Treatment of Non-Displaced Fracture of the 2nd Metatarsal
Non-displaced fractures of the 2nd metatarsal should be treated conservatively with protected weight bearing in a short leg walking boot or cast for 4-6 weeks. 1, 2
Initial Management
- Non-displaced 2nd metatarsal fractures can be effectively managed with non-operative treatment, which includes immobilization and protected weight bearing 1, 2
- A short leg walking boot or cast is the preferred immobilization method for these fractures, providing adequate stability while allowing for some mobility 2
- Radiographic confirmation with three standard views (anteroposterior, lateral, and mortise) is necessary to properly diagnose the fracture and ensure it is truly non-displaced 3
Immobilization Options
- Rigid immobilization is preferred over removable splints for displaced fractures, though for minimally displaced fractures, removable splints may be an option 4
- For non-displaced metatarsal fractures, a short leg walking cast or boot for 4-6 weeks is the standard treatment 1, 2
- Weight-bearing status should be protected initially, with gradual progression to full weight bearing as healing progresses 2
Monitoring and Follow-Up
- Regular radiographic assessment at approximately 3 weeks and at the end of immobilization is necessary to ensure proper healing and alignment 3
- If displacement occurs during treatment, reassessment and possible surgical intervention may be required 5
Rehabilitation
- Early introduction of physical training and muscle strengthening followed by long-term balance training is recommended after the immobilization period 3
- Prolonged immobilization may lead to stiffness and muscle atrophy, requiring appropriate rehabilitation 3
Surgical Indications
- Surgery is generally not indicated for non-displaced 2nd metatarsal fractures 1, 5
- Surgical fixation becomes necessary only if the fracture displaces during treatment with:
Special Considerations
- For patients with diabetes and neuropathy, special attention should be paid to offloading the foot to prevent complications such as ulceration at the fracture site 3, 6
- Proper fitting of orthotic devices is essential after the immobilization period to prevent pressure sores and complications 6
Prognosis
- Non-displaced metatarsal fractures generally have excellent outcomes with conservative management 7
- Most patients can return to normal activities within 8-12 weeks after injury 2
- Complications are rare but may include delayed union, malunion, or post-traumatic arthritis if the fracture involves a joint 1