How much does the metatarsal bone on the leg grow together. Fractures of the cuboid and sphenoid bones

The metatarsus is the part of the foot between tarsal bone and phalanges of fingers. The metatarsus is formed by five tubular bones.

Metatarsal structure

Each metatarsal bone has a wedge-shaped base, body, and head. The second metatarsal bone is the longest, and the first is the most massive and short. The first metatarsal is divided into two platforms. To both sites metatarsal adjacent sesamoid bones. The structure of the bones of the metatarsus is similar to the structure of the metacarpal bones, however, the heads of the metatarsal bones are compressed from the sides and narrowed.

The body of each metatarsal bone has three faces, and between the faces there are free spaces - interosseous spaces. By their articular surface, the bones of the metatarsus are connected to the bones of the tarsus.

In the fifth metatarsal bone, the articular facet is located only on one of its sides (medial). The fifth metatarsal bone is slightly tuberous. The tendon of the short peroneal muscle is attached to the tuberous part of the fifth bone.

The base of the first metatarsal bone forms a joint with the medial cuneiform bone. The bases of the second and third metatarsal bones are connected to lateral bone and with sphenoid bones. The fifth bone is connected to the cuboid bone.

The metatarsal bones form with the bones of the tarsus longitudinal and transverse vaults, turned with their bulge upwards. The metatarsal arch is located in the region of the heads of the metatarsal bones, and the tarsal arch is in the region of the tarsal bones.

The arches of the foot perform a shock-absorbing function when walking and during static loads, and also prevent tissue damage and create conditions for normal blood flow.

Metatarsal Head Displacement

The proximal phalanges of the fingers and metatarsal heads form the metatarsophalangeal joints. The articular capsule of the bone consists of an outer layer, represented by a dense fibrous tissue, and the inner layer formed by the synovial membrane.

The displacement of the head of the metatarsal bones leads to inflammation and further damage to the joint, the development of capsulitis and synovitis. The enlarged head of the metatarsal bones is covered with callused skin. Pain in the joint area is the main sign of displacement of the head of the metatarsal bones.

Treatment is selected taking into account the degree of deformation of the head of the metatarsal bones. With the initial manifestations of deformation, it is possible to use orthopedic devices (insoles, interdigital pads, instep supports).

Reconstructive method surgical intervention allow to eliminate flat feet and valgation of the first toe. Under local anesthesia the first metatarsal bone is fixed with metal wires in the correct position (corrective osteotomy), resection (removal) of the deformed head of the metatarsal bone (“bumps”). After surgery, arch supports are attached to the patient's foot.

metatarsal fracture

Metatarsal fractures are traumatic and stress (fatigue). Traumatic fracture (without displacement or with displacement) can occur due to twisting of the foot or a direct blow. In case of a metatarsal fracture without displacement, the bone fragments remain in the correct position. With a fracture with a displacement, there is a violation of the anatomical position of the fragments.

A traumatic fracture of the metatarsal bone manifests itself in a characteristic crunch during injury, pain in the fracture area, shortening of the finger or its deviation to the side. There may be bruising or swelling in the area of ​​the fracture.

A Jones fracture is a type of metatarsal fracture. This fracture is formed at the base of the fifth metatarsal bone and is characterized by nonunion or delayed union. One type of metatarsal fracture is a Jones fracture. Often a Jones fracture is misdiagnosed as a sprain.

Fatigue fracture of the metatarsal bones - imperceptible cracks that occur due to foot deformity, osteoporosis, pathological bone structure, prolonged repeated loads.

With a fatigue fracture of the metatarsal bone, pain occurs after or during loading, pain in the area of ​​the fracture when touched, and swelling.

In the absence of treatment or improper treatment metatarsal fractures, complications can develop - arthrosis, deformities, nonunion of the fracture, chronic pain in the foot.

Treatment of a fracture depends on its location, nature, and the presence of displacement. The following methods of treatment of metatarsal fractures are used:

  • Gypsum immobilization - used for fractures of the bones of the metatarsus without displacement;
  • Surgical intervention.

In case of a displaced fracture, bone fragments are compared, and then fixed with implants.

The human foot has a complex anatomical structure, which includes different groups ligaments, muscles and bones. In such a complex structure of the limbs, the metatarsal bones are considered to be important components, therefore, when they are fractured, many problems often arise. Any defect in the leg support is dangerous for its negative consequences, therefore, in the event of an injury, it is important to immediately find out how serious it is. Often there is a fracture of the 5th metatarsal bone, after which it is required to give Special attention rehabilitation activities.

