From the Research
For a first metatarsal fracture, a short leg non-weight bearing cast or a posterior splint with a toe plate extension is typically recommended. The posterior splint should extend from below the knee to beyond the toes, with the ankle positioned at 90 degrees and the toe plate supporting the entire foot. This immobilization is crucial because the first metatarsal bears significant weight during walking and is essential for proper foot mechanics. Initially, the patient should avoid weight-bearing for 4-6 weeks, depending on fracture severity and healing progress. After this period, a walking boot or stiff-soled shoe may be used as the fracture heals. Elevation of the foot above heart level, ice application for 15-20 minutes every 2-3 hours during the first 48-72 hours, and appropriate pain management with NSAIDs or prescribed analgesics are important adjuncts to treatment. Regular follow-up with orthopedics is necessary to monitor healing and adjust treatment as needed, as noted in recent studies on metatarsal fractures 1.
Some key considerations for the treatment of first metatarsal fractures include:
- The importance of maintaining the metatarsal parabola, sagittal position of the metatarsal heads, and a congruent metatarsophalangeal joint 1
- The use of a posterior splint or short leg non-weight bearing cast to immobilize the fracture and promote healing
- The need for regular follow-up with orthopedics to monitor healing and adjust treatment as needed
- The potential for complications, such as nonunion or malunion, if the fracture is not properly treated
It's worth noting that while there are various studies on metatarsal fractures, including those on fifth metatarsal fractures 2, 3, the most recent and relevant study for first metatarsal fractures is from 2024 1, which emphasizes the importance of proper immobilization and treatment to promote healing and prevent complications.
In terms of specific treatment options, the choice of splint or cast will depend on the individual patient's needs and the severity of the fracture. However, a short leg non-weight bearing cast or a posterior splint with a toe plate extension is generally recommended for first metatarsal fractures, as it provides the necessary immobilization and support to promote healing.