Guest author, Mike Sganga, DPM
Fractures and sprains of the foot can be treated surgically and non-surgically, depending on the locations of the injuries. We know that many fractures can heal with crutches and a boot, and some have shown that they need operative fixation for the best outcome.
The fifth metatarsal can be involved in many different fracture patterns. As you see from the chart, one can have an avulsion fracture, a Jones fracture, which is further down the bone, a shaft fracture, and a stress fracture where there was not an injury but overuse.
It is important to distinguish between all these as some heal well without surgery, and some, like the Jones, would usually need operative intervention because of poor blood supply. Here is an example of a Jones fracture and the fixation usually required to compress the edges.
Here is a picture of a routine fifth metatarsal avulsion fracture, which will heal well with crutches and a boot.
Lisfranc fractures are named for Napoleon’s surgeon who noticed that cavalrymen’s feet would get caught in the stirrup when falling from a horse. This would cause the forefoot to rotate severely causing a significant injury to the soldier. The Lisfranc joint is at the base of the metatarsals. One can either tear the ligaments, which is called a Lisfranc sprain or fracture the bones, and sometimes dislocate this joint. If the space between the first and second metatarsal is widened which is the classic Lisfranc joint, then surgery is needed to reestablish the anatomy of the foot. Just like a Roman arch, the bones of the foot form an arch, and if the arches disrupted as in this injury that arch needs to be re-created. If it is not recreated then arthritis and pain is usually the result.
Here’s a picture of a Lisfranc injury with widening of the foot, and then surgical fixation of a Lisfranc fracture. Healing can take many months after non-weightbearing and crutches.
A Lisfranc variant occurs when the Lisfranc joint between the first and second metatarsal is stable, but there are other fractures or sprains of ligaments of the other metatarsals. Treatment of this is usually non-surgical with crutches and a boot.
So, as you can see, it’s very important to obtain x-rays when a fracture of the foot is suspected and sometimes CT scan or an MRI can be helpful to diagnose subtle fractures or sprains. Full recovery and return to sports is routine for some fractures but for others that have a severe injury, sometimes the results are not as successful.