General concept of trauma and its types

A metatarsal fracture is a fairly common type of injury. This is explained by its location, because it is located in front of the base of the foot and is considered quite fragile. Heavy loads, blows and many other factors lead to injury. Such damages are classified according to some indicators. So, with a fracture of only one bone, it is customary to call it single. And when two or more bones are deformed, it can be concluded that this type of fracture is multiple (example in the photo on the right).

In addition to damage to the bases, diaphysis or neck, in accordance with the shape and localization, injuries can also be different. For example, fracture shapes can be oblique, transverse, wedge-shaped and t-shaped. This factor is considered important when prescribing treatment and determines the methods of the rehabilitation period.

According to another classification of injuries, fractures distinguish between traumatic and fatigue. The first occur as a result of a blow or some kind of impact of a mechanical nature. The consequences of such fractures may have bone displacements, which are characterized by their incorrect location in relation to each other. The absence of displacement can be said when a part of the bones is in the same plane. In addition, there are closed fractures, in which clear signs absent, and open, characterized by the presence of a wound in the injured area.

A sign of this type of fracture, such as fatigue, is the formation of subtle cracks that form as a result of significant loads on the foot, for example, when running or walking. There are five metatarsal bones. In most cases, physicians establish a fracture of the 5th metatarsal bone or the 4th, which are considered the most vulnerable.

Symptoms

Fracture of the base of the 5th metatarsal bone may be avulsion. This injury is the tearing off of a bone fragment under the influence of traction from the tendons attached to it. These fractures occur when the foot is turned inward. In the presence of an ankle sprain, they often go unnoticed.

With a Jones fracture, damage is localized at the base of the fifth metatarsal, in a place with a weakened blood supply. This explains the too slow fusion of bones after injury of this type. Usually a Jones fracture is preceded by regular stress loads. In the region of the fifth metatarsal, fractures of its middle part, head or neck often occur.

With traumatic fractures, one of the main signs is a crunch heard by the victim during injury. It is he who testifies to the fracture of the bone. After 2-3 hours or within a day after injury, edema begins to occur with pronounced bruising. In addition, the finger may noticeably decrease in size or deviate unnaturally to the side. If the leg is not loaded, the sensations of pain are quite tolerable, but when walking they immediately increase.

With a stress fracture of the fifth metatarsal, pain is felt while running or walking, but it is not very strong and resembles muscle pain. After a short rest, it subsides, but at the slightest movement it resumes again. Often there is swelling in the area of ​​injury, usually without bruising. When pressing the affected area, the patient feels a sharp pain.

First aid methods

If a fracture of the 5th metatarsal bone is expected, it is necessary to immediately minimize movement and get rid of even the slightest load on the limb - this necessary measure to prevent the risk of further injury. To slow the development of swelling and relieve pain, a good remedy is the effect on the sore spot with cold.

Ice should be applied to the sore leg during the day after the injury, however, the duration of one procedure should not exceed 20 minutes, and the interval between them should be at least 1.5 hours. If there is no ice, you can use any product from the freezer, after wrapping it in a cloth.

Also, when helping the victim with a fracture, you can use an elastic bandage, but the bandage does not need to be applied very tight. If there is a feeling of numbness or coldness in the fingers, the bandage must be loosened. Such a bandage with elastic bandage prevents the spread of edema and limits the movement of the joint.

It is important that after such an injury to the limb, it is not only in calm state but also above the body. To do this, lying on the bed, a pillow or roller should be placed under the sore leg. In a sitting position, in order to prevent the edema from spreading, it is important that the limb is on a hill - for this you can use a stool.

It should be remembered that the injured leg cannot be warmed up or steamed for a week after the injury. In order not to aggravate the process of swelling, contraindicated massage treatments and rubbing alcohol tinctures. Until the diagnosis is established by doctors, any load on the affected leg should be completely limited in order to avoid negative consequences. Only a qualified orthopedist can determine the severity of the injury.

Treatment Methods

At the beginning of treatment, painkillers are used, as well as preparations containing vitamin D and calcium. Nowadays, it is often used modern drugs that improve bone regeneration. The method of treatment depends on how severe the fracture is, and is prescribed by the doctor after a visual examination and based on x-rays.

If a fracture of the 5th metatarsal bone without displacement is diagnosed, unloading fixation of the leg is performed, after which a splint is applied gypsum bandage, called the "boot", because it is applied to the very knee. This cast should be worn for approximately 1 month. It is removed only after an X-ray, which confirms the fusion of the damaged bone. Further, the patient is recommended to wear a tight bandage and orthopedic shoes.

