Metatarsal and toe fractures in children
- Kathy Boutis, MD, FRCPC, FAAP, MSc
Kathy Boutis, MD, FRCPC, FAAP, MSc
- Assistant Professor
- University of Toronto
Most pediatric foot fractures are minor, involve the metatarsal or phalangeal bones, and require a short period of immobilization . Although recovery is usually uneventful, specific metatarsal and toe fractures (eg, Jones fractures, Salter-Harris III or IV fractures of the great toe) require early orthopedic care to avoid significant long-term complications.
The management of metatarsal and toe fractures in children will be reviewed here. Other foot fractures in children and toe fractures in adults are discussed separately. (See "Foot fractures (other than metatarsal or phalangeal) in children" and "Toe fractures in adults".)
Metatarsal fractures account for the majority of pediatric foot fractures. In children ≤5 years of age, the first metatarsal is most commonly injured [2,3]. In older children, the base of the fifth metatarsal is more frequent . Approximately one-third of metatarsal fractures involve the shaft or distal portion of the metatarsal .
Toe fractures also occur commonly in children. The first phalanx (great toe) is most frequently involved. Distal phalangeal fractures may be complicated by nail bed injuries.
From an anatomic perspective, the foot is divided into three regions (figure 1A-C):
- Jarvis JG, Moroz PJ. Fractures and dislocations of the foot. In: Fractures in Children, 6th ed, Beaty JH, Kasser JR (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.1129.
- Singer G, Cichocki M, Schalamon J, et al. A study of metatarsal fractures in children. J Bone Joint Surg Am 2008; 90:772.
- Owen RJ, Hickey FG, Finlay DB. A study of metatarsal fractures in children. Injury 1995; 26:537.
- Swischuk LE. Emergency Imaging of the Acutely Ill or Injured Child, 4th ed, Lippincott Williams & Wilkins, Philadelphia 2000.
- Hatch RL, Hacking S. Evaluation and management of toe fractures. Am Fam Physician 2003; 68:2413.
- Schnaue-Constantouris EM, Birrer RB, Grisafi PJ, Dellacorte MP. Digital foot trauma: emergency diagnosis and treatment. J Emerg Med 2002; 22:163.
- Zook EG, Guy RJ, Russell RC. A study of nail bed injuries: causes, treatment, and prognosis. J Hand Surg Am 1984; 9:247.
- Simon RR, Wolgin M. Subungual hematoma: association with occult laceration requiring repair. Am J Emerg Med 1987; 5:302.
- Seaberg DC, Angelos WJ, Paris PM. Treatment of subungual hematomas with nail trephination: a prospective study. Am J Emerg Med 1991; 9:209.
- Roser SE, Gellman H. Comparison of nail bed repair versus nail trephination for subungual hematomas in children. J Hand Surg Am 1999; 24:1166.
- Ribbans WJ, Natarajan R, Alavala S. Pediatric foot fractures. Clin Orthop Relat Res 2005; :107.
- Mahan ST, Hoellwarth JS, Spencer SA, et al. Likelihood of surgery in isolated pediatric fifth metatarsal fractures. J Pediatr Orthop 2015; 35:296.
- Herrera-Soto JA, Scherb M, Duffy MF, Albright JC. Fractures of the fifth metatarsal in children and adolescents. J Pediatr Orthop 2007; 27:427.
- CLINICAL ANATOMY
- MECHANISM OF INJURY
- CLINICAL PRESENTATION AND EXAMINATION
- RADIOGRAPHIC FINDINGS
- INITIAL MANAGEMENT
- Emergency conditions
- Analgesia and initial care
- Injury to the nail bed
- INDICATIONS FOR ORTHOPEDIC CONSULTATION OR REFERRAL
- DEFINITIVE MANAGEMENT
- Metatarsal fractures
- - Nondisplaced
- - Displaced
- - Proximal fifth metatarsal
- - Stress fractures
- Toe fractures
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Clinical findings and imaging