The foot has a very complex structure, and, despite its relatively small size, pathologies of any kind in this zone entail disruption of the functioning of the entire lower limb. Metatarsal bones are no exception.
Foot anatomy
It consists of 26 bones, and it is divided into 3 parts: tarsus, metatarsus and phalanx of the fingers.
The bones of the tarsus include 3 sphenoid, calcaneal, scaphoid, cuboid, talus (is part of the ankle) bones. They are all mediators of the transition of the ankle to the foot.
Metatarsal bones 5 - the first metatarsal bone of the foot, then the second, third and so on the count of the fingers. Their main purpose is to maintain and create the arch of the foot, without which human movement would be impossible. These are small tubular bones, they are very fragile. There is space between them.
The phalanx of the fingers 14. They are movable joints, have cartilage. The thumb has 2 phalanges, the other fingers - 3. The arch of the foot is functionally very important, because with the movements of the legs they act as a shock absorber.
Causes of pain
If the metatarsal bones of the foot are sore, the causes and treatment are always so interconnected that we can talk about etiopathogenetic therapy. Pain is associated with many diseases. They vary in nature, duration, prevalence. They can be single- or bilateral, short-term and permanent, in the form of burning, paresthesias, etc.
The following pathologies are most common:
- Inflammation of the plantar fascia. The reason is constant pressure on the plantar aponeurosis, supporting the arch of the foot. Fascia occupies the space between the heel and the metatarsus. Pathology is characteristic with heavy weight, flat feet, sports. Pain in the arch and heel occur immediately after sleep.
- Arthritis The joint itself and the foot also hurt. It manifests itself in itching and burning.
- Ligamentosis - damage to the ligaments of the foot, can be 2-sided. It develops with large loads on the foot, impaired blood circulation and microtrauma of the ligaments.
- Heel spurs - the appearance of a bone growth at the site of attachment of the fascia to the calcaneus. Moreover, there is almost always a chronic fasciitis. Pain appears when walking.
- Failure in the blood supply. At the same time, the foot hurts when walking, and at rest.
- Pinched nerve branches between the bones of the foot or at the exit from the vertebra. Most often occurs after childbirth.
- Benign neuromas. Pain occurs between the 3rd and 4th finger. They can be in the form of tingling, burning, pain, more often from 1 side. When wearing narrow shoes, the pain intensifies.
- Fractures, dislocations.
- Metabolic disorders with osteoporosis. The pain is aggravated by pressing the bones.
- Functional insufficiency of the feet is a problem of fat men, pregnant women, physical inactivity and large loads on the legs. After prolonged standing in the feet, diffuse pains appear.
- Flat feet - there is flattening of the arch, the shape of the foot changes. The legs and feet quickly become tired and very painful.
- Pathological disorders - warts, ingrown nail, curvature of the thumb. Are the result of uncomfortable shoes.
- Age-related changes in the feet - adipose tissue on the feet decreases with age, metatarsal deformity, circulatory disorders and osteoporosis occur. The role is played by the intense load on the feet.
Symptoms and treatment of the most common pathologies
Part of the metatarsal bones forms movable joints with digital phalanges. Like other joints, there is articular cartilage and an articular bag. With bruising or falling, the heads may shift, and excruciating pain occurs at the site of injury. The mobility of the joint is sharply impaired, it is impossible to step on the foot and move the toes.
The joint becomes swollen, increases in size, the skin over it turns red. The head itself can be deformed with the appearance of growths on it.
Treatment of a metatarsal bruise of the foot is determined by an x-ray. More often there is a need for surgical intervention. And although it is performed with local anesthesia, it is a radical form of therapy.
Treatment of the metatarsal bones of the foot is then expressed in the return of the bone head to the anatomically correct position and fixing it with a metal spoke.
Bone growths are removed. Shoes after such an intervention are suitable only orthopedic to maintain the bones of the foot.
Flat feet develops for various reasons:
- anomalies in the structure of the foot from birth;
- wearing narrow shoes or high heels;
- obesity;
- increased load during training;
- leg injuries with muscle weakness.
Treatment is most often conservative. The patient performs special exercises for training the arch, constantly uses orthopedic insoles. Useful walking barefoot on sand or pebbles and swimming.
To remove flat feet is completely possible only in children, while the bones grow. Adults can only see that the pathology does not progress. Flat feet can cause a hallux valgus, which increases pain.
Joint pathology
Arthritis - inflammation of the joint, arthrosis - degenerative changes in the cartilage. Treatment of arthrosis of the metatarsal bones of the foot includes the use of chondroprotectors. They nourish the remnants of cartilage. The inflamed joint also swells, enlarges, becomes hot to the touch, and hurts when walking.