A displaced metatarsal fracture is more difficult to treat. Especially when available a large number fragments or their uneven edges. Usually skeletal traction is used. It consists in drilling a hole in the fifth finger, into which a silk thread or a metal needle is inserted, after which a load is hung on it. One month later, after radiography, the results of which confirmed the restoration of the fragments in their places, a plaster boot is applied, which the patient must wear for 3-4 weeks.

In case of improper bone fusion, as a rule, the patient needs surgical intervention. The operation, called osteosynthesis in medicine, should be carried out no earlier than 20 days after injury (when the edema disappears), but no later than 1.5 months to eliminate the risk of spontaneous malunion.

Possible complications and rehabilitation

If missing adequate treatment fracture of the fifth metatarsal bone of any type, periodic pain in the foot, the development of arthrosis, deformation of the bone structure, as well as a violation normal operation limbs.

In addition, in medicine, the consequences after a fracture are divided into several groups:

  • direct, arising directly as a result of a fracture;
  • early, manifesting during the first few days after injury;
  • late, characterized by nonunion of bone fragments.

The favorable outcome of the treatment of such fractures largely depends on rehabilitation, which includes therapeutic gymnastics, physiotherapy and massage procedures, as well as taking special drugs that help restore bone tissue. How long will it take for full recovery directly depends on the complexity of the injury, the age of the patient and the characteristics of his body. It usually takes about three weeks for a full recovery after removing the cast boots. With the help of massage, joint and muscle mobility is restored much faster.

During the rehabilitation period, it is mandatory to perform special exercises:

  • Extension and flexion of the toes.
  • Transferring body weight from heels to toes and vice versa.
  • Rolling a small hard roller with the sole of your foot.
  • Performing circular rotations of the feet in one direction, then in the other.

Competent treatment and a rehabilitation course are prerequisites for a person to return to normal life after trauma to the metatarsal bone. They are necessary to avoid deformation of the foot, the development of arthrosis, possible violations normal function of the limb, as well as chronic pain and leg fatigue.

In traumatology, a fracture of the metatarsal bone of the foot is rare. Without a thorough diagnosis, the condition can be confused with a bruise or sprain, since the symptoms are similar: swelling, hematoma, strong pain, difficulty resting on the leg. Treatment should be taken seriously, since the injury is dangerous with complications in the form of deformation of the bones of the foot, chronic pain, arthrosis. Therefore, after an accident, consultation and examination by a doctor is recommended.

Why does a metatarsal fracture occur?

According to ICD 10, damage has the code S92.3. The condition appears due to injuries or stress on the joints during prolonged stress on the legs. A fracture of the bones of the human foot occurs due to such reasons:

  • falling from a height or jumping with an emphasis on the feet;
  • extreme and strength sports;
  • professional activities associated with regular weight lifting or a heavy load on the legs;
  • narrow uncomfortable shoes;
  • industrial and road accidents;
  • a direct blow to the foot with a heavy blunt object.

How to recognize trauma?

The most common fracture is the 5th metatarsal of the foot. Damage is distinguished as closed without displacement, in which the integrity of the skin is not violated. An open type of injury with a displacement is characterized by fragmentation of the bone into fragments that cut through the skin and form a wound. An injury to the base of the fifth metatarsal bone provokes, in which the fracture line is located in the articular cavity. In children and adults, the following symptoms are observed:

  • strong sharp pain when you try to lean on your leg or put pressure on the site of the bruise;
  • puffiness;
  • hematoma;
  • crunch heard at the time of injury;
  • shortening of the finger where the fracture occurred;
  • lameness or inability to lean on the leg;
  • local increase in temperature;
  • nausea and dizziness, as a reaction of the body to pain.

What are the complications?

The fracture is differentiated with dislocation.

With an open fracture, there is a risk of penetration into the wound pathogenic microorganisms- tetanus or Pseudomonas aeruginosa, staphylococci, streptococci, which provoke sepsis and cause a life-threatening condition. Fractures of the bones of the foot often resemble a bruise in symptoms, so the victim does not immediately go to the doctor. An untimely detected injury of the 3rd-4th and 5th metatarsal bones entails such consequences as:

  • chronic pain;
  • change in the structure of the bone body;
  • limited movement;
  • lameness;
  • the bone does not grow together or the union does not work properly;
  • arthrosis;
  • appearance calluses, which degenerate into a false joint.

Diagnosis and treatment

Before being taken to the emergency room, the victim must be given first aid. To do this, apply cold compress on a broken foot, and open injury it is recommended to treat the wound with hydrogen peroxide. Transport immobilization in case of a fracture, it is carried out in a sitting or lying position, providing the limbs with complete rest.

