This is an avulsion injury involving the base of the 5th metatarsal bone caused by sudden twisting injury to the foot. In most cases, there is very little displacement of the fracture segments.
Elastic strapping is applied which extends from below the knee up to the metatarsal heads. Early exercises and activity are encouraged. Short leg-plaster can be applied when the patient experiences a lot of pain. Plaster is usually removed after a period of four weeks.
FRACTURE OF THE METATARSALS
MECHANISM OF INJURY
Most of these fractures are the result of a direct violence. This happens mostly due to the fall of a heavy object or by the wheel of a vehicle passing over the foot.
NATURE OF INJURY
The lesion may involve the shaft or the neck of the bone. The amount of displacement of the fractured segment varies in accordance with the severity of the violence.
Most fractures unite satisfactorily. This is seen even when the segments are maintained in a somewhat displaced position. Sometimes the patient may experience pain by putting weight on the affected limb even after the satisfactory union of the fracture. It is essential to correct the shape and curvature of the metatarsals. Any alteration may interfere with the maintenance of the arch of the foot and may produce disability at a later stage.
Closed method: Many of the displaced fractures can be reduced satisfactorily by simple manipulation. Below-knee plaster is applied for immobilization. The limb is kept elevated on a pillow till the swelling subsides. Weight-bearing is allowed once the swelling disappears.
Internal fixation: Internal fixation by Kirschner’s wire is a satisfactory method. This is done in cases of failure of closed reduction. Kirschner wire or K wire is accessible from the orthopaedic implant manufacturers.
This condition is experienced by young adults, engaged in prolonged standing jobs. The metatarsals may sustain fracture because of continuous strain from the weight of the body. Patient experiences pain on standing. Usually, the second metatarsal bone is affected but the other metatarsals can also suffer.
X-ray: X-ray shows excessive callus formation at the site of the lesion. The fracture line may be faintly visible. There is no displacement at the site of the fracture.
Reduction of the fracture is not required as there is no displacement of the segments. The elastic bandage is applied, and the patient is advised normal walking.
FRACTURES OF THE TOES
MECHANISM OF INJURY
Fractures of the toes are usually the result of crushing injuries.
NATURE OF INJURY
Fractures may involve the proximal, middle or distal phalanges. All types of lesions may be produced which can be transverse, oblique or comminuted variety.
Immediate treatment is directed towards allaying pain and taking care of any associated soft tissue injury of the toes.
Reduction: In most cases reduction is not usually required. This may be done in cases of displaced and angulated fracture of the phalanges.
- Strapping with adjacent toe: The affected toe is immobilized by elastic strapping with the adjacent toe after putting a small piece of gauze in between the two toes.
- Removal of the top of shoe: The patient can wear a shoe with the front part of the top of the shoe removed. This prevents pressure on the painful toes.
- Fixation of a metatarsal bar: A leather band of 1.25 cm. (½”) thickness is fixed under the sole of the shoe at the site where the metatarsal heads to rest. This takes off the weight from the toes during walking. Fixation of the metatarsal bar.