Authors of section


Khairul Faizi Mohammad, Brad Yoo

Executive Editors

Markku T Nousiainen, Richard Buckley

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Distal articular fractures of the 1st to 4th metatarsal


These injuries include partial and complete articular fractures of the distal metatarsals 1-4.

They are classified as follows: 

  • Partial articular (AO/OTA 87.1–4.3B)
  • Complete articular (AO/OTA 87.1–4.3C)

where 1–4 indicates which metatarsal is injured.

The fractures may also be simple (a) or multifragmentary (b).

87 D300 Definition

Clinical presentation

The following clinical presentation is typical:

  • The patient describes an acute trauma with immediate pain and difficulty in weight-bearing
  • The foot progressively exhibits swelling and ecchymosis
  • The damaged area is very painful to palpation and weight-bearing
  • Deformities may not be appreciated. The sensation can be disrupted, particularly plantar
  • Crepitation may be appreciated with palpation of the affected area (this will be very painful for the patient)
  • The level of soft-tissue swelling increases proportionally with the number of fractured metatarsals
  • Open fractures will have draining wounds
  • Vascular compromise is uncommon
87 D300 Definition


Conventional radiographs of the foot (AP and lateral oblique views) are sufficient for diagnosis and treatment.

CT scans are invaluable for clarification of the fracture pattern and assessing additional fractures of the midfoot.

87 D300 Definition

Mechanism of injury

Fractures may be created with multiple mechanisms:

  • Axial
  • Bending
  • Torsion
  • Combined trauma

They may involve either high or low energy mechanisms.

High energy mechanism injuries are often associated with midfoot instability (Lisfranc instability).

Associated injuries

Compartment syndrome and Lisfranc injuries should always be suspected.

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