Treatment of metatarsal fractures in children
Foot injuries in children are one of the most common reasons for emergency department visits. Among all foot skeletal injuries, metatarsal fractures are particularly important, requiring special attention due to the ongoing growth of bone structures. Timely and competent treatment of metatarsal fractures in children can help prevent arch deformities and gait problems in the future.
It is important to recognize the injury promptly and refer the child to a pediatric traumatologist-orthopedist.
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Causes of foot injury in children
Children can't sit still. They seem to test their body's strength daily. The metatarsal bones are most often damaged by direct, incorrect falls or impacts.
Sports and active games
Football, track and field, gymnastics, and dance are all associated with high loads. Young athletes often experience so-called "march" or stress fractures. These are microcracks that occur due to cyclic overload, when bone tissue doesn't have time to recover.
Bad fall, jump, or twisting of the foot
A common foot injury most often occurs when jumping from a height onto a hard surface or when the foot suddenly twists inward (an inversion injury). Direct blows are also common—for example, if a heavy object falls on a child's foot or if someone accidentally steps on their foot during active play.
Symptoms of a metatarsal fracture in a child
It's difficult for parents without medical training to understand the severity of the injury. Since children cannot always accurately describe their sensations, it is important to pay attention to the following symptoms:
- Severe swelling of the foot that appears within the first hours after the incident
- Severe pain when walking or complete inability to put weight on the foot
- The appearance of a hematoma (bruise) on the dorsal or plantar side of the foot
- Visible limp, the child's attempts to walk on the heel or edge of the foot
How to distinguish a fracture from a bruise
Many people mistakenly believe that if a child can wiggle their toes, the bone is intact. This is a myth. A bruised foot is usually characterized by pain that gradually subsides with rest. With a fracture, the pain is diffuse, intensifies with axial loading (pressing on the head of the bone), and is often accompanied by a localized, "tearing" pain directly at the site of the bone injury.
Signs of displacement and more severe injury
A child with a metatarsal fracture often has a deformed foot: it appears unnaturally curved, and a crunching sound (crepitus) can be heard at the site of injury. Significant displacement of the fragments can cause damage to blood vessels and nerve endings, which can result in numbness or paleness of the toes.
Diagnosis of metatarsal fractures
Only a doctor can make an accurate diagnosis. Attempts to "probe" or, especially, "reset" the bone are strictly prohibited, as this may cause further damage to the soft tissues.
Examination by a pediatric traumatologist-orthopedist
The initial consultation is conducted by a pediatric orthopedist or traumatologist. The doctor assesses the child's range of motion, checks sensitivity, and the location of pain points. It is important for the specialist to know the circumstances of the injury: how exactly the child fell and how quickly the swelling developed.
Foot X-ray and additional examinations
A foot X-ray is the best way to assess the injury. The image is taken in several projections (usually AP and oblique): this is the only way to visualize the fracture line and determine whether there is any displacement. In complex cases where growth plate damage or an intra-articular fracture is suspected, the doctor may order a CT or MRI scan for a detailed assessment of the cartilaginous structures.
General information
Treatment of metatarsal fractures in children
Once the diagnosis is confirmed, a treatment plan is selected. The main goal is to ensure the correct anatomical position of the bones for their physiological healing.
Conservative treatment
In most cases, if a non-displaced metatarsal fracture is diagnosed in a child, conservative therapy is used. This includes rest, elevation of the limb in the first few days, and the use of cold compresses to reduce swelling.
Immobilization: plaster cast, splint, orthosis
Immobilization is necessary to stabilize the fracture fragments. Depending on the location and type of injury, the doctor may suggest various options:
- Plaster cast or polymer cast ("plastic cast")
- Splint - a plaster cast that immobilizes only part of the foot
- Orthosis - a rigid boot that allows for adjustable support and load-bearing capacity
When surgery may be needed
Surgery is rarely necessary. It is usually necessary for multiple fractures, unstable, displaced injuries that cannot be repositioned using closed techniques, or when there is a risk of malunion that affects foot function. In such cases, the bones are fixed with special pins, which are removed after callus formation.
When is it necessary to urgently take your child to the doctor?
In certain situations, your child needs to be taken to the doctor immediately. It is recommended to seek medical attention in the following situations:
- The child cannot put weight on their foot
- The swelling is growing too quickly and spreading to the ankle
- The skin of the foot has become blue or purple
- The foot is severely deformed
- The child complains of a crawling sensation or loss of feeling in the toes
Comparison of types of foot injuries
To help parents navigate the situation, we have prepared a table outlining the main differences between types of injuries.
| Symptom | Foot contusion | Non-displaced fracture | Displaced fracture |
|---|---|---|---|
| Weight bearing | Possible, but painful | Difficulty or impossible | Completely impossible |
| Swelling and bruising | Moderate, localized | Severe, progressive | Extensive, often deformed |
| Foot position | Natural | Natural | Often deformed |
| Treatment tactics | Rest, cold, ointments | Immobilization (cast/orthosis) | Repositioning, cast, or surgery |
Buy high-quality shoes with a rigid heel counter and good ankle support for active play. If your child plays sports, ensure they are exercising in a controlled manner. Wear protective gear whenever possible.
To strengthen bones, give your child calcium-rich foods and vitamin D in the dose prescribed by your pediatrician.
FAQ
How can you tell if your child has a metatarsal fracture and not a bruise?
How long does it take for a metatarsal fracture to heal in children?
Is a cast always necessary for a metatarsal fracture?
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What is a metatarsal fracture and why is it especially important in children?
These are the five tubular bones located between the tarsus and the phalanges of the toes. They are the bones that support the body when walking. Children's bones are more elastic than adults' due to their higher organic content, and the periosteum (bone shell) is thicker and better supplied with blood.
However, it is precisely this active growth that makes treating metatarsal fractures in children a specific process. This area contains growth plates (epiphyseal plates). If a fracture line passes through this zone, it can lead to premature closure of the growth plate and subsequent shortening or deformity of the foot. Therefore, if any injury is suspected, it is important to immediately consult a specialist to rule out a serious metatarsal fracture.