Metatarsal and Phalangeal Fractures

Patients with metatarsal fractures often present to primary care settings. These fractures are relatively common in foot and if malunited it becomes a frequent source of pain and disability. Nondisplaced and lesser metatarsal fractures can be treated conservatively with protected weight bearing in a below-knee cast. Displaced fractures usually need closed reduction and internal fixation. Percutaneous pinning is suitable for most fractures of the lesser metatarsals. Intra-articular fractures and comminuted fractures frequently require open reduction and plate fixation. Proximal fifth metatarsal fractures that are distal to the tuberosity usually have a poorer prognosis. Radiographs should be carefully evaluated to distinguish these fractures from tuberosity fractures. Treatment of fractures distal to the tuberosity (Jones fracture) should be individualised based on the characteristics of the fracture and patient preference. Symptomatic post-traumatic deformities need adequate correction, in most cases by osteotomy across the former fracture site.