Forefoot Fractures

Forefoot fractures are very common in medical practice. Most of them are traumatic fractures, which are frequent in phalanges and at the base of the fifth metatarsal. Less commonly, non-traumatic fractures (stress fractures) usually involve second or fifth metatarsal, especially in elderly patients or runners. In these fractures, biological factors such as blood supply and metabolic osseous state are critical and may delay bone healing, as with the well-known “Jones fracture.” Traumatic fractures are easily diagnosed just with a physical exam and an X-ray, but with non-traumatic fractures the clinical signs can be confusing and may require MRI or CT scan to achieve a correct diagnosis. Most forefoot fractures are stable and tolerate a reasonable range of malalignment allowing to be treated non-operatively, just by using either a walker (boot), a postoperative shoe, or a buddy taping. On the other hand, surgical treatment is only recommended in a few cases such as displaced fractures, articular fractures, open fractures, or delayed bone healing. Infrequently, forefoot fractures may provoke alterations in the metatarsal arch and posterior metatarsalgia, as well as post-traumatic arthritis.