Forefoot injuries

Last evidence check May 2011

Low-energy injuries to the metatarsals and toes are common. There is relatively little high-quality evidence for their management.

About half of all metatarsal fractures are to the fifth metatarsal, so this has a section on its own. Most trauma clinicians are aware of the "Jones" fracture of the fifth metatarsal and its tendency to non-union. but the vast majority of fifth metatarsal fractures require only symptomatic treatment. We've tried to separate evidence from myth in the fifth metatarsal fracture section.

Fractures of the other metatarsals are usually low-energy injuries that require only symptomatic treatment. However, some are much more severe, while others can alter the alignment of the metatarsal parabola enough to cause metatarsalgia. The metatarsals are also a common site of stress fractures.

Most toe fractures are also low-energy and residual malalignment is often well-tolerated. However, malaligned toes may not fit comfortably into shoes, or may rub on other toes, so correction and stabilisation are sometimes required. Anawareness of the risk of nail-bed injuries, physeal injuries and chronic infection is necessary in managing apparently minor distal toe injuries.

Sprains of the MTP joints are not uncommon and most can be treated symptomatically. A few more severe injuries involve severe capsular disruptions which may be irreducible or unstable, or lead to long-term symptoms in the joint such as the "turf toe" injury of the 1st MTP joint. Most of the (small!) evidence base relates to injuries of the 1st MTP joint.