The foot has a very complex structure, and, despite its relatively small size, pathologies of any kind in this area entail a disruption in the functioning of the entire lower limb. Metatarsals are no exception.
Anatomy of the foot
It has 26 bones and is divided into 3 parts: tarsus, metatarsus and phalanges.
The bones of the tarsus include 3 wedge-shaped, calcaneus, navicular, cuboid, talus (part of the ankle) bones. They are all mediators of the transition of the ankle to the foot.
Metarsal bones 5 - the first metatarsal bone of the foot, then the second, third and so on in a row of fingers. Their main purpose is to maintain and create the arch of the foot, without which the movement of a person would be impossible. These are small tubular bones, they are very fragile. There is space between them.
Phalanges of the fingers 14. They are movable joints, have cartilage. The thumb has 2 phalanges, the other fingers have 3. The arches of the foot are functionally very important because they act as a shock absorber during leg movements.
Causes of pain
If the metatarsal bones of the foot hurt, the causes and treatment are always interrelated so that we can talk about etiopathogenetic therapy. Pain is associated with many diseases. They differ in their nature, duration, and prevalence. They can be unilateral or bilateral, short-term and permanent, in the form of burning, paresthesia, etc.
The following pathologies are most common:
- Inflammation of the plantar fascia. The reason is the constant pressure on the plantar aponeurosis, which supports the arch of the foot. The fascia occupies the space between the heel and metatarsus. Pathology is characteristic with a lot of weight, flat feet, playing sports. Pain in the arch and heel occurs immediately after sleep.
- Arthritis. It hurts both the joint itself and the foot. This is manifested by itching and burning.
- Ligamentosis - damage to the ligaments of the foot, can be 2-sided. It develops with heavy loads on the foot, impaired blood circulation and microtrauma of the ligaments.
- Heel spurs - the appearance of a bone growth at the point of attachment of the fascia to the calcaneus. In this case, there is almost always chronic fasciitis. Pain appears when walking.
- Failure in the blood supply. At the same time, the foot hurts both when walking and at rest.
- Pinching of the nerve branch between the bones of the foot or at the point of exit from the vertebra. More common after childbirth.
- Benign neuromas. Pain occurs between the 3rd and 4thfinger. They can be in the form of tingling, burning, pain, more often on one side. Wearing tight shoes makes the pain worse.
- Fractures, dislocations.
- Metabolic disorders with osteoporosis. The pain is aggravated by pressing on the bones.
- Functional insufficiency of the feet is a problem of fat people, pregnant women, physical inactivity and heavy loads on the legs. After standing for a long time, diffuse pains appear in the feet.
- Flat feet - there is a flattening of the arch, the shape of the foot changes. The shins and feet get tired quickly and hurt a lot.
- Pathological disorders - warts, ingrown toenail, 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 an intense load on the feet.
Symptoms and treatment of the most common pathologies
Part of the metatarsal bones forms movable joints with the digital phalanges. As in other joints, there is articular cartilage and a joint bag. With a bruise or a fall, the heads can move, and excruciating pain occurs at the site of injury. The mobility of the joint is severely 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 contusion of the metatarsal bone of the foot is determined by the picture of the x-ray. Occurs more oftenthe need for surgical intervention. And although it is performed with local anesthesia, it is a radical form of therapy.
The treatment of the metatarsal bones of the foot is then expressed in the return of the head of the bone to the anatomically correct position and its fixation with a metal needle.
Bone outgrowths are removed. Shoes after such an intervention are only suitable for orthopedic to maintain the bones of the foot.
Flat feet develop for various reasons:
- anomalies in the structure of the foot from birth;
- wearing tight shoes or high heels;
- obesity;
- increasing the load during training;
- leg injury with muscle weakness.
Treatment is most often conservative. The patient performs special exercises to train the arch, constantly uses orthopedic insoles. Walking barefoot on sand or pebbles and swimming is helpful.
