A nondisplaced Lisfranc injury can be treated conservatively in a short leg nonwalking cast for 6 weeks followed by 6 weeks in a short leg walking cast. Most of these injuries, however, will have some degree of displacement and require open reduction and internal fixation. With the exception of stress fractures and injuries of the fifth metatarsal, metatarsal fractures typically result from a direct blow to the foot. Fractures are generally classified according to their anatomic location as neck, shaft, or base fractures, and AP and lateral radiographs are generally sufficient for assessment. A single, traumatic fracture of a metatarsal is usually minimally displaced because of the restraining forces of the intermetatarsal ligaments.
Patients describe pain with weight bearing.
On examination, they will have swelling and tenderness localized to the fracture site. These fractures can generally be treated conservatively in a cast or wooden shoe for 6 weeks with weight bearing as tolerated until the patient's pain and tenderness subside. They typically result from training errors such as too rapid an increase in mileage in a runner. Patients will report activity-related pain that gradually increases. They will generally have tenderness over the fracture site with minimal edema.