The approach to metatarsal fractures varies according to the location and type of fracture. Fractures of the metatarsal shaft are discussed below. Proximal fractures of the fifth metatarsal, metatarsal stress fractures, and toe fractures are discussed separately. (See "Proximal fifth metatarsal fractures" and "Stress fractures of the metatarsal shaft" and "Toe fractures in adults" and "Metatarsal and toe fractures in children".)
EPIDEMIOLOGY AND RISK FACTORS
Excluding toe fractures, metatarsal fractures are the most common foot fracture [1-4]. Approximately one-third of metatarsal fractures involve the shaft or distal portion of the metatarsal. Direct blows and twisting injuries cause many of these fractures. In adults, high forces are required to fracture the first metatarsal. Hence, fractures of the first metatarsal shaft are much less common than fractures of the other metatarsal shafts.
Some populations are at higher risk for traumatic metatarsal fractures:
- Elderly women with osteoporosis, decreased physical activity, or benzodiazepine use 
- Diabetics, especially if they have had diabetes for greater than 25 years or are more active 
For reference purposes, the metatarsals are numbered from first (largest) to fifth (smallest). The first metatarsal is larger than the others and more important for weight-bearing and balance . Therefore, malalignment of a first metatarsal shaft fracture is not tolerated as well as malalignment of other metatarsal fractures  (figure 1A-C).