Arthrosis is characterized by a crunch during movements. The surrounding tissue, ligaments, and muscles are involved in the inflammation process. This is called periarthritis and periarthrosis. If arthritis is completely curable, then with arthrosis this is not, the process can only be slowed down. Then only symptomatic treatment of the metatarsal bones of the foot is applicable.
For the treatment of injuries, special fixative dressings are used. Also, the root cause is important for treatment. When it comes to infection, antibiotic therapy is prescribed. In other cases, you can get by with local treatment in the form of ointments and gels, etc. Analgesics are prescribed to relieve pain. Treatment of inflammation of the metatarsal bone of the foot according to the scheme is prescribed only by a doctor.
Nervous disorders
Violation of the conduction of nerve impulses with the appearance of pain can occur in the following cases:
- pinched nerve between the bones of the metatarsus;
- pinched nerve at the level of the vertebrae;
- inflammation of the nervous tissue during hypothermia, wearing narrow shoes;
- neurinoma between the phalanges of the fingers.
As a treatment, massage sessions, physiotherapy, seasonal clothing and comfortable shoes will be prescribed. With inflammation, ointments and gels that warm and anti-inflammatory can be used.
Treatment of the metatarsal bones of the foot can be manual therapy if the pinching is in the spine and is accompanied by a displacement of the vertebrae. The goal is to return the vertebrae into place.
Metabolic Disorders in Bones
They are associated with a deficiency of vitamins, Ca, zinc, phosphorus, etc. Osteoporosis most often occurs. In this case, the bones become fragile and prone to fractures. Pathology is usually symmetrical and first affects small bones.
Pain appears during exertion and at the end of the day. Visually, the foot does not change, but all violations are visible on the x-ray.
For treatment, it is necessary to take Ca preparations and vitamins with minerals, proper nutrition. No less important is the height of the heel, which should not exceed 4-5 cm.
Treatment of the metatarsal bones of the foot is aimed at preventing further destruction of the bones. Such patients should not play sports and have serious stress. You should also normalize the weight.
Vascular disease
Most often, pain is associated with varicose veins. With it, the outflow of blood from the feet is disturbed. The goal of treatment is to restore the tone of the veins, strengthen the walls of blood vessels, the distribution of loads on the legs.
Medications can be used topically and orally. They use drugs to improve microcirculation, phlebotonics, vitamins, antiplatelet agents, etc. In general, it must be said that the causes of pain in the metatarsal bones of the foot are different, and treatment can be conservative and radical.
Diagnostics
Visual inspection may not provide enough information to make a diagnosis. Radiography is assigned in 2 projections. This is the main diagnostic method.
Ultrasound is also used, if necessary, MRI or CT. The complexity of the diagnosis is that patients most often come with advanced forms of pathologies, because, for example, with fractures of small bones, many do not go to doctors and continue to go with fractures.
General principles of treatment
The treatment of pains in the metatarsal bones of the foot is always and in all respects individually. It all starts with conservative treatment, they rarely try to resort to operations.
The doctor prescribes the necessary treatment for pain in the metatarsal bones of the foot only after determining the cause. Therapy begins with limiting the loads on the foot. Inflammation will require the use of anti-inflammatory drugs, fractures - the application of gypsum, dislocation - an elastic bandage.
Metabolic disorders are treated with hormones, vitamin and mineral complexes, angioprotectors, chondroprotectors, etc. Flat feet involves wearing special insoles and shoes. Without exacerbation of diseases, physical therapy, massage, and physiotherapy become mandatory.
Circulatory disorders, neuromas, ingrown toenails require radical surgical treatment.
Fractures in detail
The metatarsal bones are tubular and small, which is why they are susceptible to fractures. And it does not depend on age, gender and profession. Metatarsal fractures occur in 5% of all fractures, and in 20% of leg fractures. The symptoms are so different that many are unaware of the fracture. Contacting a doctor is necessary.
Metatarsal Fracture Statistics
The 4th and 5th metatarsal bones most often break. They break more often. Fracture of the external 5th bone is often complicated by displacement. The rehabilitation period for such a fracture is the longest.
Less common is a fracture of the 1st bone. The 2nd and 3rd bone are the least affected. They are in the middle and better protected.
The 2nd, 3rd and 4th metatarsal bones suffer with the direct direction of impact (falling onto the foot of a heavy object or accident). With an indirect impact, the 1st and 5th bones are damaged. Fatigue fracture occurs in the 4th bone.
Causes of Fractures
The main causes of fractures are:
- kick in the foot;
- tucking of the foot;
- weight loss on the leg;
- failed landing after a fall or jump;
- small, uniform, repetitive injuries (e.g. dancing, sport).
As well as diseases of the skeletal system.