It is completely possible to remove flat feet only in children, while the bones are growing. Adults can only make sure that the pathology does not progress. Flat feet can cause hallux valgus, which makes the pain worse.
Pathologies of joints
Arthritis - inflammation of the joint, arthrosis - degenerative changes in 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 when moving. In the process of inflammationsurrounding tissues, ligaments, muscles are involved. This is called periarthritis and periarthrosis. If arthritis is completely curable, then this is not the case with arthrosis, 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 fixing bandages are used. The root cause is also important for treatment. If it is an 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 disturbances
Violation of the conduction of nerve impulses with the appearance of pain can occur in the following cases:
- nerve pinched between metatarsal bones;
- pinched nerve at the level of the vertebrae;
- inflammation of the nervous tissue during hypothermia, wearing tight shoes;
- neurinoma between the phalanges of the fingers.
Treatment will include massages, physiotherapy, seasonal clothing and comfortable shoes. With inflammation, you can apply ointments and gels that warm and anti-inflammatory.
Treatment of the metatarsal bones of the foot may include manual therapy if the pinching is in the spine and is accompanied by displacement of the vertebrae. The goal is to return the vertebrae to their place.
Metabolic disorders in the bones
They are associated with a deficiency of vitamins, Ca, zinc, phosphorus, etc. Most often, osteoporosis occurs. In this case, the bones become brittle and prone to fracture. Pathologyis usually symmetrical and affects small bones first.
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. Equally 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 bone destruction. Such patients should not play sports and have serious loads. 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 the treatment is to restore the tone of the veins, strengthen the walls of blood vessels, and distribute the load on the legs.
Drugs can be applied 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 the treatment can be conservative and radical.
Diagnosis
Visual inspection may not give enough information to make a diagnosis. An x-ray is prescribed in 2 projections. This is the main diagnostic method.
Ultrasound is also used, if necessary, MRI or CT. The complexity of diagnosis is that patients most often come with advanced forms of pathologies, because, for example, in case of fractures of small bones, many do not go to the doctors and continue to walk with fractures.
General principlestreatment
Treatment of pain in the metatarsal bones of the foot is always and in every respect 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 load on the foot. Inflammation will require the use of anti-inflammatory drugs, fractures - the imposition of a cast, dislocations - an elastic bandage.
Metabolic disorders are treated with hormones, vitamin-mineral complexes, angioprotectors, chondroprotectors, etc. Flat feet involve wearing special insoles and shoes. Outside the exacerbation of diseases, exercise therapy, massage, physiotherapy become mandatory.
Circulatory disorders, neuromas, ingrown toenail require radical surgical treatment.
Fractures in detail
The metatarsal bones are tubular and small, which is why they are prone to fractures. And this 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. It is necessary to see a doctor in this case.
Metatarsal fracture statistics
The 4th and 5th metatarsal bones break most frequently. They break more often. Fracture of the outer 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 bones are the least affected. They are in the middle and better protected.
2nd, 3rd and 4th metatarsalsbones suffer in the direct direction of impact (falling on the foot of a heavy object or an accident). With an indirect impact, the 1st and 5th bones are damaged. A stress fracture occurs in the 4th bone.
Causes of fractures
The main causes of fractures are:
- foot strike;
- foot tuck;
- weight drop on leg;
- bad landing after a fall or jump;
- small repetitive injuries (e.g. dancing, sports).
As well as diseases of the skeletal system.
Classification of fractures
Fractures along the line of fractures can be: transverse, T-shaped, oblique, helical and wedge-shaped. Fractures are with or without displacement of debris.
Types of fracture
According to the nature of the damage, the fracture is traumatic and fatigue (stress fracture). Traumatic occurs with a direct blow, falling from a height, hitting the foot, subluxation.
Fatigue fracture occurs with repeated bruising and constant stress. It is also called Deutschelander's fracture or march fracture.
Diagnosed most often in conscripts, because they dramatically increase the load on the foot. Also at risk with such a fracture are ballerinas, dancers, athletes, gymnasts, football players. Stress fractures are usually subtle and often ignored, leading to complications. They are expressed in the displacement of the bone and injury to neighboring bones.
