Acute and stress fractures of the metatarsals in athletes

Metatarsal fractures sustained in sport can either be acute, or stress fractures. The aim of treatment of any fracture of the metatarsals in an athlete should be to achieve bony union, allow return to play quickly and at the same level as prior to the injury with few complications. In addition, further injuries should be prevented. Up to 9% of metatarsal fractures occur in sport. The majority of these involve the fifth metatarsal, particularly the proximal aspect of it. This location has a problematic blood supply and has a high rate of non-union. There is a wealth of information published about proximal fifth metatarsal fractures in the sporting population, with a consensus that surgical management provides the best outcomes. The second to fourth metatarsals are most likely to sustain stress fractures. These are likely to heal with non-operative treatment with good outcomes. Stress fractures of the fifth metatarsal are at high risk for fracture propagation, displacement and non-union so are best managed surgically. These injuries can be effectively prevented by improving bone health and biomechanics.