When A Patient Has Multiple Bilateral Metatarsal Fractures

A 54-year-old woman contacted me after breaking her fourth and fifth metatarsals on the left foot and the fourth metatarsal on her right foot. After some activity, swimming and stretching her toes a couple of times and touching her toes, she noted “it felt like my tendons were going to pop out of my feet.” 

Her feet were in controlled ankle motion (CAM) boots but says they squished her toes too much. The pain is right at the tendon attachment on both feet, right where the peroneus brevis tendon inserts into the fifth metatarsal bone on the outside of the foot.

The patient wonders if she walked on the toes so long after they were broken, could she have damaged her tendons on both feet? This is possible but not probable as such an injury would only happen after a severe fall. When the tendon is injured, the pain extends back to the ankle and sometimes up the leg. Usually, with tendon injuries, pain is not localized.

The patient has been using the hot and cold baths as well as Exogen (Bioventus). Patients in cases like these should attain a 0–2 pain level but gradually bear weight to build bone strength. Remind patients that they shouldn’t try to push through pain that is above level 3 on the standard visual analogue scale. An occasional sharp pain that last 10 to 30 seconds is nothing.

For this patient, I would recommend inserting 1/8th adhesive felt (like the felt from Moore Medical) into the shoe to build a base that has a float for the fractures. The treating clinician may need to experiment with this but this addition is important for weight shifting and will get the patient walking faster.

The patient can also use an ice pack for 10 minutes twice daily now. She can begin each evening with one minute hot, one minute cold, alternating for 20 minutes. This will help with range of motion in the hot water with the foot.

Since this is a bone problem, I would consider a vitamin D blood test and a bone density screening test as well.

Editor’s note: This blog originally appeared at https://www.drblakeshealingsole.com/2017/06/metatarsal-fractures-email-advice.html . It is reprinted with permission from the author.