Epidemiology of metatarsal fractures in Shropshire 2020–2023

Summary

The epidemiology of metatarsal fractures remains poorly understood. We identified retrospectively all adults with ≥ 1 radiologically confirmed metatarsal fracture, over 3 years. Young men and women had similar fracture rates, but overall risks were significantly higher for women (RR 1.99, 95% CI 1.76–2.26), driven by age-related falls in male fracture incidence.

Purpose

Metatarsal fractures are clinically and economically important and may reflect trauma, insufficiency or fatigue. However, their epidemiology remains poorly understood. We evaluated radiologically confirmed metatarsal fractures identified within Shropshire over a 3-year period.

Methods

Radiology reports were searched for all patients aged ≥ 18 years between 2020 and 2023, using the terms ‘metatarsal’ AND ‘fracture’, to identify patients with ≥ 1 confirmed metatarsal fracture. Age at fracture, sex, fracture description and mechanism were recorded, and population fracture rates estimated, using local census data.

Results

A total of 1121 (758 female) individual patients aged 50.7 (18.9) years, fractured 1370 metatarsals, usually the fifth in isolation, with fewer individuals fracturing two, three or four metatarsals. Fractures were located at the metatarsal base (59%), shaft (26%), neck (12%) or head (3%); were mostly oblique, transverse or comminuted; and were usually caused by low-energy inversion injuries or falls. Fracture rates per 100,000 were 105 for women aged 18–29 years, rising to 153 and 142 in the sixth and ninth decades, with comparative male rates of 102, 40 and 31. Overall, women had more metatarsal fractures than men (RR 1.99, 95% CI 1.76–2.26), the sex difference being highest for metatarsal head fractures (RR 2.98 95% CI 1.34–6.60) and lowest for shaft fractures (RR 1.67, 95% CI 1.32–2.12).

Conclusion

Most metatarsal fractures are isolated low-energy injuries of the fifth metatarsal. Overall, women suffer twice as many fractures as men, driven by sustained high fracture rates in older women and a steep age-related decline among men. The underlying reasons for this pronounced sex difference are unclear and require further study.