fracture may also result if you accidentally hit the side of your foot on a piece of furniture on the ground — and your toes are twisted or pulled sideways or in an awkward direction. The proximal phalanx, closest to the metatarsals is most likely to fracture as it is the longest of the toe bones.


Metatarsal Fractures

The metatarsals are the long bones between your toes and the middle of your foot. Like toe fractures, metatarsal fractures can result from either a direct blow to the forefoot or from a twisting injury. Some metatarsal fractures are stress fractures caused from repetitive activity or pressure on the forefoot.


Fifth Metatarsal Fracture

The fifth metatarsal is the long bone on the outside of your foot. Injuries to this bone may act differently than fractures of the other four metatarsals. Common fractures of the fifth metatarsal include:


  • Avulsion fracture (left) - through the base of the bone from an injury where the foot and ankle are twisted downward and inward. The fractured fragment is pulled away from the rest of the bone from stretching the tendon attached to the fifth metatarsal.


  • Jones fracture (right) - horizontal or transverse fracture at the base of the fifth metatarsal. One of the most common fractures of the foot and has unique characteristics that make it more likely to require surgery.

Symptoms

The most common symptoms of fracture are pain and swelling. Other symptoms may include bruising and discolouration that extends to nearby parts of the foot and pain when walking. Skin abrasions or open wounds as well as loss of sensation (an indication of nerve injury) may also be experienced depending on the severity of injury.



Causes

Traumatic fractures occur when there is a direct impact of your foot on a hard surface such as accidentally kicking something hard or dropping a heavy object on your toes. A fracture may also result if you accidentally hit the side of your foot on a piece of furniture on the ground — and your toes are twisted or pulled sideways or in an awkward direction. Stress fractures, tiny hairline cracks in the bone most commonly caused due to overuse and repeated stress are also causes of toe and forefoot fractures. These can occur from participating in high impact sports such as running, football and basketball.



Diagnosis

Diagnosis is made by medical consultation and examination, taking the patient's past medical history and physically inspecting the injured area. An X-ray may be taken to identify the location and severity of fracture.



Treatment Options

Non Operative Treatment

Non operative treatment options include:

  • Rest: adequate rest and elevation to allow time for the injury to heal
  • Immobilisation:
  • Splints may be applied to keep the toe in a fixed position
  • Rigid shoe/stiff soled shoe may be recommended to protect the toe and position it correctly
  • Cast or walking boot to weight bear
  • Buddy taping the fractured toe to the adjacent toe 

If the bone is out of place or the toe appears deformed, it may be necessary for your doctor to manipulate, or reduce, the fracture back into place.


Surgery

When surgery is indicated depending on the severity and placement of injury, the doctor realigns the fractured bones using pins, plates and/or screws to hold the bones together in place until they heal completely.


Find out more about Toe Surgery.

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