Other types of fractures by anatomical principle
In a Jones fracture, the bones are injured at the base of the 5th metatarsal. This fracture is always multiple fragmentation, and after it the bones do not grow together. Treatment of a fifth metatarsal fracture will only be successful if the diagnosis is accurate, which is quite difficult.
In case of an avulsion fracture of the foot, the bone fragment of the bone is detached with a strong tension of the tendons. Diagnosing pathology is also difficult, because all the symptoms resemble a sprain. Often associated with an ankle fracture.
With an avulsive fracture, the fracture line is transverse, without displacement. At the same time, at the base of the 5th metatarsal bone, an ankle tendon sprain occurs in parallel.
A subcapital fracture injures the neck of the metatarsal bones.
Also, fractures are open and closed.
Symptoms and signs
At the moment of injury, you can hear a characteristic crunch and feel severe pain. An injured finger can become shortened, deviate unnaturally to the side, and edema and hematoma quickly occur at the fracture site. Movement becomes impossible.
First Aid
Immobilization of the foot with splints or other improvised means is immediately required. Fixation is carried out along the entire foot to the upper third of the ankle. The injured leg should be slightly elevated. This greatly reduces the risk of acute pain and makes it easier to transport the victim.
Ice can be applied to the injury site for 20 minutes, which will reduce pain and prevent swelling from developing quickly.
Reapply ice after 10 minutes. If there are woundsit is necessary to apply an aseptic bandage.
When the bone fragments are displaced or an open fracture, it is impossible to set the fracture yourself. This is done only by a doctor after an x-ray.
To relieve pain, you can drink "Pentalgin", "Analgin". Transport only in a horizontal position on a stretcher.
Principles of treatment
General treatment regimen:
- foot immobilization with cast;
- closed reposition (bone fragments are matched without tissue incision).
Osteosynthesis is carried out with multiple comminuted fractures and large displacements. This is an operation in which the fragments are restored according to their anatomical location. Bone fragments are fixed with special plates, pins or screws. And only after the synthesis, plaster is applied.
Gypsum
Treatment of a 5th metatarsal fracture requires a cast boot. It is used in most foot fractures. With a fracture of the 5th metatarsal bone, they walk in a cast for 1.5 months.
Brace
Orthosis is used for minor single injuries. It stabilizes the foot and reduces the load on it.
How long does a fracture heal?
On average it takes 6-8 weeks. The speed of fusion depends on age, blood calcium levels, the presence of concomitant diseases and the accuracy of following the doctor's instructions.
Operation
Surgical treatment of a fracture of the fifth metatarsal bone of the foot is required only with a strong displacement of the 3rd and 4thmetatarsal bones. More often this happens when the head of the bone is fractured.
Rehabilitation and recovery
To unload the foot requires the use of crutches until the fracture is completely healed. Rehabilitation aims to restore the functioning of the muscles and tendons of the foot, normalize joint mobility. Carried out under the supervision of an orthopedist.
A sample rehabilitation package includes:
- Physiotherapy - stimulates the growth and healing of bone tissue.
- Therapeutic gymnastics and exercise therapy are shown already a month after the injury. Procedures strengthen muscles, increase joint mobility. The main exercises are flexion and extension of the fingers, lifting and lowering on toes.
- Massage starts after the removal of immobilization. It improves blood circulation and reduces swelling, increases muscle tone.
- Wearing insoles forms the correct arch of the foot and evenly distributes the load. They should be worn for 6-12 months.
Complications
If the fracture of the metatarsal bone of the foot is not properly treated or rehabilitation is ignored, the fracture is fraught with complications. Among them:
- arthritis and arthrosis;
- deformation of the bones of the foot;
- chronic foot pain;
- formation of bone spikes;
- necrosis and osteomyelitis.
Proper rehabilitation and recovery is of great importance in the treatment of a metatarsal fracture.
