There are three types of metatarsal fracture (MF), and affected individuals may provide the following anamnestic data:

• Acute or traumatic MF is the result of a traumatic impact on either of the metatarsal bones. In such cases, mechanical forces sustained during motor vehicle accidents or falls have exceeded the maximal resistance of the respective bone(s) and led to MF. Patients presenting with traumatic MF thus generally report to have been involved in such accidents. Of note, these patients may suffer from polytrauma and life-threatening injuries unrelated to MF. A thorough clinical examination is required to identify possible damage to internal organs and vascular structures.
• Stress fractures of the metatarsal bones may be seen in patients who pursue high load-bearing activities associated with repetitive impacts on their feet, e.g., runners, soccer and tennis players, among others [1] [2] [3]. It has been shown that individuals suffering from pes cavus are predisposed for MF [4].
• Systemic pathologies such as osteopenia and osteoporosis or rheumatoid arthritis may predispose for pathological MF [5] [6]. These entities may or may not have been diagnosed previously, and affected individuals may report bone pain (including but not limited to the affected foot), prior pathological fractures, or morning stiffness and joint disease, respectively.

Intense foot pain predominates the clinical picture. Foot pain generally aggravates during weight bearing activities but may be present at rest. Furthermore, surrounding soft tissues are tender and contact or slight pressure may elicit pain. Pressure pain is most severe at the site of the fracture. Focal swelling is often noted [1].

Plain radiography is the mainstay of MF diagnosis. In order to evaluate the condition of the metatarsal bones, anteroposterior and oblique radiographs should be obtained. Fractures of the metatarsal bones appear as radiolucent lines that interrupt the continuity of the physiological osseous structure. Any metatarsal bone may be affected, and patients may present with multiple MFs. Joint involvement should be assessed.

MFs most commonly involve the fifth metatarsal [7]. In this context, incidence rates of tuberosity avulsion fractures are higher than those of Jones fractures and diaphyseal stress fractures. The latter two are easily confounded [8]. They are, however, associated with different therapeutic regimens and prognoses and thus require a thorough workup. According to Lawrence and Botte, Jones fractures occur at the distal limit of the joint between the fourth and the fifth metatarsal. Diaphyseal stress fractures, in contrast, affect the proximal diaphysis [8] [9]. Stress fractures are often associated with intramedullary sclerosis, cortical hypertrophy and periosteal reaction [2].

Of note, stress fractures may not be depictable using plain radiography. A strong suspicion of MF despite the absence of radiographic anomalies thus justifies magnetic resonance imaging or scintigraphic examinations [10]. Due to radiation exposure, computed tomography scans should be reserved for specific indications. Sonography may be of use if the examiner has sufficient experience [11]. In any case, imaging studies lay the foundation for treatment planning [12].

Further diagnostic measures may be indicated to identify underlying systemic disorders, e.g., laboratory analysis of blood samples, bone density measurements, and additional diagnostic imaging.

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