The diagnosis is made by a traumatologist or orthopedic surgeon based on the patient's complaints, trauma history, visual examination, and radiography. Full clinical picture shows a picture in 3 projections, where you can see the nature of the fracture - open or closed, the degree of damage to the metatarsal bone and surrounding tissues. In severe cases, scintigraphy, ultrasound, CT, MRI are prescribed.

Therapeutic measures

The fifth metatarsal bone is poorly supplied with blood, so fusion takes a long time, requires long-term therapy and limited emphasis on the limb.

Metal synthesis is a common method for joining fragments.

At closed damage the leg is immobilized with a plaster cast. You can only move with the help of crutches. Fracture treatment open type carried out in a hospital. The doctor cleans and drains the wound, removes dead skin particles, sets the bones, fixing them, if necessary, with metal synthesis tools: pins, plates, knitting needles, bolts. Then he sews up the wound, shifts the seam with a sterile napkin and applies plaster. During the period of wearing the fixator, bed rest is recommended to avoid recurrence of displacement of fragments. Control radiographs are also recommended.

Rehabilitation after a fracture

Physiotherapy

The recovery period may take several months depending on the severity of the damage. After removing the cast, heavy physical exertion on the leg is prohibited. If walking cannot be avoided, emphasis should be placed from heel to toe. Exercise therapy for a fracture helps develop the metatarsal bones. The following exercises are effective:

  • Circular foot rotations.
  • Clenching and unclenching fingers.
  • Turning the feet up and down and from side to side.
  • Rolling a ball placed under the foot.

A fracture of the fifth metatarsal bone of the foot is a violation of its anatomical integrity, which occurred under the influence of traumatic factors.

Most often this happens during the tucking of the leg or during moments of intense exertion. It is not uncommon for such an injury to occur as a result of falling weights on the foot or landing on a hard surface after a jump.

Causes of this type of injury:

  • osteoporosis;
  • stretching of the ligaments that hold the bones of the foot within the anatomical norm;
  • prolonged physical activity;
  • excess weight, which creates additional stress on the joints lower extremities.

Important! Increases the risk of foot tuck and metatarsal fracture Wearing high-heeled shoes, in which the metatarsal joint for a long time is in an unnatural position.

Types of injuries

Principles of treatment of fractures on different areas the fifth metatarsal bone have a number of significant differences. Injuries are localized at the base of the bone, in its middle part or in the region of the head.

It is important to correctly diagnose and determine the type of injury:

  1. An avulsion fracture of the base of the 5th metatarsal bone occurs due to a sharp inversion of the foot inward. There is a disconnection of the bone fragment due to the tension of the tendons. Recognizing this type of damage is quite difficult, since the symptoms of ankle sprains come to the fore.
  2. Jones fracture is a violation of the integrity of the fifth metatarsal bone 5 cm from the base. So in this zone there is not very intensive blood supply, the fusion of fragments occurs slowly. In patients with circulatory disorders of the lower extremities, the bones may long time don't grow together.
  3. A fracture of the fifth metatarsal bone of the foot may be accompanied by a displacement, that is, a violation of the anatomical correct location bone fragments in relation to each other. Their improper fusion can lead to foot deformity and lameness.
  4. In a fracture without displacement, separation of bone sections does not occur.
  1. A marching fracture of the 5th metatarsal bone refers to the so-called fatigue injuries. An injury occurs when the foot assumes an unnatural position during prolonged intense exercise.
  2. At closed fracture no damage occurs skin at the site of a broken bone.
  3. An open fracture is determined by the presence of a wound formed by bone fragments. This type of injury is dangerous pathogenic microflora, the formation of phlegmon and the ingestion of pathogens of tetanus or gas gangrene.

Depending on the direction of the fracture line, the following types of fractures of the fifth metatarsal bone are distinguished:

  • wedge-shaped;
  • T-shaped;
  • longitudinal;
  • transverse;
  • oblique.

How trauma manifests

Symptoms of a metatarsal fracture vary depending on the type and location of the damage, but they also have a number of common features:

  • edema;
  • pain when touching the site of injury, when standing, walking, stretching (flexing) fingers and other physical activity on the foot;
  • bruising due to laceration blood vessels bone fragments.

However, there are signs that are characteristic of certain types of described fractures.

At the time of the occurrence of a traumatic fracture, a crunch is clearly audible, emitted by torn dense bone tissues.

