Metatarsal Fractures Explained

One of the most common injuries in rugby is the metatarsal fracture. This kind of injury has been very common in the history of rugby. Several high- profiled rugby players have suffered from the same injury- England flanker Tom Rees, All Black Mils Muliaina and England centre Mike Tindall. The anatomy of the foot will however help us understand this injury better and deeper.

Metatarsal bones are long and slender bones found in between the Tarsal bone and the Phalanges. There are 5 Metatarsal bones in each foot. These bones perform as a rigid lever for the forward propulsion of the ankle and the foot. They metatarsals also act like a flexible structure which helps with balance and holding up the entire body.

Metatarsal fractures are caused by direct trauma, overuse and excessive rotation (sudden twisting with the ball). Bone injuries like this are very common since there is very little soft tissue that protects the top of the foot. Rugby players in a ruck or stamping on the foot can often produce this type of injury.

Four anatomic segments divide the fifth metatarsal. These are the base, the junction, the shaft, and the neck. Several fractures can be made out of these segments.

Fracture of the fifth metatarsal is the most common rugby metatarsal injuries. This can often occur by excessive twisting of the ankle. In most cases this type of fracture doesn't need to be surgically repaired. Walking immediately in a removable plastic cast is usually advised.

Metatarsal fractures can be caused by overuse. This is common in new younger rugby players or players that play a hard gruelling season with little or no rest. A stress fracture will eventually turn into full fracture when the pain in the foot region worsens. The stress fracture of the 2nd metatarsal heals well while the healing of the stress fracture of the 5th metatarsal can be quite problematic.

How Do We Know Its Metatarsal Fracture?

The rugby player will present with severe foot pain and will complain of difficulty walking which usually entails a metatarsal fracture. Swelling may also be common and bruising will be evident after 1-2 days. X-rays can be used to confirm a positive diagnosis.

How Do We Treat Metatarsal Fracture?

The player should visit the emergency room as soon as possible for treatment if a metatarsal fracture is suspected. The doctor will confirm the diagnosis with an X-ray. Ice therapy can be beneficial in dealing with pain and pain medications are necessary.

The terminal treatment for this injury varies on the type and condition of the fracture. Alignment and treatment with an immobilization cast is greatly appreciated in fractures caused by direct trauma.

A removable plastic cast is used for stress fractures of the 2nd metatarsal and rotational fracture of the 5th metatarsal. However, many orthopaedist advocate surgical repair of the fracture. This method will allow the patient to resume rugby possibly after 6 weeks. Surgical repairing is usually recommended for stress fractures and when there is a widening fracture line with complete obliteration of the medullary canal (this is the cavity containing bone marrow in the long part of a metatarsal) at the fractures site.

The Aircast Walker features a lightweight removable plastic cast with a durable, semi-rigid shell which provides far greater protection compared to a conventional plaster cast.

View the aircast walker

In most cases rugby players suffer from a type 1 fracture, which is classified as a fracture line with sharp margins and no widening of the fracture. Minimal evidence of periosteal reaction to chronic stress. A periosteal reaction is the formation of new bone in response to injury. Treatment involves a non weight bearing cast for 6-8 weeks or walking boot.

How Do We Prevent Metatarsal Fracture?

Very little can be done to prevent this kind of injury especially when force is applied to the foot during a rugby game. Yet, it is very necessary to wear suitable footwear to provide protection to the foot.