From the Guidelines
For a 2nd metatarsal fracture, simple immobilization with a short leg walking cast or a rigid-soled post-operative shoe is the most appropriate treatment, as evidenced by the American College of Foot and Ankle Surgeons 1. To apply a splint:
- Place a metatarsal pad under the affected area to reduce pressure.
- Apply a well-padded short leg cast from below the knee to the toes, or fit a rigid-soled post-operative shoe.
- Ensure the ankle is at 90 degrees and the toes are in a neutral position. Instruct the patient to:
- Elevate the foot when resting
- Use crutches or a cane for the first 1-2 weeks to reduce weight-bearing
- Gradually increase weight-bearing as tolerated This approach immobilizes the fracture site, allowing proper bone alignment and healing. The metatarsal pad helps distribute pressure away from the injured area. Gradual weight-bearing promotes healing while preventing muscle atrophy. Follow up with X-rays at 2 and 4 weeks to assess healing. If pain persists or worsens, re-evaluate for potential complications or need for surgical intervention, as surgery is the usual treatment for more complex cases 1.
From the Research
Appropriate Splint for a 2nd Metatarsal Fracture
- The appropriate splint for a 2nd metatarsal fracture is not explicitly stated in the provided studies, but the management of metatarsal shaft fractures can be used as a reference 2.
- Metatarsal shaft fractures are initially treated with a posterior splint and avoidance of weight-bearing activities; subsequent treatment consists of a short leg walking cast or boot for four to six weeks 2.
- A below knee removable supportive walking boot with a rocker bottom sole was used to treat a stress fracture at the base of the second metatarsal in a case report 3.
- Pressure bandage and full weight bearing can be used as a treatment for simple metatarsal fractures, including 2nd metatarsal fractures, with a median of 10 days of pain and 21 days to full weight bearing 4.
Treatment Considerations
- The location and stability of the fracture, as well as the patient's pain level, should be taken into account when determining the appropriate treatment 5, 2.
- Weight-bearing and duration of immobilization are based on the stability of the fracture and the patient's pain level 5.
- Close attention should be paid to the great toe because of its role in weight-bearing, but this may not be directly applicable to 2nd metatarsal fractures 5.