At this moment appears sharp pain, it becomes difficult for a person to step on and lean on the injured limb. If you continue to load the leg, then the pain syndrome will increase, and the bone fragments may shift relative to each other.

In a short period of time, edema develops and increases local temperature. You can notice a change in the position of the little finger or its shortening relative to the normal anatomical size. In almost 100% of cases of traumatic fracture of the fifth metatarsal bone, a bruise appears on the lateral surface of the foot.

At rest, the pain may subside somewhat, but it does not go away completely. Its character may change - from acute it will turn into aching or pulsating. With a strong sprain, the ankle joint and even the muscles of the lower leg can hurt.

Pain in a fatigue fracture of the metatarsal bone of the foot is not so pronounced, it can resemble muscle pain and completely subside at rest. However, during loading pain return and gradually intensify. The damaged area swells due to edema, but there may be no fever and hematoma.

A displaced metatarsal fracture results in pathological foot mobility that was previously impossible. On palpation (palpation), crepitant sounds can be heard. When turning the foot outward, the pain increases sharply.

With an open fracture, fragments of the metatarsal bone can be visually seen in the lumen of the wound.

Diagnostic methods

Quite often, with a fatigue fracture, a person does not seek help from a doctor, because he does not know about the nature of the damage and does not attach importance to it.

In some cases, the correct fusion of the bones occurs on its own, but often such a negligent attitude leads to complications and deformation of the foot.

Attention! Wrong position foot when walking after injury leads to increased load on the knee and ankle joints, in which irreversible processes can begin with time.

To avoid sad consequences, it is necessary to contact a specialist in time who will be able to deliver correct diagnosis and prescribe appropriate treatment.

Methods for diagnosing a fracture of the fifth metatarsal include:

  • inspection;
  • palpation;
  • radiography in three different planes;

The latter method is rarely used. It is used in the case when there is a strong swelling of the tissues, distorting the image on x-ray.

First aid

If a fracture of the fifth metatarsal bone is suspected, first of all, it is necessary to completely remove the load from the injured limb and, if possible, immobilize it.

With a strong pain syndrome it is advisable to give an analgesic, and in case of panic or hysteria - depressant. If one is not at hand, you should give a few sips of water, while maintaining calm yourself. It is necessary to speak with a calm voice to the victim, to explain that help is already on its way.

If timely hospitalization is not possible, then it is necessary to act according to the following scheme:

  1. Apply ice to the injury site. It can be ice wrapped in a bag and a cloth napkin, a bottle of cold water, a piece of frozen meat from the refrigerator, etc. This procedure prevent the formation of severe swelling and relieve pain slightly. It is put only on clothes / a piece of fabric.
  2. After 20 minutes, the cold object must be removed, and a fixing bandage made of an elastic bandage should be applied to the foot. If the patient feels numbness in the fingers, it should be slightly loosened.
  3. Lay the injured foot so that it is above the level of the pelvis.
  4. It is strictly forbidden to rub or warm the damaged area. Light heat can be applied only a day after the fracture of the metatarsal bone in order to speed up the process of resorption of the fluid accumulated in the tissues.

All these actions are aimed at reducing edema and preventing displacement of bone fragments. However, consider them as full treatment it is forbidden.

With an open fracture, transporting the patient to the hospital is mandatory not only for wound treatment, but also for the administration of anti-tetanus serum.

How is a fracture treated?

Fracture of the fifth metatarsal should only be treated qualified specialist after an accurate diagnosis.

Important! If the injury is not accompanied by displacement of fragments, then a plaster cast is applied to the damaged area, starting from the phalanges of the fingers and ending at the lower edge of the knee. This ensures complete immobility of the ankle and proper bone fusion.

Wearing such a "boot" should be about a month. With a positive result x-ray examination the plaster is removed and replaced with a tight fixing bandage.

When the fragments of the fifth metatarsal bone are displaced, the method can be used skeletal traction using a metal rod or a silk thread inserted into the foot through a small hole near the little finger. When the fragments fall into place, which is confirmed by the results of radiography, a plaster bandage is applied to the leg.

In the presence of an open fracture or multiple displacements, osteosynthesis is used. This method is based on the implantation of a metal rod or plate into the bone, which remains there until the complete fusion of the metatarsal bone. After a certain period of time, reoperation for the extraction of the implant.

Additionally, all patients are prescribed medications calcium, vitamin D or fish oil.

rehabilitation period

The outcome of the treatment of a metatarsal fracture also depends on the patient's rehabilitation measures, including:

  • massage;
  • medical gymnastics;
  • physiotherapy manipulations.