Fracture classification
Fractures along the line of fractures can be: transverse, T-shaped, oblique, helical and wedge-shaped. Fractures occur with or without displacement of fragments.
Types of fracture
By the nature of the damage, the fracture is traumatic and fatigue (stress fracture). Traumatic occurs with a direct hit, falling from a height, hitting the foot, subluxation.
Fatigue fracture occurs with repeated bruises and constant stress. It is also called Deutschelender’s fracture or marching.
It is diagnosed most often in draftees, because they have a sharp increase in the load on the foot. Also at risk with such a fracture include ballerinas, dancers, athletes, gymnasts, soccer players. Stress fractures usually do not have vivid manifestations and are often ignored, therefore leading to complications. They are expressed in bone displacement and trauma to adjacent bones.
Other types of anatomical fractures
With a Jones fracture, the bones are injured at the base of the 5th metatarsal bone. This fracture is always multiple fragmentation, and after it the bones do not grow together. The treatment of a fifth metatarsal fracture of the foot will be successful only in the case of an accurate diagnosis, which is rather complicated.
With a tear-off fracture of the foot, the bone fragment of the bone is disconnected with a strong tendon tension. Diagnosing the pathology is also difficult, because all the symptoms resemble a sprain. It is often combined with an ankle fracture.
In an avulsive fracture, the fracture line is transverse, without displacement. At the same time, at the base of the 5th metatarsal bone an extension of the ankle tendons occurs in parallel.
With a subcapital fracture, the neck of the metatarsal bones is injured.
Also, fractures are open and closed.
Symptoms and signs
At the time of injury, you can hear a characteristic crunch and feel severe pain. A damaged finger can become shortened, unnaturally deviate to the side, and swelling and bruising quickly occur at the fracture site. Movement becomes impossible.
First aid
Immobilization of the foot with the help of tires or other improvised tools is immediately required. Fixation is performed throughout the foot to the upper third of the ankle. A damaged leg should be slightly raised. This significantly reduces the risk of acute pain and simplifies the transportation of the victim.
Ice can be applied to the site of damage for 20 minutes, which will reduce pain and prevent swelling from developing rapidly.
Repeat ice application after 10 minutes. In the presence of wounds, an aseptic dressing must be applied.
When bone fragments are displaced or an open fracture is not possible to correct the fracture. This is done only by the doctor after an x-ray.
To stop the pain, you can drink "Pentalgin", "Analgin." Transport only horizontally on a stretcher.
Treatment principles
General treatment regimen:
- immobilization of the foot with the application of gypsum;
- closed reposition (fragments of bone are compared without tissue incision).
Osteosynthesis is performed with multiple comminuted fractures and large displacements. This is an operation during which fragments are restored by their anatomical location. Bone fragments are fixed with special plates, knitting needles or screws. And only after the synthesis, gypsum is applied.
Gypsum
Treatment of a fracture of the 5th metatarsal bone of the foot requires the application of a plaster boot. It is used in most fractures of the foot. With a fracture of the 5th metatarsal bone in plaster go 1.5 months.
Orthosis
The orthosis is used for mild single injuries. It stabilizes the foot and reduces the load on it.
How long does the fracture heal?
On average, it takes 6-8 weeks. The rate of splicing depends on age, the level of calcium in the blood, the presence of concomitant diseases and the accuracy of the doctor’s instructions.
Operation
Surgical treatment of a fracture of the fifth metatarsal foot bone is required only with a strong displacement of the 3rd and 4th metatarsal bones. More often this happens with a fracture of the bone head.
Rehabilitation and recovery
To unload the foot, the use of crutches is required up to the complete healing of the fracture. Rehabilitation aims to restore the functioning of the muscles and tendons of the foot, normalize the mobility of the joints. It is carried out under the supervision of an orthopedist.
The approximate rehabilitation complex includes:
- Physiotherapy - stimulates the growth and healing of bone tissue.
- Therapeutic gymnastics and exercise therapy are shown a month after the injury. Procedures strengthen muscles, increase joint mobility. The main exercises are flexion and extension of the fingers, raising and lowering on the toes.
- Massage begins after removal of the immobilization. It improves blood circulation and reduces edema, increases muscle tone.
- Wearing arch support forms the correct arch of the foot and evenly distribute the load. They should be worn for 6-12 months.
Complications
With improper treatment of a metatarsal fracture of the foot or ignoring rehabilitation, the fracture is fraught with complications. Among them:
- arthritis and arthrosis;
- deformation of the bones of the foot;
- chronic pain in the foot;
- bone spike formation;
- necrosis and osteomyelitis.
In the treatment of fracture of the metatarsal bones of the foot, great importance is given to proper rehabilitation and recovery.