Metatarsal and toe fractures in children
- Kathy Boutis, MD, FRCPC, FAAP, MSc
Kathy Boutis, MD, FRCPC, FAAP, MSc
- Assistant Professor
- University of Toronto
- Section Editor
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Associate Professor of Pediatrics
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
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):
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- 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